Navigating the journey of advanced heart failure and transplant beyond the clinic: implementation of a peer mentorship program

Background For patients with advanced heart failure and their families, heart transplantation and/or the need for a ventricular assist device are lifesaving and life-changing events. From the time they first hear about the need for advanced therapies to receiving and learning to live with a new heart, it can be a complex and overwhelming experience. Many patients seek guidance from others with lived experience in addition to clinician support. Purpose In response to the recommendations of people with lived experience and nurses managing the care of people with heart failure, we sought to implement and evaluate a Peer Mentorship Program in Practice (PMP-IP) to improve outcomes and experiences. Methods Building on the findings of a pilot study aimed at informing the development of the structure, processes, and content of the program, we sought to achieve the following objectives: (1) select and tailor implementation strategies to integrate the PMP program in a quaternary Heart Transplant Clinic and identify barriers and enablers of successful and sustained implementation, and (2) evaluate the implementation of the PMP program along key pertinent metrics, We conducted a single-centre, multi-method implementation study guided by the Knowledge-to-Action framework. We report on the completion of the first objective, in which we conducted a series of in-depth individual interviews to further refine the PMP and develop an implementation plan that meets the needs of the stakeholders. We conducted a constant comparative analysis informed by an interpretive description analytical approach. Results We conducted a total of 16 interviews with 9 patients, 1 family caregiver, and 6 clinicians. The iterative exercise of drawing and condensing themes from the interview transcriptions guided modifications to the pilot structure. We configured the role of the mentee as the "driver" of the relationship and the mentor as the responsive "passenger," while recommending that the clinician take a "backseat" focused on safety and communication. The final blueprint for implementation outlined four distinct phases: recruitment and training; nurse-led matching of compatible/aligned mentors and mentees; a period of mentorship supported by the clinic nurses; and a final evaluation to evolve the mentorship relationship. Patient partner team members participated in the creation and endorsement of these concepts and processes throughout. Conclusion There is a need to develop effective and sustainable strategies to support the growing number of patients facing decisions about advanced heart failure therapies beyond that the clinic team can offer. The development of a peer mentorship program assisted by clinicians and co-constructed with people with lived experience as investigators provides an innovative approach to improve patients’ experience and leverage the unique expertise of peers. Future research will inform the evaluation of this initiative.