Extended‐duration thromboprophylaxis for abdominopelvic surgery: Development and evaluation of a risk‐stratified patient decision aid to facilitate shared decision making

Abstract

Background Extended‐duration thromboprophylaxis is used to decrease risk of venous thromboembolism (VTE) after surgery but may increase the risk of bleeding. The decision to complete a course of extended‐duration thromboprophylaxis can be challenging. Objective The objective of this study was to develop an acceptable patient decision aid (PtDA) to facilitate shared decision making for the use of extended‐duration thromboprophylaxis following major abdominal surgery. Methods An evidence‐based, risk‐stratified PtDA was created. The evidence on benefits and harms of a 28‐day postoperative course of low‐molecular‐weight heparin (LMWH) versus in‐hospital prophylaxis only were synthesized. Outcomes included minor bleeding, major bleeding, clinically significant VTE, and fatal VTE. Risks were calculated and reported by Caprini score. Alpha testing of the PtDA draft with various stakeholders was performed using a 10‐question survey to assess acceptability of the PtDA with patients, thrombosis experts, and surgeons. The primary outcome was the acceptability of the PtDA. Results Acceptability testing was performed with 11 patients, 11 thrombosis experts, and 11 surgeons. Most responders felt the language on the PtDA was easy to follow (28/33, 85%), and that the information was well balanced between management options (9/11 [82%] patients; 17/21 [80%] clinicians). Most patients (9/11, 82%) and clinicians (18/22, 82%) believed it would be a useful clinical tool, and were satisfied with the overall quality of the PtDA (27/33, 82%). Conclusions A risk‐stratified, evidence‐based PtDA was created to facilitate shared decision making for the use of extended‐duration LMWH following major abdominal surgery. This clinical tool was acceptable with patients and physicians and is available at https://decisionaid.ohri.ca/decaids.html .

The Development and Testing of a Patient Decision Aid for Individuals with Homologous Recombinant Proficient Ovarian Cancer Who Are Considering Niraparib Maintenance Therapy

“…Guest et al performed a similar analysis and concluded that twelve is a sufficient sample size for interview studies assessed for emergent themes [ 14 ]. Results from our alpha testing were similar to other decision aids developed using the Ottawa template [ 17 , 18 , 19 , 20 ]. Ivankovic et al developed and alpha tested their decision aid on extended thromboprophylaxis following major pelvic surgery in 2022 [ 20 ].…”

“…Results from our alpha testing were similar to other decision aids developed using the Ottawa template [ 17 , 18 , 19 , 20 ]. Ivankovic et al developed and alpha tested their decision aid on extended thromboprophylaxis following major pelvic surgery in 2022 [ 20 ]. Physician feedback was split (50/50) in terms of the length of the decision aid and the amount of information contained.…”