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For patients considering a left ventricular assist device (LVAD), we developed a decision aid (DA) and demonstrated its effectiveness. The I-DECIDE-LVAD project subsequently disseminated the DA to LVAD programs across the country and assessed its use, finding 70% of total programs adopted it into routine practice. Qualitative data were collected to further understand how and why the DA was implemented. Semi-structured interviews about the DA's use were conducted with a sub-set of LVAD programs. The interview guide and analysis were guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance). Interviews were transcribed, coded, and analyzed using content analysis. We interviewed 37 participants from 20 different LVAD programs; 19 were LVAD coordinators, 18 heart failure cardiologists, 20 female, mean age of 44 years. Interviews showed the DA was used differently across programs. For Reach, sites distributed the DA 1) to all patients evaluated for LVAD as standard of care, 2) ad hoc, or 3) by specific clinicians but not as an organized programmatic effort. Distribution to caregivers was encouraged either by directly providing to caregivers or by asking patients to share it. Adoption of the DA occurred through both top-down (medical director to LVAD coordinator) and bottom-up (coordinator or social worker to leadership team) approaches, and successful adoption often required both committee/team approval and coordinator buy in. For Implementation, the DA was used in both inpatient and outpatient settings. Outpatient use was often earlier in disease progression and allowed patients to view the DA over time, at home with family. Inpatient use had both advantages and challenges; patients were captive audiences in their hospital rooms with time to review, but might be too sick or overwhelmed. The DA was typically provided by the LVAD coordinator around a formal teaching session, including 1) during, where it was used as a guide for teaching, 2) before, to prep the patients, or 3) after, as a resource. The DA was adopted across programs with various levels of Reach and Implementation, in part due to its versatility in how, when, and by whom it could be provided. Having one tool that can be used in multiple settings and in various capacities has likely increased its adoption into routine practice. [ABSTRACT FROM AUTHOR]

A pamphlet and video decision aid (DA) developed for patients and families considering a left ventricular assist device (LVAD) was previously shown to be effective in improving decision quality. Subsequently, the DA was disseminated to LVAD programs across the country as part of the I-DECIDE-LVAD project. A patient survey was performed to understand patients' experiences in shared decision making and in using the DA. Twenty programs that reported using the I-DECIDE-LVAD DA were selected to broadly represent various institutional types, program sizes, and geographic regions across the United States. Each site was asked to distribute a survey to up to 30 patients who had recently been evaluated for LVAD. The survey contained questions related to patients' decision experiences including a validated 4-item decision process measure (scored 0-4) and the 3-item CollaboRATE measure (scored 0-9); higher scores indicate higher-quality shared decision making for both measures. Additionally, the survey asked if and how the patient used the DA, and the validated Acceptability Questionnaire about the DA. Sixteen programs distributed 439 surveys and received 205 responses (response rate 46.7%). On the decision process measure, patients scored a mean of 2.8 out of 4 (range 0-4). On the CollaboRATE measure, patients scored a mean of 8.5 out of 9 (range 3.7 - 9.0). A total of 63.5% of respondents reported receiving the I-DECIDE DA pamphlet and 39.5% received the video. The majority (58.5%) of patients received the DA from an LVAD coordinator and most commonly (39.5%) over two weeks before their implant. Of those that received it, 47.5% spent more than 15 minutes with the pamphlet and 84.9% watched the entire video. Additionally, 94% reviewed the DA with someone, most commonly a wife (29%) or daughter (14%). The content of the DA was rated as highly acceptable, including that it was the right amount of information (66.4%), easy to understand (52.8%), and helpful in the decision-making process (83.6%); respondents also reported that the DA was either completely balanced (56.4%) or slanted towards getting an LVAD (23.5%). Patients who were evaluate for LVAD reported high-quality shared decision making. The majority of patients remember receiving the LVAD DA. How they used the DA in terms of when they received it and with whom they watched it varied. [ABSTRACT FROM AUTHOR]