Patient perspectives on decision making in heart failure

Abstract

Background: Patients with heart failure (HF) face an array of challenging decisions involving medications, devices, and transplants. The goal of this qualitative study was to describe patients' perceptions surrounding difficult decisions along with factors that influenced their decisions.

Methods and results: We studied 22 patients with symptomatic HF from the University of Colorado Hospital using in-depth, semistructured interviews. We used descriptive theme analysis in an iterative process to analyze responses to the question: "Can you tell me about any important or difficult decisions you have had to make about your heart condition?" Two distinct decision-making styles emerged: active (55%) and passive (45%). Active decision makers identified interventions such as implantable cardioverter-defibrillators, medications, and transplants to be the most difficult decisions and weighed concerns for side effects, family, and quality of life. Passive decision makers generally did not identify a difficult decision and described factors such as trust in God, trust in the physician, and power of the physician as reasons for their passivity.

Conclusions: Patients with HF use active and passive decision styles in their approach to medical decision making. Future work should investigate communication techniques to assure that passive decision makers receive health care that is concordant with their values.