Complex Decision-Making in Heart Failure: A Systematic Review and Thematic Analysis.

BACKGROUND: Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making. OBJECTIVE: The specific aims of this review are to examine complex treatment decision-making, specifically implantable cardiac defibrillators, ventricular assist device, and cardiac transplantation, and to recognize commonalities and key points in the decisional process. METHODS: MEDLINE, CINAHL, PsycINFO, and Web of Science were searched for English-language studies that included qualitative findings reflecting the complexity of heart failure decision-making. Using a 3-step process, findings were synthesized into themes and subthemes. RESULTS: Twelve articles met criteria for inclusion. Participants included patients, caregivers, and clinicians and included decisions to undergo and decline treatment. Emergent themes were "processing the decision," "timing and prognostication," and "considering the future." Subthemes described how participants received and understood information about the therapy, making and changing a treatment decision, timing their decision and gauging health status outcomes in the context of their decision, the influence of a life or death decision, and the future as a factor in their decisional process. CONCLUSIONS: Commonalities were present across therapies, which involved the timing of discussions, the delivery of information, and considerations of the future. Exploring this further could help support patient-centered care and optimize shared decision-making interventions.

Fear of falling among community-dwelling older adults: A scoping review to identify effective evidence-based interventions.

Fear of falling presents a significant problem for many older adults by reducing physical function and increasing the risk of future falls. Several different types of interventions have improved fear of falling and a summary of efficacious interventions will help clinicians recommend treatment options. Using the Arksey and O'Malley Framework for scoping reviews, the purpose of this review was to identify efficacious interventions for treating fear of falling among community-dwelling older adults in order to provide a list of potential treatment options for care providers. A total of 45 publications were identified for inclusion in this review.

Memory Matters: A Mixed-Methods Feasibility Study of a Mobile Aid to Stimulate Reminiscence in Individuals With Memory Loss.

Reminiscence interventions are potentially effective in improving well-being of persons with memory loss (PWMLs) and may also enhance relationships with family and professional caregivers. Using a parallel convergent mixed-methods design, the feasibility of "Memory Matters" (MM), a mobile device application developed to promote reminiscence, was evaluated. Eighteen PWMLs and eight family members were enrolled from a long-term care facility and asked to use MM for 4 weeks. Participants were observed using MM at enrollment and 2 weeks and completed 1-month interviews. Six staff participants also completed a system review checklist and/or focus group at 1 month. Three qualitative domains were identified: (a) context of use, (b) barriers to use, and (c) MM influences on outcomes. Participants reported real-time social engagement, ease of use, and other benefits. However, PWMLs were unlikely to overcome barriers without assistance. Empirical data indicated that family and staff perceived MM favorably. Participants agreed that MM could provide stimulating, reminiscence-based activity. [Journal of Gerontological Nursing, 42(7), 15-24.].