Abstract 15: Decisional Needs in Patients Considering Left Ventricular Assist Device as Destination Therapy: Contrast Between Acceptors and Decliners
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".