Perspectives from mechanical circulatory support coordinators on the pre-implantation decision process for destination therapy left ventricular assist devices.
OBJECTIVE
To understand mechanical circulatory support (MCS) coordinators' perspectives related to destination therapy left ventricular assist devices (DT LVAD) decision making.


BACKGROUND
MCS coordinators are central to the team that interacts with patients considering DT LVAD, and are well positioned to comment upon the pre-implantation process.


METHODS
From August 2012 to January 2013, MCS coordinators were recruited to participate in semi-structured, in-depth interviews. Established qualitative approaches were used to analyze and interpret data.


RESULTS
Eighteen MCS coordinators from 18 programs were interviewed. We found diversity in coordinators' roles and high programmatic variability in how DT LVAD decisions are approached. Despite these differences, three themes were consistently recommended: 1) DT LVAD is a major patient-centered decision: "you're your best advocate… this may not be the best choice for you"; 2) this decision benefits from an iterative, multidisciplinary process: "It is not a one-time conversation"; and 3) this process involves a tension between conveying enough detail about the process yet not overwhelming patients: "It's sometimes hard to walk that line to not scare them but not paint a rainbow and butterflies picture."


CONCLUSIONS
MCS coordinators endorsed a shared decision-making process that starts early, uses non-biased educational materials, and involves a multidisciplinary team sensitive to the tension between conveying enough detail about the therapy yet not overwhelming patients.
Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA; Colorado Health Outcomes Group, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: colleen.mcilvennan@ucdenver.edu.
Colleen K
CK
McIlvennan
Colorado Health Outcomes Group, University of Colorado School of Medicine, Aurora, CO, USA; Division of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Daniel D
DD
Matlock
University of Colorado, Boulder, CO, USA.
Madhav P
MP
Narayan
Division of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Carolyn
C
Nowels
Colorado Health Outcomes Group, University of Colorado School of Medicine, Aurora, CO, USA.
Jocelyn S
JS
Thompson
Program of Mechanical Circulatory Support, University of Colorado Hospital, Aurora, CO, USA.
Anne
A
Cannon
Program of Mechanical Circulatory Support, University of Colorado Hospital, Aurora, CO, USA.
William J
WJ
Bradley
Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA; Colorado Health Outcomes Group, University of Colorado School of Medicine, Aurora, CO, USA.
Larry A
LA
Allen
D003657:Decision Making; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007407:Interviews as Topic; D008297:Male
Destination therapy; Health-related quality of life; Heart failure; Heart-assist device; Patient-centered care