1. Colleen K. McIlvennan, DNP, ANP
Decision Tree
Colleen K. McIlvennan, DNP, ANP
Assistant Professor of Medicine
Section of Advanced Heart Failure and Transplantation
INTERMACS 2016

2. Disclosures
None.

3. Outline What is Shared Decision Making? LVAD Therapy (DT)
Decision Support Tools

4. 1. What is Shared Decision Making?

5. Shared Decision Making

6. --Steve Wilkins, MPH

7. Classes of Treatment Decisions
Benefit
When scientific evidence for benefit strongly outweighs harm, behavioral support (e.g. smoking cessation, beta-blocker) designed to describe, justify, and recommend is most appropriate.
Risk

8. Classes of Treatment Decisions
Benefit
LVAD
32F peri-partum CM
INTERMACS 2
Risk

9. Classes of Treatment Decisions
Shared decision making is most easily applied to preference-sensitive decisions, to help patients think through, forecast, and deliberate their options.
Benefit
Risk

10. Classes of Treatment Decisions
LVAD
75M multi-morbidity
INTERMACS 5
Benefit
Risk

11. 2. DT LVAD Therapy

12. McIlvennan, Magid, Ambardekar, Thompson, Matlock, Allen
McIlvennan, Magid, Ambardekar, Thompson, Matlock, Allen. Circ Heart Fail. 2015

13. Dichotomy in Approach Reflective
“…it was a hard choice. It wasn't an easy choice for me to make ...so I fumbled with that for a little while before I made the decision to do it.”
“I don't know if the pump would keep me alive. And even if it does, I'm not sure it would be worth living. “
McIlvennan et al. Circ Cardiovasc Qual Outcomes. 2014

14. Dichotomy in Approach Reflective Automatic
“…it was a hard choice. It wasn't an easy choice for me to make ...so I fumbled with that for a little while before I made the decision to do it.”
“I don't know if the pump would keep me alive. And even if it does, I'm not sure it would be worth living. “
I: “Did you weigh the pros and cons of the decision at all?”
R: “No. No. Didn't even think twice about it. When they told me that I couldn’t have a transplant…this was the only option I had. That or push up daisies…so I automatically took this.”
McIlvennan et al. Circ Cardiovasc Qual Outcomes. 2014

15. Shared Decision-Making Process
Explain and define the medically reasonable options
Shared Decision-Making Process
describe the risks, benefits, burdens of each option
solicitation of patient preferences, values, goals

16. 3. Decision Support Tools

18. Decision Aids

19. Thompson, Matlock, McIlvennan, Jenkins, Allen. JACC Heart Fail. 2015

20. Thompson, Matlock, McIlvennan, Jenkins, Allen. JACC Heart Fail. 2015

22. Controlled Patient Testimonials

24. Future Directions
Ideal timing?
Does indication matter?
New technology

25. Questions?