Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed methods pilot study protocol

Humphries, Brittany; León-García, Montserrat; Bates, Shannon M.; Guyatt, Gordon; Eckman, Mark H.; D’Souza, Rohan; Shehata, Nadine; Jack, Susan M.; Alonso‐Coello, Pablo; Xie, Feng

doi:10.1136/bmjopen-2020-046021

Cited by 7 publications

(24 citation statements)

References 73 publications

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“…These factors have been shown to influence the decision-making process [ 46 ], and their clarification is especially important in low risk settings (i.e., women with a prior history of VTE associated with a non-hormonal temporary provoking risk factor), in which we showed lower levels of willingness to take antithrombotic treatment [ 41 , 47 ]. This is particularly relevant when using systematic reviews to inform the development of tools used to support SDM [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Women’s values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review

León-García

Humphries

Maraboto

et al. 2022

BMC Pregnancy Childbirth

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Background Venous thromboembolism (VTE) in pregnancy is an important cause of maternal morbidity and mortality. Low-molecular-weight heparin (LMWH) is the cornerstone of prophylaxis and treatment of thrombotic events during pregnancy. LMWH has fewer adverse effects than other anticoagulants, does not cross the placenta, and is safe for the fetus. However, the use of LMWH during pregnancy is sensitive to womens’ underlying preferences. The objective of this review is to systematically assess women’s values and preferences research evidence on this topic. Methods We searched four electronic databases from inception to March 2022, and included studies examining values and preferences of using LMWH among pregnant women at risk of VTE. We followed a convergent integrated mixed-methods design to compare and contrast quantitative outcomes (utility and non-utility measures) and qualitative findings. We assessed the certainty of the values and preferences evidence with the GRADE approach for quantitative findings, and with GRADE-CERqual for qualitative evidence. Results were presented in a conjoint display. Results We screened 3,393 references and identified seven eligible studies. The mixed methods analysis resulted in four themes. Datasets confirmed each other in that: 1) the majority of women consider that benefits of treatment outweigh the inconveniences of daily injections; and 2) main concerns around medication are safety and injections administration. Quantitative outcomes expanded on the qualitative findings in that: 3) participants who perceived a higher risk of VTE were more willing to take LMWH. Finally, we found a discrepancy between the datasets around: 4) the amount of information preferred to make the decision; however, qualitative data expanded to clarify that women prefer making informed decisions and receive support from their clinician in their decision-making process. Conclusions We are moderately confident that in the context of pregnancy, using LMWH is preferred by women given its net beneficial balance. Integrating data from different sources of evidence, and representing them in a jointly manner helps to identify patient’s values and preferences. Our results may inform clinical practice guidelines and support shared decision-making process in the clinical encounter for the management of VTE in the context of pregnancy.

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Section: Discussionmentioning

confidence: 99%

“…Our aim was to conduct a systematic review on values and preferences for LMWH therapy during pregnancy using a mixed-methods integrative design. We conducted this review as part of the DASH-TOP project [ 19 ] that aims to improve the quality of thromboprophylaxis decisions in this population.…”

Section: Introductionmentioning

confidence: 99%

Women’s values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review

León-García

Humphries

Maraboto

et al. 2022

BMC Pregnancy Childbirth

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“…Other studies have developed communication tools [36] and support materials aimed at facilitating the application of SDM by health professionals [37], but they did not assess their effectiveness. Two recent study protocols will assess the effectiveness of risk communication in breast cancer screening (DECIDO study) [38] and the integration of decision analysis in a decision tool for thromboprophylaxis during pregnancy (DASH-TOP) [39].…”

Section: Patient and Public Involvement In Research And Development O...mentioning

confidence: 99%

“…The topics addressed within the European Union are varied, such as the construction of methodological frameworks for implementing an Integrated Multimorbidity Care Model in local health systems (Joint Action CHRODIS-PLUS), the development of massive online open courses (MOOCs) to improve digital health lit-eracy skills of European citizens as an open education initiative for all (IC-Health project), among others. Different publications report the results of these collaborations [27,28,39,51,[63][64][65].…”

Section: Collaborative Projects and International Networkingmentioning

confidence: 99%

Shared decision-making in Spain in 2022: An updated revision of the current situation

Perestelo-Pérez

Rivero-Santana

Álvarez‐Pérez

et al. 2022

Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheit

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“…The international collaborative group, DASH-TOP (12) is developing a SDM intervention to support women and their clinicians in making decisions about the best strategy to prevent recurrent VTE during pregnancy. This SDM intervention contains three components: 1) evidence-based information about the risks and bene ts of taking LMWH to prevent VTE; 2) values elicitation exercises to explore women's preferences for each of the four health states relevant to this decision (i) use of LMWH during pregnancy;…”

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confidence: 99%

Assessment of the DASH-TOP Shared decision-making intervention using the decisional conflict scale: A mixed- method study

León-García

Humphries

Morales³

et al. 2023

Preprint

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Background 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. Methods Design: A convergent, parallel, mixed-methods design. Participants: The sample consisted of 22 health care professionals, students of an Applied Clinical Research in Health Sciences (ICACS) master program. Intervention: 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. Results 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. Conclusions 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.

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Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed methods pilot study protocol

Cited by 7 publications

References 73 publications

Women’s values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review

Women’s values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review

Shared decision-making in Spain in 2022: An updated revision of the current situation

Assessment of the DASH-TOP Shared decision-making intervention using the decisional conflict scale: A mixed- method study

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