Date Presented 04/21/2023
Supports are needed to address the preparedness and mutuality of patients with mechanical circulatory support and their caregivers. OT interventions can promote daily participation as well as physical and mental health for dyads.
Primary Author and Speaker: Ricardo Daniel Ramirez
Additional Authors and Speakers: Susan Magasi
Contributing Authors: Kathleen L. Grady
PURPOSE: Over 22,000 patients received mechanical circulatory support (MCS) in the past two decades (Kirklin et al., 2017). Early post-MCS patients report participation challenges, depression, anxiety, and low self-efficacy (Grady et al., 2015). Preparedness and mutuality are major factors in the quality of life for MCS patients and caregivers (Magasi et al., 2019). There is limited literature articulating OT’s role with this population. The purpose of this study is to describe OT’s role in supporting MCS dyads through the lenses of mutuality and preparedness.
DESIGN: The research team conducted a secondary analysis of cross-sectional semi-structured qualitative interviews of MCS patients and caregivers. MCS patients had a continuous flow left ventricular assist device. Caregivers identified as primary, unpaid caregivers. All participants were at least 21 years of age and English-speaking. Recruitment took place in a single Midwest site using a maximum variability sampling strategy.
METHOD: Semi-structured interviews were conducted by a research team with vast experience with chronic clinical populations. Interviews lasted 30 to 60 minutes and were recorded, transcribed, and deidentified. The team used a two-phase thematic analysis and applied strategies to enhance rigor. Preparedness and mutuality concepts were used to structure findings.
RESULTS: Dyads reported limited preparation for MCS management, resulting in anxiety. Preparedness increased as they became habituated to MCS tasks. While some relationships strengthened, others strained due to loss of independence, self-perceived burden, and role loss. A supportive social environment promoted mutuality and preparedness.
CONCLUSION: OT practitioners can address participation barriers for MCS dyads across practice settings. Intervention strategies are presented to promote mutuality and preparedness. New opportunities exist for OT practitioners to demonstrate their distinct value with the MCS population.
Kirklin, J. K., Pagani, F. D., Kormos, R. L., Stevenson, L. W., Blume, E. D., Myers, S. L., … Naftel, D. C. (2017). Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. The Journal of Heart and Lung Transplantation, 36(10), 1080–1086. https://doi.org/10.1016/j.healun.2017.07.005
Grady, K. L., Magasi, S., Hahn, E. A., Buono, S., McGee, E. C., & Yancy, C. (2015). Health-related quality of life in mechanical circulatory support: Development of a new conceptual model and items for self-administration. The Journal of Heart and Lung Transplantation, 34(10), 1292–1304. https://doi.org/10.1016/j.healun.2015.04.003
Magasi, S., Buono, S., Yancy, C. W., Ramirez, R. D., & Grady, K. L. (2019). Preparedness and mutuality affect quality of life for patients with mechanical circulatory support and their caregivers. Circulation: Cardiovascular Quality and Outcomes, 12(1), 1-10. https://doi.org/10.1161/CIRCOUTCOMES.117.004414