Abstract 243: Organic Dissemination and Natural Implementation of Decision Aids for Left Ventricular Assist Device

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Abstract

Objective: We systematically created pamphlet and video decision aids (DAs) for destination therapy left ventricular assist device (DT LVAD) and hosted them online for free public use. Although DAs have been shown to improve patient knowledge and satisfaction, they are rarely used. Thus, we aimed to assess 1) if our DAs were being used in clinical practice and 2) evaluate the factors influencing uptake.

Methods: We contacted people who previously requested information about our DAs. Through snowball sampling, we identified additional programs that may be using them. Participants completed a semi-structured interview. We analyzed the interviews using normalization process theory (NPT).

Results: From May 2014 to November 2016, 30 people (surgeons, cardiologists, social workers, coordinators, nurses, industry managers) from 25 different organizations contacted our research team inquiring about use of the DAs. Nearly all were contacted for an interview (1 excluded for involvement in efficacy trial), with an additional 8 referred through snowballing. Of the 37 eligible, 28 people from 25 different organizations across the United States, Canada, and France participated. We found that 11 organizations currently use the DAs, 5 plan to use them but have not yet, and 9 do not currently use them nor have active plans to use them in the near future. All interviewees agreed that LVAD is a complex decision which requires as much knowledge transfer as possible. Using the 4 constructs of NPT—coherence, cognitive participation, collective action, reflexive monitoring—we found that the DAs were seen either as “good” educational resources, or as an important element of the education process that helped improve decision making (coherence). LVAD coordinators and social workers were typically the ones to use the DAs directly with patients; however, initial implementation at the program was done by a champion of the DAs, which was either the coordinator or social worker themselves or physicians who advocated for their use (cognitive participation). Use of the materials ranged from merely providing the pamphlet to utilizing both the pamphlet and the video as the cornerstone of teaching for all patients considering LVAD (collective action). Those using the DAs reported value and benefits to their use; some who did not use the DAs wished they could but were limited by systemic or programmatic issues, while those who did not plan to use them reported a lack of time, personnel, and resources as the reason for not implementing (reflexive monitoring).

Conclusion: Members of many LVAD centers around the world independently inquired about freely available DT LVAD DAs, and over half of those centers are actively or in the process of implementing the DAs into routine care. Implementation was facilitated by unmet informational needs, invested clinical champions, a favorable environment, and successful experiences with the DAs.

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