Perceived Stress and Depressive Symptoms as Predictors of Decisional Conflict in Dyads Considering a Left Ventricular Assist Device

Circ Cardiovasc Qual Outcomes. 2020 Mar;13(3):e006155. doi: 10.1161/CIRCOUTCOMES.119.006155. Epub 2020 Mar 9.


Background: The decision to pursue a left ventricular assist device (LVAD) commits loved ones to major caregiving responsibilities and, often, medical decision-making. How emotional domains overlap within patients and their caregivers and contribute to conflict around the decision to pursue LVAD remains largely unexplored.

Methods and results: The associations within and between individuals in patient-caregiver dyads considering LVAD were estimated in a specific type of structural equation model known as the Actor-Partner Interdependence Model. This model tested whether each person's depression and stress predicted their own decisional conflict (actor effects), as well as their partner's decisional conflict (partner effects). At the time of study enrollment when a formal LVAD evaluation was initiated, 162 patient-caregiver dyads completed assessments of decisional conflict using the Decisional Conflict Scale, depressive symptoms using the Patient Health Questionnaire-2, and stress using the Perceived Stress Scale. Across both models, decisional conflict was significantly correlated within patient-caregiver dyads (β=0.47 and 0.44, for depression and perceived stress models, respectively, P<0.001). Greater perceived stress in both the patient (β=0.18; P<0.05) and caregiver (β=0.28; P<0.001) was significantly related to greater decisional conflict (both actor effects). Greater patient depressive symptoms were related to greater patient decisional conflict (β=0.16; P<0.05), whereas caregiver depression symptoms was not related to their own decisional conflict (β=0.07; P=0.37). There were no partner effects identified between decisional conflict and perceived stress or depressive symptoms.

Conclusions: Patient and caregiver conflict over the decision to pursue an LVAD was highly correlated in this sample, with greater perceived stress significantly predicting greater decisional conflict in both patients and caregivers. Depressive symptoms in patients also predicted greater patient decisional conflict. No partner effects were identified in predicting decisional conflict. These results contribute to a larger body of work acknowledging the importance of patient-caregiver well-being in serious illness. Registration: URL:; Unique identifier: NCT02344576.

Keywords: decision-making, shared; depression; heart failure; heart-assist devices.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Caregivers / psychology*
  • Choice Behavior*
  • Conflict, Psychological*
  • Cost of Illness
  • Depression / diagnosis
  • Depression / psychology*
  • Emotions*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Heart Failure / diagnosis
  • Heart Failure / physiopathology
  • Heart Failure / psychology
  • Heart Failure / therapy*
  • Heart-Assist Devices* / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Risk Factors
  • Stress, Psychological / diagnosis
  • Stress, Psychological / psychology*
  • Ventricular Function, Left*

Associated data