Integrating Values Based Communication in Heart Failure Management

Survey of Illness Beliefs in Heart Failure: 14-item measure of the accuracy of patients' beliefs about heart failure. Items are rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Responses are scored to reflect accurate versus inaccurate illness beliefs, producing a total score ranging from 0 to 14. Higher scores indicate more accurate illness beliefs (better outcome).

We will be using the State-Trait Anxiety Inventory (STAI), which is a 40-item self-report psychological test measuring two distinct types of anxiety: temporary, situation-based "state anxiety" and long-standing, baseline "trait anxiety". Administered to patient participants only. State anxiety (20 items) and trait anxiety (20 items) are subscales. Each subscale is scored from 20 to 80, with higher scores indicating greater anxiety (worse outcome).

Preparedness for Caregiving Scale: 8-item measure assessing caregivers' perceived preparedness to provide care and manage caregiving-related tasks. Items are rated on a 5-point scale from 0 (not at all prepared) to 4 (very well prepared), with total scores ranging from 0 to 32. Higher scores indicate greater caregiver preparedness (better outcome).

The KCCQ-12 is a survey for people with heart failure measuring physical limits, symptoms, quality of life, and social restrictions. 12-item patient-reported measure of health status in heart failure, including symptoms, physical limitations, social limitations, quality of life, and symptom stability. Scores are transformed to a 0-100 scale, with 0 representing the worst health status and 100 representing the best health status. Higher scores indicate better heart failure-related health status (better outcome).

Concordance between the clinician's assessment of the patient's current New York Heart Association (NYHA) functional class (Class I-IV) and the patient's heart failure health status as assessed using the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Clinician responses will be categorized as concordant, discordant, or intermediate based on prespecified mapping of KCCQ-12 responses to NYHA functional class. Lower discordance indicates better clinician-patient assessment agreement.

CollaboRATE: 3-item patient-reported measure of the quality of shared decision-making during a healthcare encounter. Each item is scored from 0 (no effort was made) to 9 (every effort was made). The total score ranges from 0 to 27, with higher scores indicating greater perceived shared decision-making (better outcome).

Concordance between the clinician's assessment of the patient's current overall quality of life (excellent, very good, good, fair, or poor) and the patient's quality of life as assessed using the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Clinician responses will be categorized as concordant, discordant, or intermediate based on prespecified mapping of KCCQ-12 responses. Higher concordance indicates better clinician-patient assessment agreement.

Concordance between the clinician's assessment of the frequency of the patient's current heart failure symptoms (never, rarely, sometimes, often, or almost always) and the patient's symptom burden as assessed using the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Clinician responses will be categorized as concordant, discordant, or intermediate based on prespecified mapping of KCCQ-12 responses. Higher concordance indicates better clinician-patient assessment agreement.

Concordance between the clinician's anticipated patient health status trajectory over the next 6-12 months (significant improvement, some improvement, approximately the same, some decline, significant decline, or uncertain) and the patient's current health status as assessed using the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Clinician responses will be categorized as concordant, discordant, or intermediate based on prespecified mapping of KCCQ-12 responses. Higher concordance indicates better clinician-patient assessment agreement.

Concordance between the clinician's identification of the primary factor currently impacting the patient's quality of life (heart failure symptoms, other medical conditions/comorbidities, physical functioning or limitations, emotional/psychological concerns, social or family circumstances, financial or housing concerns, treatment burden/healthcare demands, other, or unable to assess) and the patient's reported health status and quality-of-life responses on the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12). Responses will be categorized as concordant, discordant, or intermediate according to prespecified mapping. Higher concordance indicates better clinician-patient assessment agreement.