Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential...

Area of Science:

• Medical Decision Making
• Health Outcomes Research
• Pharmacoeconomics

Background:

• Shared decision-making is crucial when evidence is inconclusive and treatment options have balanced risks and benefits.
• Low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) during pregnancy presents such a clinical scenario.
• Integrating patient values with clinical evidence is essential for optimal treatment choices.

Purpose of the Study:

• To describe the rationale and methodology of a pilot study applying decision analysis to shared decision-making.
• To explore the use of prophylactic LMWH in pregnant women or those considering pregnancy with a history of VTE.
• To enhance the decision-making process by bridging evidence-based medicine with patient-specific values.

Main Methods:

• An international, mixed-methods, sequential explanatory study design.
• Quantitative phase: Shared decision-making intervention (choice exercise, values elicitation, personalized decision analysis) followed by measurement of decisional conflict, self-efficacy, and satisfaction.
• Qualitative phase: Semi-structured interviews to explore participants' experiences and perceptions of the intervention, followed by integrated meta-inferences.

Main Results:

• The study is designed to collect and analyze quantitative data on decisional conflict, self-efficacy, and satisfaction.
• Qualitative data will explore participants' experiences and perceptions of the shared decision-making intervention.
• Integrated findings will provide meta-inferences to inform future clinical practice and research.

Conclusions:

• Decision analysis offers a quantitative framework to support shared decision-making in complex clinical situations.
• The pilot study will assess the feasibility and impact of a decision-analytic intervention for VTE prophylaxis in pregnancy.
• This approach aims to empower patients by aligning treatment decisions with their unique values and preferences.