Decision making for destination therapy left ventricular assist devices: "there was no choice" versus "I thought about it an awful lot".
Decision making for destination therapy left ventricular assist devices: "there was no choice" versus "I thought about it an awful lot".
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DOI：
10.1161/circoutcomes.113.000729
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发表时间：
2014-05
期刊：
影响因子：
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通讯作者：
Matlock DD
中科院分区：
文献类型：
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作者：
McIlvennan CK;Allen LA;Nowels C;Brieke A;Cleveland JC;Matlock DD
目的治疗左心辅助装置(DT LVAD)是治疗终末期疾病最具侵入性的医疗干预措施之一。患者如何决定是否继续植入设备尚不清楚。我们的目的是了解接受或拒绝DT LVAD的患者的决策过程。在2012年10月至2013年9月期间，我们进行了半结构化的深度访谈，以了解患者的决策体验。数据分析采用了归纳法和演绎法相结合的方法。22名符合条件的患者接受了采访，其中15名患者接受了DT LVAD，7名患者拒绝接受治疗。我们发现，在决策过程中，一些患者(11名接受者)是“自动的”，而另一些患者(3名接受者，7名拒绝者)在他们的决策方法上是“反思”的。自动组的特征是对死亡的恐惧和对活得尽可能长的压倒一切的渴望：“[Lvad]是我有…的唯一选择或者推高雏菊…所以我不由自主地拿了这个。相比之下，反思组经历了一个合理的过程，权衡风险、收益和负担：“有比死亡更糟糕的事情。”无论采用何种方法，大多数患者都将DT LVAD的决定视为一种高度情绪化的过程，许多患者寻求家人或精神上的支持。一些患者通过反思一个过程并通过风险和收益进行推理，为DT LVAD提供了面对决定的机会。对另一些人来说，活下去的欲望取代了这种反思过程。在考虑如何支持面临这一复杂决定的患者时，认识到这种差异是重要的。
Destination therapy left ventricular assist devices (DT LVAD) are one of the most invasive medical interventions for end-stage illness. How patients decide whether or not to proceed with device implantation is unknown. We aimed to understand the decision-making processes of patients who either accept or decline DT LVADs. Between October 2012–September 2013, we conducted semi-structured, in-depth interviews to understand patients’ decision-making experiences. Data were analyzed using a mixed inductive and deductive approach. Twenty-two eligible patients were interviewed, 15 with DT LVADs and 7 who declined. We found a strong dichotomy between decision processes with some patients (11 accepters) being “automatic” and others (3 accepters, 7 decliners) being “reflective” in their approach to decision making. The automatic group was characterized by a fear of dying and an overriding desire to live as long as possible: “[LVAD] was the only option I had…that or push up daisies…so I automatically took this”. In contrast, the reflective group went through a reasoned process of weighing risks, benefits, and burdens: “There are worse things than death.” Irrespective of approach, most patients experienced the DT LVAD decision as a highly emotional process and many sought support from their families or spiritually. Some patients offered a DT LVAD face the decision by reflecting on a process and reasoning through risks and benefits. For others, the desire to live supersedes such reflective processing. Acknowledging this difference is important when considering how to support patients who are faced with this complex decision.