Patient Values and Preferences in Decision Making for Antithrombotic Therapy: A Systematic Review

MacLean, Samantha; Mulla, Sohail; Akl, Elie A.; Jankowski, Miłosz; Vandvik, Per Olav; Ebrahim, Shanil; McLeod, Shelley; Bhatnagar, Neera; Guyatt, Gordon

doi:10.1378/chest.11-2290

Cited by 223 publications

(167 citation statements)

References 52 publications

(111 reference statements)

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“…An incremental net benefit approach, combined with preference elicitation methods, provides a practical framework for incorporating patient preferences into risk benefit analyses. 16 A systematic review by MacLean et al 36 identified 48 studies of patients' preferences for antithrombotic therapy. Most of these studies, however, used other preference elicitation methods, such as standard gamble, time trade-off, or hypothetical scenarios to derive patients' risk thresholds.…”

Section: Discussionmentioning

confidence: 99%

Patients’ Preferences in Anticoagulant Therapy

Najafzadeh

Gagne

Choudhry

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background-With proliferating treatment options for anticoagulant therapy, physicians and patients must choose among them based on their benefits and risks. Using a Discrete Choice Experiment, we elicited patients' relative preferences for specific benefits and risks of anticoagulant therapy. Methods and Results-We selected a sample of US patients with cardiovascular disease from an online panel and elicited their preferences for benefits and risks of anticoagulant therapy: nonfatal stroke, nonfatal myocardial infarction, cardiovascular death, minor bleeding, major bleeding, bleeding death, and need for monitoring. These attributes were used to design scenarios describing hypothetical treatments that were labeled as new drug, old drug, or no drug. Latent class analysis was used to identify groups of patients with similar preferences. A total of 341 patients completed all Discrete Choice Experiment questions. On average, patients valued a 1% increased risk of a fatal bleeding event the same as a 2% increase in nonfatal myocardial infarction, a 3% increase in nonfatal stroke, a 3% increase in cardiovascular death, a 6% increase in major bleeding, and a 16% increase in minor bleeding. The odds of choosing no drug or old drug versus new drug were 0.72 (95% confidence interval, 0.61-0.84) and 0.86 (95% confidence interval, 0.81-0.93), respectively. Previous stroke or myocardial infarction was associated with membership in the class with larger negative preferences for these outcomes. Key Words: benefit-risk assessment ◼ choice behavior ◼ patient centered outcome research ◼ utility theory

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Section: Discussionmentioning

confidence: 99%

Patients’ Preferences in Anticoagulant Therapy

Najafzadeh

Gagne

Choudhry

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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“…Also, because a recurrence is 3 times as likely to be a PE if the initial event was a PE rather than a DVT, case fatality for recurrent VTE may be substantially higher (perhaps double) when the initial VTE was a PE. 27,28 Nonfatal events are also important: (1) PE, DVT, and bleeding are distressing for patients 29,30 and costly 31 ; (2) recurrent DVT, especially in the same leg, increases risk and severity of the postthrombotic syndrome (PTS) 31,32 ; and (3) recurrent PE may cause chronic cardiopulmonary impairment. 1 Which patients should stop anticoagulants at 3 months and which should remain on anticoagulants indefinitely?…”

Section: Consequences Of a Recurrent Vte Or A Major Bleedmentioning

confidence: 99%

“…Consequently, patient preferences should influence decisionmaking, particularly when there is a weak recommendation for indefinite therapy. 30,67 To solicit preferences, patients first need to be informed of the risks and benefits with different options, areas of uncertainty, and why the decision is sensitive to their preferences and values. 68 Health care providers should be prepared to say which option they think is best, and to explain why.…”

Section: Influence Of Patient Preferences and Costmentioning

confidence: 99%

Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism

Kearon

Akl

2014

Blood

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It takes about 3 months to complete “active treatment” of venous thromboembolism (VTE), with further treatment serving to prevent new episodes of thrombosis (“pure secondary prevention”). Consequently, VTE should generally be treated for either 3 months or indefinitely (exceptions will be described in the text). The decision to stop anticoagulants at 3 months or to treat indefinitely is dominated by the long-term risk of recurrence, and secondarily influenced by the risk of bleeding and by patient preference. VTE provoked by a reversible risk factor, or a first unprovoked isolated distal (calf) deep vein thrombosis (DVT), has a low risk of recurrence and is usually treated for 3 months. VTE associated with active cancer, or a second unprovoked VTE, has a high risk of recurrence and is usually treated indefinitely. The decision to stop anticoagulants at 3 months or to treat indefinitely is more finely balanced after a first unprovoked proximal DVT or pulmonary embolism (PE). Indefinite anticoagulation is often chosen if there is a low risk of bleeding, whereas anticoagulation is usually stopped at 3 months if there is a high risk of bleeding. The decision to continue anticoagulation indefinitely after a first unprovoked proximal DVT or PE is strengthened if the patient is male, the index event was PE rather than DVT, and/or d-dimer testing is positive 1 month after stopping anticoagulant therapy.

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“…20,[37][38][39] The American College of Chest Physicians systematically reviewed literature relating to values and preferences of patients considering antithrombotic therapy. 40 The absence of informative data would highlight an important research need that can be articulated in the CPG. In the absence of informative data, CPG workgroups must make judgments regarding typical values and preferences and the extent of variability in these, to guide their recommendations.…”

Section: Steps 1 and 2: Topic Nomination And Topic Scopingmentioning

confidence: 99%

A Framework for Crafting Clinical Practice Guidelines that are Relevant to the Care and Management of People with Multimorbidity

et al. 2014

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Many patients of all ages have multiple conditions, yet clinicians often lack explicit guidance on how to approach clinical decision-making for such people. Most recommendations from clinical practice guidelines (CPGs) focus on the management of single diseases, and may be harmful or impractical for patients with multimorbidity. A major barrier to the development of guidance for people with multimorbidity stems from the fact that the evidence underlying CPGs derives from studies predominantly focused on the management of a single disease. In this paper, the investigators from the Improving Guidelines for Multimorbid Patients Study Group present consensusbased recommendations for guideline developers to make guidelines more useful for the care of people with multimorbidity. In an iterative process informed by review of key literature and experience, we drafted a list of issues and possible approaches for addressing important coexisting conditions in each step of the guideline development process, with a focus on considering relevant interactions between the conditions, their treatments and their outcomes. The recommended approaches address consideration of coexisting conditions at all major steps in CPG development, from nominating and scoping the topic, commissioning the work group, refining key questions, ranking importance of outcomes, conducting systematic reviews, assessing quality of evidence and applicability, summarizing benefits and harms, to formulating recommendations and grading their strength. The list of issues and recommendations was reviewed and refined iteratively by stakeholders. This framework acknowledges the challenges faced by CPG developers who must make complex judgments in the absence of high-quality or direct evidence. These recommendations require validation through implementation, evaluation and refinement.

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Patient Values and Preferences in Decision Making for Antithrombotic Therapy: A Systematic Review

Cited by 223 publications

References 52 publications

Patients’ Preferences in Anticoagulant Therapy

Patients’ Preferences in Anticoagulant Therapy

Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism

A Framework for Crafting Clinical Practice Guidelines that are Relevant to the Care and Management of People with Multimorbidity

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