Standardized protocols can reduce the impact of implicit bias but are underused. Since the Institute of
Medicine’s report, “Unequal Treatment”, multiple studies have confirmed that standardization of decision-
making processes reduces bias, but bias in the allocation of advanced therapies has not been addressed.
Using an evidence-based framework for behavior change [Capability, Opportunity, and Motivation for Behavior
Change/Behavior Change Wheel (COM-B/BCW)], we developed a standardized protocol strategy, Seeking
Objectivity in Allocation of Advanced Heart Failure (SOCIAL HF), that addresses significant barriers to equity in
advanced therapies: 1) bias, 2) subjectivity in evaluation of social support and adherence, and 3) poor group
dynamics. Thus, SOCIAL HF includes: 1) evidence-based bias training tailored for HF, 2) restriction to
objective evaluations of social support and adherence, and 3) environmental restructuring and modeling of
meeting settings to include anonymous electronic voting and equitable seating arrangement. In complex
decision-making that includes individuals and groups, our standardized protocol strategy, SOCIAL HF, has the
greatest likelihood of achieving health equity in advanced HF. Our goal is to assess real-world effectiveness
(Aim 1) and implementation (Aim 2) of SOCIAL HF for allocation of advanced HF therapies, heart transplant
and ventricular assist device implantation. We will use a cluster randomized design to test the effectiveness of
SOCIAL HF strategy. We will evaluate implementation of SOCIAL HF across study sites using mixed-methods
in order to learn optimal implementation strategies to achieve equity. We will use normalization process theory
to evaluate how SOCIAL HF affects processes and outcomes important to advanced HF centers (e.g.
fidelity/variation). We will use RE-AIM framework (reach, effectiveness, adoption, implementation, and
maintenance) to evaluate factors that promote reach and adoption and resources needed for implementation.
We have the relationships, infrastructure, and expertise to execute this project; our multidisciplinary team
includes experts in HF, evidence-based bias reduction training, clinical trials, mixed-methods, and