León-García Montserrat, Humphries Brittany, Xie Feng, Gravholt Derek L, Golembiewski Elizabeth, Eckman Mark H, Bates Shannon M, Hargraves Ian, Pelayo Irene, López Sandra Redondo, Caño Juan Antonio Millón, Alcántara Milagros A Suito, D'Souza Rohan, Shehata Nadine, Jack Susan M, Guyatt Gordon, Perestelo-Perez Lilisbeth, Alonso-Coello Pablo
Institut of Research Sant Pau (IR Sant Pau), Barcelona, Spain.
Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
Thromb J. 2024 Sep 6;22(1):81. doi: 10.1186/s12959-024-00648-x.
Venous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and mortality, and the use of preventive low-molecular-weight heparin (LMWH) can be challenging. Clinical guidelines recommend eliciting pregnant individuals' preferences towards the use of daily injections of LMWH and discussing the best option through a shared decision-making (SDM) approach. Our aim was to identify individuals' preferences concerning each of the main clinical outcomes, and categorize attributes influencing the use of LMWH during pregnancy.
Design: Convergent mixed-methods.
Pregnant women or those planning a pregnancy with VTE recurrence risk.
A SDM intervention about thromboprophylaxis with LMWH in pregnancy.
Quantitatively, we report preference scores assigned to each of the health states. Qualitatively, we categorized preference attributes using Burke's pentad of motives framework: act (what needs to be done), scene (patient's context), agent (perspectives and influence of people involved in the decision), agency (aspects of the medication), and purpose (patient's goals). We use mixed-method convergent analysis to report findings using side-by-side comparison of concordance/discordance.
We comprehensively determined preferences for using LMWH by pregnant individuals at risk of VTE: through value elicitation exercises we found that the least valued health state was to experience a pulmonary embolism (PE), followed by major obstetrical bleeding (MOB), deep vein thrombosis (DVT), and using daily injections of LMWH (valued as closest to a 'healthy pregnancy'); through interviews we found that: previous experiences, access to care (scene) and shared decision-making (agent) affected preferences. LMWH's benefits were noted, but substantial drawbacks were described (agency). For participants, the main goal of using LMWH was avoiding any risks in pregnancy (purpose). Side-by-side comparisons revealed concordance and discordance between health states and motives.
Mixed-methods provide a nuanced understanding of LMWH preferences, by quantifying health states preferences and exploring attributes qualitatively. Incorporating both methods may improve patient-centered care around preference-sensitive decisions in thromboprophylaxis during pregnancy.
妊娠期静脉血栓栓塞症（VTE）是孕产妇发病和死亡的主要原因，而使用预防性低分子量肝素（LMWH）可能具有挑战性。临床指南建议了解孕妇对每日注射LMWH的偏好，并通过共同决策（SDM）方法讨论最佳选择。我们的目的是确定个体对每个主要临床结局的偏好，并对影响妊娠期LMWH使用的属性进行分类。
设计：混合方法汇聚设计。
有VTE复发风险的孕妇或计划怀孕的女性。
关于妊娠期LMWH血栓预防的SDM干预。
在定量方面，我们报告分配给每个健康状态的偏好分数。在定性方面，我们使用伯克动机五要素框架对偏好属性进行分类：行为（需要做什么）、场景（患者背景）、主体（参与决策的人的观点和影响）、媒介（药物的各个方面）和目的（患者的目标）。我们使用混合方法汇聚分析，通过并列比较一致性/不一致性来报告研究结果。
我们全面确定了有VTE风险的孕妇使用LMWH的偏好：通过价值诱导练习，我们发现最不受重视的健康状态是发生肺栓塞（PE），其次是严重产科出血（MOB）、深静脉血栓形成（DVT）以及每日注射LMWH（被认为最接近“健康妊娠”）；通过访谈我们发现：既往经历、获得医疗服务的机会（场景）和共同决策（主体）影响偏好。LMWH的益处得到了认可，但也描述了其显著的缺点（媒介）。对于参与者来说，使用LMWH的主要目标是避免妊娠期间的任何风险（目的）。并列比较揭示了健康状态和动机之间的一致性和不一致性。
混合方法通过量化健康状态偏好和定性探索属性，对LMWH偏好提供了细致入微的理解。将这两种方法结合起来可能会改善妊娠期血栓预防中围绕偏好敏感决策的以患者为中心的护理。
