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

Abstract

ObjectivesTo gain insight into formal methods of integrating patient preferences and clinical evidence to inform treatment decisions, we explored patients’ experience with a personalised decision analysis intervention, for prophylactic low-molecular-weight heparin (LMWH) in the antenatal period.DesignMixed-methods explanatory sequential pilot study.SettingHospitals in Canada (n=1) and Spain (n=4 sites). Due to the COVID-19 pandemic, we conducted part of the study virtually.Participants15 individuals with a prior venous thromboembolism who were pregnant or planning pregnancy and had been referred for counselling regarding LMWH.InterventionA shared decision-making intervention that included three components: (1) direct choice exercise; (2) preference elicitation exercises and (3) personalised decision analysis.Main outcome measuresParticipants completed a self-administered questionnaire to evaluate decision quality (decisional conflict, self-efficacy and satisfaction). Semistructured interviews were then conducted to explore their experience and perceptions of the decision-making process.ResultsParticipants in the study appreciated the opportunity to use an evidence-based decision support tool that considered their personal values and preferences and reported feeling more prepared for their consultation. However, there were mixed reactions to the standard gamble and personalised treatment recommendation. Some participants could not understand how to complete the standard gamble exercises, and others highlighted the need for more informative ways of presenting results of the decision analysis.ConclusionOur results highlight the challenges and opportunities for those who wish to incorporate decision analysis to support shared decision-making for clinical decisions.

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

“…The intervention was tested following a mixed-methods sequential explanatory design, with women in Canada and Spain between 2019-2021 (27). As part of the intervention evaluation study, fteen women provided their preference scores through value elicitation exercises.…”

“…Additionally, we conducted semistructured interviews to assess their decision-making process and asked them to complete three validated questionnaires to evaluate decisional con ict, satisfaction, and self-e cacy related to their decision-making. We published a mixed-method study focused on participant's perspectives of the intervention, encompassing the three intervention components that supported their decision-making process as well as the results from the validated questionnaires (27).…”

“…In this secondary analysis of participant data from the original DASH-TOP study (27), our objectives are:…”

“…To support pregnant individuals in deciding about the use of LMWH for thromboprophylaxis, we developed an informed decision-making intervention(26) and assessed it in the Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP) study (27). The ndings of the DASH-TOP intervention indicate that the use of this SDM approach led to reductions in decisional con ict, increased patient satisfaction, and improved patient self-e cacy in the decision-making process.…”

“…The ndings of the DASH-TOP intervention indicate that the use of this SDM approach led to reductions in decisional con ict, increased patient satisfaction, and improved patient self-e cacy in the decision-making process. (27) In this secondary analysis, we aim to assess the preferences reported by participants of the DASH-TOP study (27) regarding whether to take LMWH during pregnancy. We employed a mixed-methods convergent analysis to (i) quantitatively represent participants' values and preferences concerning each of the health states illustrated in the DASH-TOP intervention and (ii) qualitatively categorize the attributes of patients' preferences towards the utilization of LMWH during pregnancy, which were gathered narratively through interviews during the original study, by applying Burke's pentad of motives theory.…”