Article Text

Download PDFPDF
067 Qualitaive findings from a European study of clinicians’ perceptions of shared decision-making when managing antithrombotic therapy in patients with advanced cancer towards the end-of-life
  1. Michelle Edwards1,
  2. Elin Baddeley1,
  3. Steph Sivell1,
  4. Kate Lifford1,
  5. Carme Font2,
  6. Isabelle Mahe3,
  7. Annmarie Nelson1,
  8. Erik Klok4,
  9. Simon Noble1,
  10. Anette Arbjerg Højen5
  1. 1Marie Curie Research Centre, Cardiff University, Cardiff UK
  2. 2Medical Oncology Department, Hospital Clinic, Barcelona, Spain
  3. 3Université Paris Cité, APHP, Hôpital Louis Mourier, Service de Médecine Interne, Paris, France
  4. 4Department of Medicine – Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
  5. 5Danish Center for Health Services Research, Aalborg University Hospital, Aalborg, Denmark

Abstract

Introduction Decisions about the management of Antithrombotic Therapy (ATT) for patients with advanced cancer towards the end-of-life are complex with a lack of evidence about optimal management. There are competing benefits and risks to patients’ health and quality of life. Serenity is a Pan-European study to develop and evaluate a Shared Decision-Making Support Tool (SDMST) to assist such decisions. This paper presents part of the qualitative findings which explain clinicians’ perspectives on shared decision-making for managing ATT.

Method Semi-structured interviews were conducted with clinicians from different specialties who deliver care to patients who have been prescribed ATT and have advanced cancer in Wales, Denmark, France and Spain. Interview summaries were created and shared between the European research teams to compose a thematic framework. The framework is being applied to interview transcripts to conduct a framework analysis.

Results Preliminary results from interviews with 69 clinicians show that they perceive this as a complex decision, with a lack of evidence and risk prediction tools to guide decisions when managing ATT near the end-of-life. Clinicians had no experience in using a SDMST to support treatment choices in this setting. They emphasised the importance of understanding patients’ preferences and values and described challenges in explaining complex information in a way that adequately informs a shared decision.

Discussion Given the complexity of decisions about managing ATT, clinicians could benefit from an evidence- based SDMST to help inform patients of the risks of continuing or stopping ATT, to facilitate shared decision-making and ensure that patients’ preferences and values are included in decisions.

Conclusion The preliminary qualitative work has identified a need for support to deliver shared decision-making for managing ATT. More interviews will be conducted and added to the framework analysis; the overall findings will be used to inform the development, evaluation and implementation of a SDMST.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.