Abstract 15: Decisional Needs in Patients Considering Left Ventricular Assist Device as Destination Therapy: Contrast Between Acceptors and Decliners
Notice bibliographique
Résumé
Background: Left ventricular assist device as destination therapy (DT LVAD) is an option for some transplant ineligible patients who are actively dying of heart failure. Essentially, patients are faced with the decision to undergo major surgery to implant a partial artificial heart or transition to end-of-life care. While LVADs can extend life, they are also associated with significant risks including infection, stroke, and caregiver burden. How patients make this decision is poorly understood. Methods: We performed semi-structured, in-depth interviews based on the Ottawa Decision Support Framework to understand patients’ decisional needs in accepting or declining DT LVAD. All patients who had DT LVAD in place and patients who declined DT LVAD at an academic medical center between October-December 2012 were interviewed. Interviews were audio-recorded and transcribed. Data were analyzed using a mixed inductive and deductive approach. Additionally, we measured decision regret using the validated, 5-item decision regret scale. Results: All 17 eligible patients were interviewed, 13 with DT LVADs and 4 who had declined. Their mean age was 68. Patients accepting DT LVADs often did not perceive a decision. “I had to do it if I wanted to exist anymore.” This perception appeared to come from a belief that choosing end-of-life medical care was not an option, “This [LVAD] was the only option I had..that or push up daisies...so I automatically took this.” They also noted that the risks of the LVAD were not that important as they had “nothing to lose.” Those who declined an LVAD stated they were not afraid of death, asserted that their life lived had meaning, and recognized the potential burdens to both themselves and their family, “There are worse things than death.” For both accepters and decliners, this was an emotionally and spiritually driven decision. Both groups felt highly involved and informed. They also endorsed little decision regret (mean 5/100 for acceptors, 0/100 for decliners). Conclusions: There is a fundamental difference in values surrounding death among patients who either accept or decline a DT LVAD. Decision support interventions around this complex medical decision need to consider patient values first before getting into more cognitive aspects of the decision making process.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».