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142 Values and preferences towards the use of prophylactic low-molecular- weight heparin during pregnancy: a convergent mixed-methods analysis of data from the decision analysis in shared decision making for thromboprophylaxis during pregnancy (DASH-TOP) study
  1. Montserrat León-García1,2,3,
  2. Brittany Humphries4,
  3. Derek Gravholt3,
  4. Elizabeth Golembiewski3,
  5. Mark H Eckman5,
  6. Shannon M Bates6,
  7. Ian Hargraves3,
  8. Irene Pelayo7,8,
  9. Sandra Redondo López9,
  10. Juan Antonio Millón Caño10,
  11. Milagros A Suito Alcántara11,
  12. Rohan D’Souza4,12,
  13. Nadine Shehata13,
  14. Susan M Jack4,14,
  15. Gordon Guyatt4,6,
  16. Feng Xie4,15,
  17. Lilisbeth Perestelo-Perez16,17,
  18. Pablo Alonso-Coello1,18
  1. 1Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
  2. 2Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
  3. 3Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA
  4. 4Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  5. 5Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati College of Medicine, Cincinnati, OH, USA
  6. 6Department of Medicine, McMaster University, Hamilton, ON, Canada
  7. 7Department of Obstetrics and Gynecology, Ramón y Cajal Hospital, Madrid, Spain
  8. 8Faculty of Medicine, Alcalá de Henares University, Madrid, Spain
  9. 9Department of Haematology, Ramón y Cajal Hospital, Madrid, Spain
  10. 10Hemostasis and Thrombosis Unit. Hospital de la Santa Creu i Sant Pau. Barcelona, Spain
  11. 11Hemostasis and Thrombosis Unit. Hematology Service. Hospital Universitario Vall d’Hebron. Barcelona, Spain
  12. 12Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
  13. 13Departments of Medicine, Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, Ontario, Canada
  14. 14School of Nursing, McMaster University, Hamilton, Ontario, Canada
  15. 15Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
  16. 16Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
  17. 17Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
  18. 18CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain

Abstract

Introduction Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality, and the use of preventive low-molecular-weight heparin (LMWH) can be challenging. Clinical guidelines recommend eliciting pregnant individuals’ preferences towards the use of LMWH and discussing the best option through a shared decision-making (SDM) approach. This study identifies identified individuals’ preferences concerning main health state, and categorizes attributes influencing the use of LMWH.

Design Convergent mixed-methods.

Participants Pregnant women or those planning a pregnancy with VTE recurrence risk. Intervention: A SDM intervention about LMWH thromboprophylaxis in pregnancy.

Analysis Quantitatively, we report preference scores assigned to each of the health states. Qualitatively, we categorized preference attributes using Burke’s pentad of motives framework: scene, agent, agency, act, and purpose. We use mixed-method convergent analysis to report findings using side-by-side comparison.

Results The least valued health state was to experience a pulmonary embolism (PE), followed by major obstetrical bleeding (MOB), deep vein thrombosis (DVT), and using daily injections of LMWH (valued as closest to a ‘healthy pregnancy’). Women’s previous experiences, access to care (scene) and shared decision-making (agent) affected preferences. LMWH’s benefits were noted, but substantial drawbacks were described (agency). The main goal was avoiding the risk of VTE (purpose). Side-by-side comparisons revealed concordance between motives and DVT and PE health states. Discordance appeared between using daily injections of LMWH and agent- and agency motives and between MOB and agency motives.

Discussion Mixed-methods provide a nuanced understanding of LMWH preferences in pregnancy, by quantifying health states preferences and exploring attributes qualitatively. Incorporating both methods may improve patient-centered care.

Conclusion Convergent mixed-method analysis helps to intuitively ‘tell the whole story’ of patient’s needs, desires, and values, ultimately facilitating discussions between patients and clinicians, promoting a SDM process, and leading patients to make the right decision that fits in their life.

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