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Dissertation/Thesis Abstract

Factors Associated with Adoption of the International Society for Heart & Lung Transplantation (ISHLT) Recommendations for Mechanical Circulatory Support: Psychosocial Assessment of Left Ventricular Assist Device (LVAD) Candidates
by Clancy, Malachy J., Ph.D., University of the Sciences in Philadelphia, 2020, 195; 27999041
Abstract (Summary)

Background: Patient selection is considered one of the most important aspects towards a successful Left Ventricular Assist Device (LVAD) outcome. The 2018 International Society for Heart & Lung Transplantation (ISHLT) recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates for long-term Mechanical Circulatory Support (MCS) guides clinicians on evaluation content and process for psychosocial assessment prior to MCS implantation. Information about the attitudes, beliefs, and practices of clinical practice guidelines for individuals caring for LVAD patients and the impact of assessments of psychosocial functioning on the assessment process is limited.

Objectives: The objective of this study was to describe the beliefs regarding clinical practice guideline use for psychosocial assessment, barriers to completion and adoption of CPG’s, and assessment practices used within US LVAD program. Understanding factors associated with the adoption of the 2018 ISHLT Recommendations is the principal aim of this research study.

Methods: In 2019, a cross-sectional survey of LVAD programs listed in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) (n = 162) and Destination Therapy (DT) CMS programs (n = 21) for a total sample of 183 centers in North America was conducted to understand practices and policies used during psychosocial assessment and to assess challenges and barriers to the assessment process.

Results: Fifty-Eight (31.8%) of the 182 (one center reported closing in 2018) centers within the sample responded. Both self-reported adoption (n = 51, 87.9%) and consistency with clinical practice (n = 55, 94.8%) were generally high amongst respondents. Few challenges and barriers were reported to adoption with most categorizing “other” issues (range 7–9) or “no clear method to complete” (range 4–6). No statistically significant difference was found in assessing both clinician level and hospital level factors who reported adoption of the 2018 ISHLT Recommendations.

Conclusion: Respondents generally reported high rates of adoption and consistency with clinical practice of the 2018 ISHLT Recommendations, however variations in assessment methodologies and consistency with each individual domain completion limit the generalizability of these results. Findings from this study have implications for guideline developers, professional organizations, healthcare payers, and patients to improve the treatment and care for individuals with advanced heart failure.

Indexing (document details)
Advisor: Schemm, Ruth
Commitee: Janke, E. Amy, Logerstedt, David S., Petty, Michael
School: University of the Sciences in Philadelphia
Department: Health Policy
School Location: United States -- Pennsylvania
Source: DAI-B 81/12(E), Dissertation Abstracts International
Subjects: Health sciences, Surgery
Keywords: Adoption, Clinical practice guidelines, Health policy, Left ventricular assist device, Patient selection
Publication Number: 27999041
ISBN: 9798607382759
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