Frequency and Predictors of Virtual Visits in Patients With Heart Failure Within a Large Health System: Retrospective Cohort Study.

Background: Virtual care interventions have the potential to improve access to care and serial medication intensification for patients with chronic heart failure with reduced ejection fraction (HFrEF). However, concerns remain that these interventions might unintentionally create or widen existing disparities in care delivery and patient outcomes.

Objective: This study aimed to characterize the health care use patterns of patients who have HFrEF, including specialty type and frequency of in-person and virtual visits.

Approaches for establishing trust and alleviating stress during the surrogate informed consent process for critical care research.

Background: Trust with researchers is a consideration among surrogate decision makers (SDMs) who are approached to provide consent for research participation on behalf of critically ill patients. However, little is known about strategies that researchers can use to build trust with SDMs and alleviate stress when making these decisions.

Research Question: What are the best approaches to building trust and alleviating stress that can be used in the surrogate informed consent process?

Study Design And Methods: A convergent parallel mixed-methods study including surveys, focus groups, and semi-structured interviews with principal investigators (PIs), research coordinators (RCs), SDMs, and critically ill patients who were approached for participation in a critical care research clinical trial.

AMPDECIDE amputation level patient decision aids: a feasibility study.

Objective: This was a feasibility study of the AMPDECIDE amputation level selection patient decision aids (one transmetatarsal vs. transtibial, the other transtibial vs. transfemoral) designed to inform a larger efficacy trial.

The Performance of the Surrogate Informed Consent Process for Critical Care Research: A Multi-Modal Study of Investigators, Coordinators, Surrogates, and Patients.

Background: Although surrogates are often required to participate in the informed consent process for critical care research, how to best engage surrogates in this process remains unclear.

Research Question: What are the best practices for conducting the surrogate informed consent processes for critical care research?

Study Design And Methods: This mixed-methods study was performed across academic medical centers located in the United States. It included quantitative surveys with open-ended questions, focus groups, and semi-structured interviews with principal investigators (PIs), research coordinators (RCs), and surrogate decision makers (SDMs) who were approached about a critical care research clinical trial and, when possible, the patient who had been critically ill.

Using the 5Ms Framework to Advance Aging-Responsive Care for Heart Failure with Reduced Ejection Fraction.

Complexity of care is the inevitable consequence of an aging population and is particularly true in instances where patients are managing chronic conditions such as heart failure with reduced ejection fraction (HFrEF). HFrEF itself is complex, with an undulating course of illness, increased risk of sudden cardiac death, and myriad accompanying treatment considerations. Generalist management of HFrEF among older patients is further complicated by competing comorbidities, potential for financial toxicity, potential for mental health symptoms, and risk of care with does not align with goals and preferences.

Improving lung cancer decision-making using a conversation tool (iDECIDE): a stepped wedge pragmatic clinical trial.

Lung cancer is a leading cause of cancer-related mortality. However, few treatment decision-making resources exist. In this study, we evaluate a low literacy lung cancer treatment conversation tool to enhance shared decision-making (SDM).

Development and Pilot Testing for a Novel Shared Decision-Making Tool for Tracheostomy Decision-Making.

Background: Tracheostomy and prolonged mechanical ventilation decision-making is one of the most emotionally difficult decisions facing surrogate decision-makers in health care. Often, surrogates face decisions between the potential for prolonged life support verses transitions to comfort measures and possible death. Despite more than two decades of research, major gaps exist in improving the decision-making process.

"Hospice was Created by the KKK"-Black Americans' Perspectives on Hospice Care.

Background: Misperceptions of hospice persist in communities of color. This study explored what Black Americans understand about and how they describe hospice care. The goal was to determine if older Black Americans can accurately describe hospice and to explore potential barriers and facilitators to hospice enrollment.

Implementation of a "People-Like-Me" Tool for Personalized Rehabilitation After Total Knee Arthroplasty: A Mixed Methods Pilot Study.

Rationale: While there are numerous tools available to inform if and when to use total knee arthroplasty (TKA), very few tools exist to help guide the recovery period after surgery.

Aims And Objectives: We piloted a decision support tool that promotes a "people-like-me" (PLM) approach to rehabilitation after total knee arthroplasty (TKA). The PLM approach encourages person-centered care by "using historical outcomes data from similar (past) patients as a template of what to expect for a new patient".

Contributors and Solutions to High Out-of-Pocket Costs for Heart Failure Medications: A State-of-the-Art Review.

As expensive therapeutics rise to the fore of heart failure management, out-of-pocket (OOP) medication costs have become increasingly relevant to patient care. Prescription medication costs influence medical decision-making and affect adherence. Yet, individualized cost estimates are seldom available during clinical encounters when prescription decisions are made.

