Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic Group
Background US regulatory framework for advanced heart failure therapies (AHFT), ventricular assist devices, and heart transplants, delegate eligibility decisions to multidisciplinary groups at the center level. The subjective nature of decision‐making is at risk for racial, ethnic, and gender bias....
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027701 |
| _version_ | 1827572754567659520 |
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| author | Khadijah Breathett Ryan Yee Natalie Pool Megan C. Thomas Hebdon Shannon M. Knapp Kathryn Herrera‐Theut Esther de Groot Erika Yee Larry A. Allen Ayesha Hasan JoAnn Lindenfeld Elizabeth Calhoun Molly Carnes Nancy K. Sweitzer |
| author_facet | Khadijah Breathett Ryan Yee Natalie Pool Megan C. Thomas Hebdon Shannon M. Knapp Kathryn Herrera‐Theut Esther de Groot Erika Yee Larry A. Allen Ayesha Hasan JoAnn Lindenfeld Elizabeth Calhoun Molly Carnes Nancy K. Sweitzer |
| author_sort | Khadijah Breathett |
| collection | DOAJ |
| description | Background US regulatory framework for advanced heart failure therapies (AHFT), ventricular assist devices, and heart transplants, delegate eligibility decisions to multidisciplinary groups at the center level. The subjective nature of decision‐making is at risk for racial, ethnic, and gender bias. We sought to determine how group dynamics impact allocation decision‐making by patient gender, racial, and ethnic group. Methods and Results We performed a mixed‐methods study among 4 AHFT centers. For ≈ 1 month, AHFT meetings were audio recorded. Meeting transcripts were evaluated for group function scores using de Groot Critically Reflective Diagnoses protocol (metrics: challenging groupthink, critical opinion sharing, openness to mistakes, asking/giving feedback, and experimentation; scoring: 1 to 4 [high to low quality]). The relationship between summed group function scores and AHFT allocation was assessed via hierarchical logistic regression with patients nested within meetings nested within centers, and interaction effects of group function score with gender and race, adjusting for patient age and comorbidities. Among 87 patients (24% women, 66% White race) evaluated for AHFT, 57% of women, 38% of men, 44% of White race, and 40% of patients of color were allocated to AHFT. The interaction between group function score and allocation by patient gender was statistically significant (P=0.035); as group function scores improved, the probability of AHFT allocation increased for women and decreased for men, a pattern that was similar irrespective of racial and ethnic groups. Conclusions Women evaluated for AHFT were more likely to receive AHFT when group decision‐making processes were of higher quality. Further investigation is needed to promote routine high‐quality group decision‐making and reduce known disparities in AHFT allocation. |
| first_indexed | 2024-03-07T19:22:02Z |
| format | Article |
| id | doaj.art-8ef4c45e48c040e990b5620a7b01eee3 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T19:22:02Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-8ef4c45e48c040e990b5620a7b01eee32024-02-29T10:25:12ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-03-0112510.1161/JAHA.122.027701Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic GroupKhadijah Breathett0Ryan Yee1Natalie Pool2Megan C. Thomas Hebdon3Shannon M. Knapp4Kathryn Herrera‐Theut5Esther de Groot6Erika Yee7Larry A. Allen8Ayesha Hasan9JoAnn Lindenfeld10Elizabeth Calhoun11Molly Carnes12Nancy K. Sweitzer13Division of Cardiovascular Medicine Indiana University Indianapolis INDivision of Cardiovascular Medicine, Research Team Indiana University Indianapolis INSchool of Nursing University of Northern Colorado Greeley COSchool of Nursing University of Texas Austin TXDivision of Cardiovascular Medicine Indiana University Indianapolis INDepartment of Medicine/Pediatrics University of Michigan Ann Arbor MIDepartment of General Practice University Medical Center Utrecht Utrecht NetherlandsSchool of Medicine University of Arizona Tucson AZDivision of Cardiovascular Medicine University of Colorado Denver CODivision of Cardiovascular Medicine The Ohio State University Columbus OHDivision of Cardiovascular Medicine Vanderbilt University Nashville TNDepartment of Population Health University of Kansas Lawrence KSDepartment of Medicine University of Wisconsin Madison WIDivision of Cardiovascular Medicine University of Washington at St Louis St Louis MOBackground US regulatory framework for advanced heart failure therapies (AHFT), ventricular assist devices, and heart transplants, delegate eligibility decisions to multidisciplinary groups at the center level. The subjective nature of decision‐making is at risk for racial, ethnic, and gender bias. We sought to determine how group dynamics impact allocation decision‐making by patient gender, racial, and ethnic group. Methods and Results We performed a mixed‐methods study among 4 AHFT centers. For ≈ 1 month, AHFT meetings were audio recorded. Meeting transcripts were evaluated for group function scores using de Groot Critically Reflective Diagnoses protocol (metrics: challenging groupthink, critical opinion sharing, openness to mistakes, asking/giving feedback, and experimentation; scoring: 1 to 4 [high to low quality]). The relationship between summed group function scores and AHFT allocation was assessed via hierarchical logistic regression with patients nested within meetings nested within centers, and interaction effects of group function score with gender and race, adjusting for patient age and comorbidities. Among 87 patients (24% women, 66% White race) evaluated for AHFT, 57% of women, 38% of men, 44% of White race, and 40% of patients of color were allocated to AHFT. The interaction between group function score and allocation by patient gender was statistically significant (P=0.035); as group function scores improved, the probability of AHFT allocation increased for women and decreased for men, a pattern that was similar irrespective of racial and ethnic groups. Conclusions Women evaluated for AHFT were more likely to receive AHFT when group decision‐making processes were of higher quality. Further investigation is needed to promote routine high‐quality group decision‐making and reduce known disparities in AHFT allocation.https://www.ahajournals.org/doi/10.1161/JAHA.122.027701group decision‐makinggroup thinkheart failureheart transplantationracial disparitiesventricular assist device |
| spellingShingle | Khadijah Breathett Ryan Yee Natalie Pool Megan C. Thomas Hebdon Shannon M. Knapp Kathryn Herrera‐Theut Esther de Groot Erika Yee Larry A. Allen Ayesha Hasan JoAnn Lindenfeld Elizabeth Calhoun Molly Carnes Nancy K. Sweitzer Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic Group Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease group decision‐making group think heart failure heart transplantation racial disparities ventricular assist device |
| title | Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic Group |
| title_full | Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic Group |
| title_fullStr | Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic Group |
| title_full_unstemmed | Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic Group |
| title_short | Group Dynamics and Allocation of Advanced Heart Failure Therapies—Heart Transplants and Ventricular Assist Devices—By Gender, Racial, and Ethnic Group |
| title_sort | group dynamics and allocation of advanced heart failure therapies heart transplants and ventricular assist devices by gender racial and ethnic group |
| topic | group decision‐making group think heart failure heart transplantation racial disparities ventricular assist device |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027701 |
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