Values and preferences towards the use of prophylactic low-molecular-weight heparin during pregnancy : a convergent mixed-methods secondary analysis of data from the decision analysis in shared decision making for thromboprophylaxis during pregnancy (DASH-TOP) study
León-García, Montserrat (Centro Cochrane Iberoamericano (CCIb))
Humphries, Brittany (McMaster University (Canadà))
Xie, Feng (McMaster University (Canadà))
Gravholt, Derek Loy (Centro Cochrane Iberoamericano (CCIb))
Golembiewski, Elizabeth (Mayo Clinic (Rochester, Estats Units d'Amèrica))
Eckman, Mark (University of Cincinnati College of Medicine (Cincinnati, Estats Units d'Amèrica))
Bates, Shannon (McMaster University (Hamilton, Canadà))
Hargraves, Ian G. (Mayo Clinic (Rochester, Estats Units d'Amèrica))
Pelayo-Delgado, Irene (Universidad de Alcalá)
Redondo López, Sandra (Hospital Universitario Ramón y Cajal (Madrid))
Millón Caño, Juan Antonio (Institut de Recerca Sant Pau)
Suito Alcántara, Milagros A. (Hospital Universitari Vall d'Hebron)
D'Souza, Rohan (McMaster University (Hamilton, Canadà))
Shehata, Nadine (Mount Sinai Hospital (Toronto, Canadà))
Jack, Susan Michelle (McMaster University (Hamilton, Canadà))
Guyatt, Gordon (McMaster University (Hamilton, Canadà))
Perestelo-Pérez, Lilisbeth (Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS))
Alonso-Coello, Pablo (Institut de Recerca Sant Pau)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	Background: Venous thromboembolism (VTE) in pregnancy 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 daily injections of LMWH and discussing the best option through a shared decision-making (SDM) approach. Our aim was to identify individuals' preferences concerning each of the main clinical outcomes, and categorize attributes influencing the use of LMWH during pregnancy. Methods: Design: Convergent mixed-methods. Participants: Pregnant women or those planning a pregnancy with VTE recurrence risk. Intervention: A SDM intervention about thromboprophylaxis with LMWH 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: act (what needs to be done), scene (patient's context), agent (perspectives and influence of people involved in the decision), agency (aspects of the medication), and purpose (patient's goals). We use mixed-method convergent analysis to report findings using side-by-side comparison of concordance/discordance. Results: We comprehensively determined preferences for using LMWH by pregnant individuals at risk of VTE: through value elicitation exercises we found that 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'); through interviews we found that: previous experiences, access to care (scene) and shared decision-making (agent) affected preferences. LMWH's benefits were noted, but substantial drawbacks were described (agency). For participants, the main goal of using LMWH was avoiding any risks in pregnancy (purpose). Side-by-side comparisons revealed concordance and discordance between health states and motives. Conclusions: Mixed-methods provide a nuanced understanding of LMWH preferences, by quantifying health states preferences and exploring attributes qualitatively. Incorporating both methods may improve patient-centered care around preference-sensitive decisions in thromboprophylaxis during pregnancy.
Ajuts:	Instituto de Salud Carlos III F18/00014 Instituto de Salud Carlos III PI17/01874
Nota:	Altres ajuts: BH received a doctoral award from the Canadian Institutes for Health Research (Grant number: GSD - 152327). RD holds a Canada Research Chair in Maternal Health (CRC-2021\u201300337).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Low-molecular-weight heparin ; Preferences ; Pregnancy ; Shared decision-making ; Values ; Venous thromboembolism
Publicat a:	Thrombosis journal, Vol. 22 Núm. 1 (december 2024) , p. 81, ISSN 1477-9560

DOI: 10.1186/s12959-024-00648-x
PMID: 39243049

20 p, 1.4 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
Articles > Articles de recerca
Articles > Articles publicats