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066 Optimising antithrombotic therapy for people with cancer at the end-of-life: protocol for developing, evaluating and implementing the ‘serenity’ shared decision support tool
  1. Adrian Edwards1,
  2. Kate Lifford1,
  3. Suzanne Cannegieter2,
  4. Jamilla Goedegebuur2,
  5. A Højen3,
  6. Stavros Konstantinides4,
  7. Johan Langendoen5,
  8. Isabelle Mahé6,
  9. Simon Mooijaart7,
  10. Mark Pearson8,
  11. Sebastian Smitz9,
  12. Erik Klok2,
  13. Simon Noble1,
  14. The Serenity Consortium Group
  1. 1Division of Population Medicine, Cardiff University, Cardiff, UK
  2. 2Department of Medicine — Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
  3. 3Aalborg University Hospital, Aalborg, Denmark
  4. 4University Medical Center Mainz, Mainz, Germany
  5. 5Todaytomorrow, Rotterdam, the Netherlands
  6. 6Department of Innovative Therapies in Haemostasis, Hôpital Louis Mourier, APHP, Paris, France
  7. 7Department of Medicine — Internal Medicine and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
  8. 8Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
  9. 9Department of Cardio-Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland

Abstract

Introduction Cancer raises thrombotic risk; antithrombotic therapy has probably little or even negative effects on well-being for people with cancer during their last year of life, but deprescribing antithrombotic therapy is rare in practice.

Antithrombotic therapy often continues until death, possibly causing bleeding, poorer quality-of-life and higher costs. Decision support in this high-stakes context with high existential uncertainty could be highly beneficial.

Methods The SERENITY consortium comprises researchers and clinicians from eight European countries with expertise in clinical fields, epidemiology, psychology, public & patient, and decision support. SERENITY’s comprehensive approach across IPDAS development criteria includes: realist review, flash mob research, epidemiology (Netherlands, Denmark, UK), multi-country qualitative interviews about current practice, influences on (de-)prescribing decisions and decision support needs of patients and clinicians (2023). Results will inform a Delphi process for consensus (clinicians, patients, decision support developers) on optimal shared decision support tool design, content and development (2024), which will be tested in a randomised controlled trial (2025–6). Targeted implementation and dissemination plans will be developed to enable SERENITY tool adoption across Europe, and incorporation in clinical guidelines and policies (2027–28). Funding is by Horizon Europe.

Results SERENITY will develop an information-driven shared decision support tool to facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end-of-life.

Discussion Internationally-applicable, multi-language, multi-method evidence- based decision support development is complex but potentially valuable for patients facing high-stakes decisions. We will discuss lessons learned, with reference to IPDAS criteria.

Conclusions We will develop an intervention seeking to guide appropriate use of antithrombotic therapy, prevents bleeding complications and saves healthcare costs. The tool is intended to enhance empowerment, quality-of-life and treatment satisfaction for people with advanced cancer and their care-givers.

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