The Role of Patients' Treatment Expectations in Ventricular Assist Device Support: Results From a Convergent Mixed Methods Study.

OBJECTIVES

Treatment expectations influence patient-reported outcomes in chronic conditions; however, their role in ventricular assist device (VAD) therapy remains poorly understood. This study aimed to: (i) identify treatment expectations held by individuals with a VAD, (ii) assess the extent to which these expectations have been met, and (iii) examine how treatment expectations relate to VAD-specific health-related quality of life (HRQoL).

METHODS

A cross-sectional convergent mixed methods design with equal weighting of the qualitative and quantitative parts was employed. Quantitative questionnaire data (N = 47) from adult individuals with a VAD were analyzed using descriptive statistics and Bayesian multiple linear regression. Qualitative data (N = 8) were obtained through semi-structured interviews and analyzed using reflexive thematic analysis.

RESULTS

Participants reported having had high positive treatment expectations and moderate negative treatment expectations, on average. Approximately half of the participants indicated that they felt better than expected, while one-third felt worse than expected. Bayesian multiple linear regression analysis revealed strong evidence for several expectation domains and expectation violation as relevant for HRQoL. The thematic analysis resulted in three themes: "No choice: survival as context for expectations," "Shared experience and social support as mechanisms for coping and expectation adjustment," and "Setting expectations through provider communication."

CONCLUSIONS

This mixed methods study suggests that treatment expectations play a significant role in VAD therapy and may be associated with HRQoL. Assessing and, in some cases, managing treatment expectations may improve VAD care and enable more informed decision-making.