title: Patients' decision making process and expectations of a left ventricular assist device pre and post implantation.
abstract: OBJECTIVE
  To examine patients' pre-implantation decision-making and pre and post-implantation expectations of left ventricular assist devices (LVADs).
  
  
  BACKGROUND
  LVADs have been shown to improve both quantity and quality of life of patients living with Stage D heart failure (HF). However, they also pose significant risks.
  
  
  METHODS
  15 LVAD participants followed in a longitudinal study of Stage D HF patients were included in this thematic analysis.
  
  
  RESULTS
  Three themes were identified: no choice; I thought I would be doing better; I feel good, but now what. Evidence from pre-implantation to post-implantation suggested that patients' perceived expectations of quality of life improvement were not met.
  
  
  CONCLUSIONS
  In light of their declining health, most patients felt their only alternative to implantation was death. In the post-implantation period, patients expected greater improvements in their quality of life. Evidence based guidelines for discussions of goals of care, post-implant expectations, and palliative care are necessary.
authors.affiliation: College of Nursing, The Pennsylvania State University, USA. Electronic address: lkitko@psu.edu.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kitko
authors.affiliation: College of Nursing, The Pennsylvania State University, USA.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Hupcey
authors.affiliation: College of Nursing, The Pennsylvania State University, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Birriel
authors.affiliation: College of Nursing, The Pennsylvania State University, USA.
authors.forename: Windy
authors.initials: W
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life
keywords: Decision making; Heart failure; Longitudinal; Palliative care; Qualitative; Ventricular assist device