Why the study?
Patient-centered care assumes clarity and consistency of patient values and preferences, but the stability of these values regarding care aggressiveness and LVAD preferences in advanced heart failure was unclear.
Do patient-reported values regarding aggressive care and treatment preferences remain stable over time in patients considering destination therapy LVAD?
Do patient-reported values regarding aggressive care and treatment preferences remain stable over time in patients considering destination therapy LVAD?
While most patients considering destination therapy LVAD have stable values and treatment preferences, a substantial minority experience significant changes over time, highlighting the need for ongoing shared decision-making and support for depression and illness acceptance.
Patient values and LVAD preferences appear mostly stable; supports one-time assessment but leaves open impact on decisions.
BACKGROUND: Patient-centered care includes matching treatments to patient values and preferences. This assumes clarity and consistency of values and preferences relevant to major medical decisions. We sought to describe stability of patient-reported values regarding aggressiveness of care and preferences for left ventricular assist devices (LVADs) for advanced heart failure. METHODS AND RESULTS: We conducted a secondary analysis of patients undergoing LVAD evaluation at 6 US centers. Surveys at baseline, 1 month, and 6 months included a single 10-point scale on the value of aggressive care (score 1 = "do everything," 10 = "live with whatever time I have left") and treatment preference (LVAD, unsure, no LVAD). Data were captured for 232 patients, of whom 196 were ultimately deemed medically eligible for LVAD, and 161 were surgically implanted by 1 month. Values at baseline favored aggressive care (mean [SD], 2.49 [2.63]), trending toward less aggressive over time (1 month, 2.63 [2.05]; 6 months, 3.22 [2.70]). Between baseline and 1 month, values scores changed by ≥2 points in 28% (50/176), as did treatment preferences for 18% (29/161) of patients. Values score changes over time were associated with lower illness acceptance, depression, and eventual LVAD ineligibility. Treatment preference change was associated with values score change. CONCLUSION: Most patients considering LVAD were stable in their values and treatment preferences. This stability, as well as the association between unstable treatment preferences and changes to stated values, highlighted the clinical utility of the values scale of aggressiveness. However, a substantial minority reported significant changes over time that may complicate the process of shared decision making. Improved methods to elicit and clarify values, including support to those with depression and low illness acceptance, is critical for patient-centered care.[Box: see text].
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A 2021 study studied this question.
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