Decision-making for destination therapy left ventricular assist devices: implications for caregivers.

TLDR: In this paper, the decision-making processes of patients who either accept or decline DT LVADs were investigated, and they found a strong dichotomy between decision processes with some patients (11 accepters) being automatic and others (3 accepc, 7 decliners) being reflective in their approach to decision making, characterized by a fear of dying and an over-riding desire to live as long as possible.

Abstract: Background—Destination therapy left ventricular assist devices (DT LVADs) are one of the most invasive medical interventions for end-stage illness. How patients decide whether or not to proceed with device implantation is unknown. We aimed to understand the decision-making processes of patients who either accept or decline DT LVADs. Methods and Results—Between October 2012 and September 2013, we conducted semistructured, in-depth interviews to understand patients’ decision-making experiences. Data were analyzed using a mixed inductive and deductive approach. Twenty-two eligible patients were interviewed, 15 with DT LVADs and 7 who declined. We found a strong dichotomy between decision processes with some patients (11 accepters) being automatic and others (3 accepters, 7 decliners) being reflective in their approach to decision making. The automatic group was characterized by a fear of dying and an over-riding desire to live as long as possible: “[LVAD] was the only option I had…that or push up daisies…so ...