Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation





First Advisor

Dr. Debra K. Moser


Heart failure (HF) is one of the top causes of mortality in the United States and globally. In order to combat the high mortality rates of this disease, medical technology, including internal cardioverter defibrillators (ICD) and left ventricular assist devices (LVAD), have become one of the most common treatments. Over the past 10 years the utilization of these cardiac devices has increased exponentially, which has created a new phenomenon of how we discuss death with patients who have one of these devices. The purpose of this dissertation is to increase understanding of the end-of-life decision making processes and current experiences that patients with a cardiac device are having.

This dissertation includes four original manuscripts that focus on patients with a cardiac device and their experiences with decision-making at the end-of-life. The first paper is a data-based paper that examines experiences of patients with an ICD and what factors are associated with having a conversation with their providers about end-of-life. The second paper is an integrative review of the literature regarding what is currently known about end-of-life with an LVAD. The third paper is a psychometric evaluation of the Control Attitudes Scale-Revised (CAS-R) for patients with an LVAD. The fourth paper is a data-based manuscript that looks at patients with an LVAD and their attitudes and experiences with end-of-life conversations with providers and next-of-kin and the impact of cognition on these attitudes and experiences. The findings of this dissertation will hopefully inform providers of patients with cardiac devices about their patients end-of-life decision making processes. It will also demonstrate the gaps that are currently in practice, and ideally be able expand on how to assist patients and providers on improving communication about end-of-life decision making.

Digital Object Identifier (DOI)

Funding Information

Robert Wood Johnson Future of Nursing Scholars Program