Expanding the Use of a Decision Aid to Help Patients Decide on Treatment for Advanced Heart Failure

This PCORI-funded implementation project made a left ventricular assist device, or LVAD, decision aid—shown to increase patient knowledge of LVADs and satisfaction with LVAD implants—part of standard practice at eight hospitals.

Stakeholders Involved in This Project

• LVAD coordinators, physician champions, and patient partners at each hospital.
• Partner hospitals included Houston Methodist, Baylor St. Luke’s, Aurora St. Luke’s, Brigham and Women’s, Cleveland Clinic, Montefiore, University of Chicago, and INTEGRIS Baptist

Publicly Accessible Project Materials

• Implementation toolkit (available at www.lvaddecisionaid.com/toolkit)  

For more information about these materials, please contact the Project Team at [email protected].

The project team developed these materials, which are available for free on the website listed above. Please note that the materials do not necessarily represent the views of PCORI and that PCORI cannot guarantee their accuracy or reliability.

Project Achievements

• Translated decision aid into Spanish
• Demonstrated the feasibility of expanding use of the decision aid into clinical practice at eight hospitals
• Developed a COVID-19 supplement to the decision aid to provide tailored risk-prevention messages to users; used behavioral economics-based approach to encourage uptake
• Created a publicly available implementation toolkit, which includes resources on beginning implementation, solutions to common barriers, and checklists for full implementation

• Identified clinic-level factors influencing successful uptake of the decision aid in practice and concrete strategies for enhancing uptake

Implementation Strategies

• Promoted shared decision making

• Adapted the shared decision making approach, including plans for decision aid integration, to work for sites’ existing resources and workflows
• Adapted the decision aid to include updated information about a new LVAD approved by the U.S. Food and Drug Administration, to address patients’ questions and concerns related to COVID-19, and to translate the decision aid into Spanish
• Provided sites with tools to support implementation, including manuals and toolkits
• Provided educational materials to patients as part of decision aid
• Conducted educational meetings for clinicians, including grand rounds and lunch and learns
• Trained LVAD coordinators and clinicians on shared decision making and on how to introduce and use the decision aid with patients and caregivers, through webinars
• Identified and prepared physician champions at sites to promote delivery and use of the decision aid by LVAD coordinators and clinicians
• Conducted site visits
• Provided technical assistance to sites, including ongoing consultation and performance feedback

• Developed an implementation guide to support further use of the shared decision making approach at other sites

Evaluation Outcomes

To document implementation:

• Reach, the percentage of eligible patients or caregivers of patients who received the decision aid
• Fidelity, the percentage of times staff indicated they:
  • Administered the decision aid
  • Provided assistance in use of the decision aid
  • Explained shared decision making
  • Discussed the patient’s most important values
  • Discussed other options
  • Provided time for open-ended questions from patients
  • Offered to facilitate meetings with an LVAD patient
  • Encouraged the patient to bring the decision aid to physician appointments
  • Referred the patient to a social worker or financial advisor
  • Invited the patient to receive a knowledge quiz

To assess healthcare and health outcomes:

• Qualitative interviews with physicians and staff about decision aid use.

COVID-19-Related Project Activities

• PCORI supplemental funding supported project activities to address needs evolving or emerging in the context of the COVID-19 public health crisis.

  At the onset of the pandemic, patients with advanced heart failure who were thinking about getting an LVAD had questions and concerns about COVID-19. With supplemental funding, the project team developed a resource about COVID-19. The resource focused on:

• Changes to the LVAD treatment process due to COVID-19
• Ways to reduce the risk of getting COVID-19 before and after surgery

During visits with LVAD clinic staff, more than 260 patients viewed this resource as they used the decision aid.