Larry A. Allen|Colleen K. McIlvennan|Jocelyn S. Thompson|Shannon M. Dunlay|Shane LaRue|Eldrin F. Lewis|Chetan B. Patel|Laura Blue|Diane L. Fairclough|Erin Leister|Russell E. Glasgow|Joseph C. Cleveland|Clifford Phillips|Vicie Baldridge|Mary Norine Walsh|Daniel D. Matlock
Effectiveness of an Intervention Supporting Shared Decision Making for Destination Therapy Left Ventricular Assist Device
University of Colorado Denver|Outcomes Research Consortium|Outcomes Research Consortium|University of Colorado Denver|Outcomes Research Consortium|Mayo Clinic|Washington University in St. Louis|Brigham and Women's Hospital|Duke Medical Center|Duke Medical Center|Outcomes Research Consortium|Colorado School of Public Health|Outcomes Research Consortium|Colorado School of Public Health|Outcomes Research Consortium|Geriatric Research Education and Clinical Center|University of Colorado Denver|National Patient Safety Foundation|St Vincent Hospital|Outcomes Research Consortium|Geriatric Research Education and Clinical Center|University of Colorado Denver
shared decision making helps patients clinicians elect therapies aligned patients values preferences particularly important invasive therapies considerable tradeoffsto assess effectiveness shared decision support intervention patients considering destination therapy left ventricular assist device dt lvad placementfrom 2015 2017 randomized steppedwedge trial conducted 6 us lvad implanting centers including 248 patients considered dt lvad randomly varying time usual care sites transitioned intervention consisting clinician education use dt lvad pamphlet video patient decision aids follow occurred 1 6 monthsdecision quality measured knowledge valueschoice concordancein total 135 patients enrolled control 113 intervention periods enrollment 59 238 participants intensive care 60 241 older 70 years 39 157 women 45 181 racialethnic minorities 62 250 college graduates patient knowledge mean test performance decisionmaking period improved 595 649 control group vs 591 700 intervention group adjusted difference difference 55 p 03 stated values 1 month scale 1 everything live longer 10 live whatever time left mean 237 control 333 intervention p 03 patientreported treatment choice 1 month favored lvad control group intervention group 47 595 vs 95 913 p 001 correlation stated values patientreported treatment choice 1 month stronger intervention group control group difference kendalls 028 95 ci 005045 however improved correlation stated values actual treatment received 6 months intervention compared control group difference kendalls 001 95 ci 024 025 adjusted rate lvad implantation 6 months higher control group 799 intervention group 539 p 008 significant variation site differences decision conflict decision regret preferred controla shared decisionmaking intervention dt lvad modestly improved patient decision quality measured patient knowledge concordance stated values patientreported treatment choice improve concordance stated values actual treatment received rate implantation lvads substantially lower intervention compared control groupclinicaltrialsgov identifier nct02344576