Adopting A Patient Decision Aid Into Routine Practice For Left Ventricular Assist Device: Diffusion Of Innovation Characteristics

• Published in: Journal of cardiac failure 2023-04, Vol.29 (4), p.636-636
• Main Authors: Thompson, Jocelyn S, Matlock, Daniel, McIlvennan, Colleen, Allen, Larry, Mosley, Bridget, Wynia, Matthew K, Morris, Megan, Tietbohl, Caroline
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.218

Due to the complex nature of patient decision making for left ventricular assist device (LVAD), we developed a pamphlet and video decision aid (DA) for patients and families considering LVAD therapy and demonstrated its effectiveness in improving decision quality. Herein, we utilized Diffusion of Innovations (DOI) theory to guide national implementation of this DA across all LVAD programs in the US. DOI outlines characteristics of interventions for potential adopters to consider, including compatibility, cost, effectiveness, observability, relative advantage, simplicity, and trialability. We sought to understand how each DOI characteristic affected adoption among LVAD programs. A sequential explanatory mixed methods study was performed. A survey focused on DOI characteristics for DA adoption was distributed through four professional society listservs targeting heart failure clinicians (April-May 2019). Using a semi-structured interview guide based on DOI characteristics, qualitative interviews about clinicians’ views of DA adoption were then conducted with a sub-set of programs with varying levels of reported DA use (January 2020-May 2021). Survey data were analyzed using descriptive statistics. Interviews were transcribed, coded, and analyzed using content analysis. A total of 530 individuals from 125 different LVAD programs completed the survey. Respondents included physicians (15.1%), advanced practice providers (23.2%), registered nurses (40.6%), and social workers (12.6%). Interview participants (n=37) included LVAD coordinators and cardiologists from 20 programs. The survey showed that the majority of respondents viewed the DA as compatible with existing workflows (79.5%) and were not concerned with cost of time (79.6%). Observability of positive outcomes (96.0%) was the most important consideration, followed by reported effectiveness of DA (80.8%). Interviews supported these findings but found differences for other characteristics. While 70.5% of survey respondents agreed that there was a perceived need for a DA (relative advantage), interviews between DA users and non-users differed. Relative advantage was a key motivating factor for DA users who perceived the DA as an unbiased tool to enhance existing practices, whereas non-users saw the DA as intending to correct poor performance and thus felt it was unnecessary. Fewer survey respondents agreed that trialability (64.2%) and simplicity (46.6%) were necessary for adoption, which DA users supported