Facilitators and Barriers to Values Discussions Following LVAD Implantation: Perspectives from Diverse Patients and Family Caregivers.

Background: Delivering care that is responsive to who or what is most important to patients and family caregivers is a key aspect of quality care, yet it remains unclear how clinicians can best support individuals in expressing their personal values. We aimed to describe patient- and family caregiver-identified facilitators and barriers to engaging in values discussions with clinicians following implantation of a left ventricular assist device (LVAD).

Methods And Results: Using a qualitative descriptive approach, patients with an LVAD and their caregivers participated in 1-on-1 semistructured interviews and self-reported sociodemographics (January 2023-July 2023).

An online driving decision aid for older drivers reduces ambivalence and regret about driving decisions: Randomized trial.

Background: Decisions about driving cessation can be stressful for older adults. We tested effects of a driving decision aid (DDA) on psychosocial outcomes among older drivers during two-year follow-up.

Methods: Multisite randomized controlled trial of licensed drivers ages ≥70 with at least one diagnosis associated with increased likelihood of driving cessation, without significant cognitive impairment.

Integrating Out-of-Pocket Costs Into Shared Decision-Making for Heart Failure With Reduced Ejection Fraction: A Stepped-Wedge Trial (POCKET-COST-HF).

Background: Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction can entail high out-of-pocket (OOP) costs, prompting concerns about financial toxicity and access. OOP costs are generally unavailable during encounters. This trial assessed the impact of providing patient-specific OOP costs to patients and clinicians.

Ethical issues in implementation science: perspectives from a National Heart, Lung, and Blood Institute workshop.

Ethical issues arise in the context of implementation science that may differ from those encountered in other research settings. This report, developed out of a workshop convened by the Center for Translation Research and Implementation Science within the United States National Heart, Lung, and Blood Institute, identifies six key themes that are important to the assessment of ethical dimensions of implementation science. First, addressing ethical challenges in implementation science does not require new ethical principles, commitments, or regulations.

Whether and how to store firearms in the home: Qualitative insights from care partner experiences in the Safety in Dementia Trial.

Background: Most people with dementia (PWD) in the United States live in community settings supported by family and/or unpaid care partners. Firearms access is one of many decisions care partners navigate alongside PWD in efforts to prevent injuries and deaths. Conversations about firearms access are socially challenging, although specific challenges to be overcome have not been described.

Older Veterans' perspectives on participation in a clinical exercise program: A qualitative study of the VA Gerofit exercise program.

Objectives: We explored the perspectives of older veterans in Gerofit, a Department of Veteran Affairs (VA) supervised clinical exercise program, to understand the factors associated with participation and how the program supported personal health goals.

Methods: Twenty semistructured interviews were conducted with active and inactive Gerofit participants. We used a hybrid inductive and deductive approach to thematic analysis of transcripts, with the latter informed by the Health Action Process Approach model of behavior change.

Identifying Decisional Needs for Adult Tracheostomy and Prolonged Mechanical Ventilation Decision Making to Inform Shared Decision-Making Interventions.

Background: Decision making for adult tracheostomy and prolonged mechanical ventilation is emotionally complex. Expectations of surrogate decision makers and physicians rarely align. Little is known about what surrogates need to make goal-concordant decisions.

Association of multimorbidity with guideline-directed medical therapy intensification in heart failure: Findings from the EPIC-HF trial.

A potential contributor to the suboptimal rates of guideline directed medical therapy (GDMT) prescribing for heart failure with reduced ejection fraction (HFrEF) is the burden of multimorbidity in patients with HFrEF. We examined the effect of multimorbidity on GDMT prescription in the EPIC-HF trial, finding that multimorbidity was associated with decreased likelihood of GDMT intensification. Further study is needed to guide treatment in high-risk, multimorbid patients with HFrEF.

"You just have to be careful how you do it": A qualitative study of the Healthwise decision aid for older drivers.

Objective: Decisions about driving retirement are difficult for older adults, their families, and health care providers. A large randomized trial found that an existing online Healthwise decision aid decreased decision conflict and increased knowledge about driving decisions. This study sought to discover how, when, and where the tool might be most effective for older drivers, their family members, and their health care providers.

"Things That You Thought Mattered, None of That Matters": A Qualitative Exploration of Family Caregiver Values following Left Ventricular Assist Device Implantation.

Background: Intentional exploration, or elicitation, of patient and family values-who/what matters most-is critical to the delivery of person-centered care, yet the values elicitation experiences of family caregivers have been understudied. Understanding caregiver experiences discussing, reflecting upon, and acting on their values is critical to optimizing health decisions after left ventricular assist device (LVAD) implantation.

Objective: The aim of this study was to explore the values elicitation experiences of family caregivers of individuals with an LVAD in the postimplantation period.