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Implementation Project (Implementation of Effective Shared Decision Making Approaches PFA)
In progress; Recruitment not applicable

Expanding a Shared Decision Making Program for Patients Considering LVAD Treatment

Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is expanding the use of a shared decision making program, shown to help patients with advanced heart failure decide whether to get a left ventricular assist device, or LVAD, to LVAD clinics across the United States.
Heart failure occurs when the heart doesn’t pump blood as it should. In advanced heart failure, people feel shortness of breath and other symptoms even at rest. An LVAD is a battery-powered pump that doctors implant in the heart to help people with advanced heart failure live longer. But LVADs have serious risks, such as stroke, bleeding, and infection. In addition, people who get LVADs need help from a caregiver and must make changes to their lifestyle. Patients must understand these trade-offs to make the best decisions for themselves.

What is the goal of this implementation project?

In shared decision making, or SDM, patients work with their doctors to select treatments and medical tests based on what’s most important to them. PCORI-funded research study found that patients who took part in an SDM program knew more about LVADs and were more likely to get treatment that matched their goals than patients who received usual LVAD education. The program included printed materials and videos to help patients understand the benefits and risks of LVADs. The program also trained doctors and staff in using the materials with patients and caregivers.

This project is starting the SDM program in LVAD clinics across the United States. The project team is working with interested clinics to adopt the program. Clinics can select the materials and supports that work best for them.

What will this project do?

The project team is first putting the program in place at 18 LVAD clinics that had expressed interest in the program. Then the team is surveying the remaining 157 LVAD clinics in the United States. Surveys ask how interested and ready clinics are to make SDM part of the regular education they provide to patients with advanced heart failure. The team is then offering all interested LVAD clinics free patient materials, user manuals, training webinars, and support calls for staff.

The SDM program is designed to fit LVAD clinics’ needs. The LVAD care team can use the program before or during a clinic visit or offer it to patients as a standalone resource. The American College of Cardiology and the Heart Failure Society of America are supporting efforts to make the LVAD SDM materials easily accessible to the LVAD clinics.

What is the expected impact of this project?

The project will put this SDM program in place at many of the LVAD clinics in the United States. The project evaluation will describe the level of interest in the program among clinics. The evaluation will also confirm that the program is working as intended to help patients with advanced heart failure with their decision to get an LVAD.

More about this implementation project:

Stakeholders Involved in This Project

  • American College of Cardiology
  • Heart Failure Society of America
  • MyLVAD.com
  • Society for Transplant Social Workers
  • American Association of Heart Failure Nurses
  • International Consortium of Circulatory Assist Clinicians

Implementation Strategies

  •  Assess for readiness at sites. 
  • Promote shared decision making. 
  • Adapt the shared decision making approach, including plans for decision aid integration, to work for sites’ existing resources and workflows. 
  • Provide educational materials to patients, as part of decision aid. 
  • Provide sites with tools to support implementation, including an implementation user guide. 
  • Train LVAD clinic staff to deliver the program through webinars. 
  • Use a phased implementation approach based on site readiness. 
  • Identify and prepare local champions at sites. 
  • Provide technical assistance to sites, including consultation. 
  • Offer continuing education and maintenance of certification credits.

Evaluation Outcomes

To document implementation:

  • Number of LVAD clinics reporting that they use the decision aid in clinical care
  • Site survey-based report on consistency of decision aid use with patients
  • Barriers to and facilitators of LVAD SDM program implementation

To assess healthcare and health outcomes:

  • Patient LVAD decision quality and acceptability

Journal Citations

Related Journal Citations

Journal Citation

Shared Decision-Making for Left Ventricular Assist Devices: Rationale and Design of a Nationwide Dissemination and Implementation Project

Project Information

Daniel D. Matlock, MD, MPH
University of Colorado Denver
$2,588,989
Tailored Implementation of a Decision Support Strategy for Left Ventricular Assist Devices

Key Dates

June 2018
July 2023
2018

Study Registration Information

HSRP20191566

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Supporting Shared Decision Making for Patients with Heart Failure Offered a Left Ventricular Assist Device -- The DECIDE-LVAD Trial

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Last updated: September 26, 2023