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ABSTRACT
Bias in advanced heart failure therapy allocation results in inequitable outcomes for minoritized populations. The purpose of this study was to examine how bias is introduced during group decision-making with an interprofessional team using Breathett’s Model of Heart Failure Decision-Making. This was a secondary qualitative descriptive analysis from a study focused on bias in advanced heart failure therapy allocation. Team meetings were recorded and transcribed from four heart failure centers. Breathett’s Model was applied both deductively and inductively to transcripts (n = 12). Bias was identified during discussions about patient characteristics, clinical fragility, and prior clinical decision-making. Some patients were labeled as “good citizens” or as adherent/non-adherent while others benefited from strong advocacy from interprofessional team members. Social determinants of health also impacted therapy allocation. Interprofessional collaboration with advanced heart failure therapy allocation may be enhanced with the inclusion of patient advocates and limit of clinical decision-making using subjective data.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
The participants of this study did not give written consent for their data to be shared publicly. Due to the sensitive nature of the research, supporting data is not available.
Ethical approval
This study was approved by the University of Arizona Institutional Review Board.
Additional information
Funding
Notes on contributors
Megan Hebdon
Dr. Megan Hebdon is an assistant professor in the School of Nursing at the University of Texas at Austin. Her research focuses on the supportive care needs of family caregivers, teams and systems that impact patient and family well-being, and qualitative methodologies.
Natalie Pool
Dr. Natalie Pool is an assistant professor in the School of Nursing at the University of Northern Colorado. Her research focuses nursing workforce diversity, cultural safety in educational and clinical settings, and qualitative research methods.
Ryan Yee
Ryan Yee, MS, is a research assistant at Indiana University. He is a long-time team member of Dr. Khadijah Breathett’s Cadiovascular Equity Research Team, and has expertise in recruitment, data management, and project coordination.
Kathryn Herrera-Theut
Dr. Kathryn Herrera-Theut is a resident at the University of Michigan Department of Medicine and Pediatrics. She is pursuing work focused on rural and underserved communities.
Erika Yee
Erika Yee is a fourth-year medical student at the University of Arizona College of Medicine - Tucson who is starting her intern year this coming June followed by a residency in Interventional Radiology at the University of Chicago. Her research interests include health disparities, bias in medicine, and health equity.
Larry A. Allen
Dr. Larry A. Allen is the chief of the Division of Cardiology at the University of Colorado Medicine. His clinical interests are heart failure, cardiac transplantations, and mechanical circulatory support, including ventricular assist devices. His research interests are risk prediction, readmission, care transitions, and shared decision-making.
Ayesha Hasan
Dr. Ayesha Hasan is medical director of the Cardiac Transplant Program and the director of the Heart Failure Devices Clinic, which focuses on management of nonresponders to cardiac resynchronization therapy. She is an associate professor of clinical medicine and director of the heart failure and transplant fellowship at Ohio State. Dr. Hasan has a special interest in device therapy for heart failure, including biventricular pacing, hemodynamic monitoring and ventricular device support.
JoAnn Lindenfeld
Dr. JoAnn Lindenfeld is a professor of medicine at Vanderbilt Health. Her areas of expertise are in cardiovascular medicine, heart transplantation, congestive heart failure, and mechanical circulatory support.
Elizabeth Calhoun
Dr. Elizabeth Calhoun is professor in the department of Population Health and associate dean for population health at the University of Kansas Medical Center. She is a leader in minority health and health disparities research. Dr. Calhoun’s work spans the cancer continuum, including clinical research, patient navigation, and policy development.
Nancy K. Sweitzer
Dr. Nancy K. Sweitzer is Vice Chair of Clinical Research for the Department of Medicine Director of Clinical Research for the Division of Cardiology. Here clinical expertise is in heart failure with preserved ejection fraction, advanced heart failure, cardiogenic shock, mechanical circulatory support and heart transplantation. Her research focuses on human studies of all aspects of heart failure, including cardiovascular clinical trials, , novel therapeutics in heart failure, improving quality of cardiovascular care, improving disparities in cardiovascular care, and cognitive dysfunction in cardiovascular diseases.
Anna Welling
Anna Welling is a psych mental health nurse practitioner (PMHNP) student and research assistant in the School of Nursing at the University of Texas at Austin. Her previous nursing experience includes medical, surgical and neuro ICU and inpatient psychiatric nursing for children, adolescents, adults. She intends to dedicate her career to working with child and adolescent populations, with the goal of expanding access to mental healthcare.
Khadijah Breathett
Dr. Khadijah Breathett is an associate professor at Indiana University, Division of Cardiology. Her clinical work focuses on the prevention and treatment of the advanced heart disease including longitudinal heart transplantation and ventricular assist device care. Dr. Breathett has developed randomized controlled trials, outcomes studies, observational population studies, mixed-method studies, implementation science studies, and community interventions focused on reducing racial and gender disparities in cardiovascular disease.