Assessment of a venous thromboembolism prophylaxis shared decision-making intervention (DASH-TOP) using the decisional conflict scale : a mixed-method study
León-García, Montserrat (Institut d'Investigació Biomèdica Sant Pau)
Humphries, Brittany (McMaster University (Canadà))
Morales, Pablo Roca (Universidad Villanueva)
Gravholt, Derek (Institut d'Investigació Biomèdica Sant Pau)
Eckman, Mark H. (University of Cincinnati College of Medicine)
Bates, Shannon M. (McMaster University (Canadà))
Suárez, Nataly R. Espinoza (Université Laval)
Xie, Feng (McMaster University (Canadà))
Perestelo-Pérez, Lilisbeth (Servicio Canario de la Salud)
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Venous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and death. The use of low-molecular-weight heparin (LMWH), despite being the standard of care to prevent VTE, comes with some challenges. Shared decision-making (SDM) interventions are recommended to support patients and clinicians in making preference-sensitive decisions. The quality of the SDM process has been widely assessed with the decisional conflict scale (DCS). Our aim is to report participants' perspectives of each of the components of an SDM intervention (DASH-TOP) in relation to the different subscales of the DCS. A convergent, parallel, mixed-methods design. The sample consisted of 22 health care professionals, students of an Applied Clinical Research in Health Sciences (ICACS) master program. We randomly divided the participants in three groups: Group 1 received one component (evidence -based information), Group 2 received two components (first component and value elicitation exercises), and Group 3 received all three components (the first two and a decision analysis recommendation) of the SDM intervention. Analysis: For the quantitative strand, we used a non-parametric test to analyze the differences in the DCS subscales between the three groups. For the qualitative strand, we conducted a content analysis using the decisional conflict domains to deductively categorize the responses. Groups that received more intervention components experienced less conflict and better decision-making quality, although the differences between groups were not statistically significant. The decision analysis recommendation improved the efficacy with the decision-making process, however there are some challenges when implementing it in clinical practice. The uncertainty subscale showed a high decisional conflict for all three groups; contributing factors included low certainty of the evidence-based information provided and a perceived small effect of the drug to reduce the risk of a VTE event. The DASH-TOP intervention reduced decisional conflict in the decision -making process, with decision analysis being the most effective component to improve the quality of the decision. There is a need for more implementation research to improve the delivery of SDM interventions in the clinical encounter.
Ajuts:	Instituto de Salud Carlos III PI17/01874
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Decision aids ; Decisional conflict ; Informed decision choices ; Shared decision-making ; Values and preferences and decision analysis
Publicat a:	BMC Medical Informatics and Decision Making, Vol. 23 Núm. 1 (december 2023) , p. 250, ISSN 1472-6947

DOI: 10.1186/s12911-023-02349-3
PMID: 37932759

14 p, 4.2 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
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