title: Anchoring in Destination-Therapy Left Ventricular Assist Device Decision Making: A Mechanical Turk Survey.
abstract: BACKGROUND
  People with end-stage heart failure may have to decide about destination-therapy left ventricular assist device (DT-LVAD). Individuals facing difficult decisions often rely on heuristics, such as anchoring, which predictably bias decision outcomes. We aimed to investigate whether showing a larger historical Heartmate XVE creates an anchoring effect, making the smaller Heartmate II (HMII) appear more favorable.
  
  
  METHODS
  With the use of Amazon Mechanical Turk, participants watched videos asking them to imagine themselves dying of end-stage heart failure, then were presented the option of LVAD as potentially life-prolonging therapy. Participants were randomized to a control group who were only shown the HMII device, and the intervention group who saw the XVE device before the HMII. Participants then completed surveys.
  
  
  RESULTS
  A total of 487 participants completed the survey (control = 252; intervention = 235); 79% were <40 years of age, 84% were white, and 55% were male. The intervention group was not more likely to accept the LVAD therapy (68% vs 61%; P = .37). However, participants in the intervention group were more likely (51% vs 17%; P < .01) to agree or strongly agree with the statement that the HMII was "smaller than expected." Participants in the intervention group were also more likely to rate the size of the device as "important" or "very important" in their decision (61% vs 46%; P < .01).
  
  
  CONCLUSIONS
  Although the XVE anchor did not affect likelihood of accepting the LVAD, it did affect device perception. This article highlights an important point with clinical implications: factors such as anchoring have the potential to inappropriately influence perceptions and decisions and should be carefully considered in research and practice.
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Arcadia M
authors.initials: AM
authors.lastname: Paine
authors.affiliation: Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Jocelyn S
authors.initials: JS
authors.lastname: Thompson
authors.affiliation: Section of Advanced Heart Failure and Transplantation, Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: McIlvennan
authors.affiliation: Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Amy
authors.initials: A
authors.lastname: Jenkins
authors.affiliation: Colorado Biostatistics Consortium, Aurora, Colorado.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hammes
authors.affiliation: Colorado Biostatistics Consortium, Aurora, Colorado.
authors.forename: Miranda
authors.initials: M
authors.lastname: Kroehl
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado; VA Denver Geriatric Research, Education, and Clinical Center, Denver, Colorado. Electronic address: daniel.matlock@ucdenver.edu.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003657:Decision Making; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000706:statistics & numerical data; D011474:Prosthesis Design; D012016:Reference Values; D012307:Risk Factors; D012737:Sex Factors; D014481:United States; D014741:Video Recording; D055815:Young Adult
keywords: Amazon Mechanical Turk; DT-LVAD; LVAD; MTurk; decision making