Subscribe to RSS
Deciding on Treatment Duration for Unprovoked Venous Thromboembolism: What is Important to Patients?Funding None.
Background After 3 months of anticoagulation for unprovoked venous thromboembolism (VTE), a decision must be made to stop or continue indefinitely by weighing risks of recurrence and bleeding through shared decision-making (SDM). Despite the importance of patient involvement, patients' perspectives on treatment duration are understudied.
Aim To describe the knowledge of VTE and anticoagulation, need for education, perception of risks and benefits of extended treatment, and factors influencing patient's preference to stop or continue treatment after unprovoked VTE.
Methods Semistructured interviews were conducted between May 2019 and August 2020 with adults with unprovoked VTE in one university hospital and one general hospital. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using conventional content analysis.
Results Eighteen patients were interviewed (median age 64, range: 32–83 years). Three major themes were identified: diagnosis and initial treatment, SDM, and perception of treatment. Education, knowledge, coping, and attitude toward health care suffused major themes. The impact of VTE on daily life varied between individuals, as did the preferred extent of SDM. Overall, patients who felt involved and informed were more satisfied with received care, more aware of risks and benefits of treatment, and more likely to be treatment adherent. Generally, patients were more concerned with risk of recurrent VTE than with risk of bleeding during anticoagulation. We identified a multitude of aspects important to patients when deciding to stop or continue anticoagulation.
Conclusion Sufficient information and an individualized extent of SDM are of crucial importance for patients when deciding on treatment duration after unprovoked VTE.
Keywordsdeep venous thrombosis - pulmonary embolism - qualitative research - anticoagulation - shared decision-making
A.v.d.B., M.A.d.W., M.N., and H.A.H.K. designed the study protocol. A.v.d.B. and M.A.d.W. conducted the interviews, analyzed the data, and drafted the manuscript. M.N. and M.t.W. were responsible for patient inclusion. All authors critically revised the manuscript, were responsible for and approved its final version.
* Authors contributed equally.
Received: 13 April 2021
Accepted: 22 June 2021
24 June 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Konstantinides SV, Meyer G, Becattini C. et al. ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
- 2 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
- 3 Ortel TL, Neumann I, Ageno W. et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4 (19) 4693-4738
- 4 Khan F, Rahman A, Carrier M. et al; MARVELOUS Collaborators. Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis. BMJ 2019; 366: l4363
- 5 Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R. Implementing shared decision making in the NHS. BMJ 2010; 341: c5146
- 6 Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns 2014; 94 (03) 291-309
- 7 Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: a systematic review of self-management support strategies in primary health care practice. PLoS One 2019; 14 (08) e0220116
- 8 Stacey D, Légaré F, Lewis K. et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4 (04) CD001431
- 9 Elwyn G, Frosch D, Thomson R. et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012; 27 (10) 1361-1367
- 10 Hunter R, Noble S, Lewis S, Bennett P. Long-term psychosocial impact of venous thromboembolism: a qualitative study in the community. BMJ Open 2019; 9 (02) e024805
- 11 Rolving N, Brocki BC, Andreasen J. Coping with everyday life and physical activity in the aftermath of an acute pulmonary embolism: a qualitative study exploring patients' perceptions and coping strategies. Thromb Res 2019; 182 (March): 185-191
- 12 Noble S, Lewis R, Whithers J, Lewis S, Bennett P. Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study. BMJ Open 2014; 4 (04) e004561
- 13 Etxeandia-Ikobaltzeta I, Zhang Y, Brundisini F. et al. Patient values and preferences regarding VTE disease: a systematic review to inform American Society of Hematology guidelines. Blood Adv 2020; 4 (05) 953-968
- 14 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19 (06) 349-357
- 15 Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA. Subcommittees on Control of Anticoagulation, and Predictive and Diagnostic Variables in Thrombotic Disease. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost 2016; 14 (07) 1480-1483
- 16 Kriston L, Scholl I, Hölzel L, Simon D, Loh A, Härter M. The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns 2010; 80 (01) 94-99
- 17 Kerr C, Nixon A, Wild D. Assessing and demonstrating data saturation in qualitative inquiry supporting patient-reported outcomes research. Expert Rev Pharmacoecon Outcomes Res 2010; 10 (03) 269-281
- 18 Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15 (09) 1277-1288
- 19 Haxaire C, Tromeur C, Couturaud F, Leroyer C. A qualitative study to appraise patients and family members perceptions, knowledge, and attitudes towards venous thromboembolism risk. PLoS One 2015; 10 (11) e0142070
- 20 Stoff BK, Swerlick RA. Reframing risk part II: methods for improving medical risk communication. J Am Acad Dermatol 2013; 69 (04) 637-639
- 21 Spierings J, van Rhijn-Brouwer FCC, de Bresser CJM. et al. Treatment decision-making in diffuse cutaneous systemic sclerosis: a patient's perspective. Rheumatology (Oxford) 2020; 59 (08) 2052-2061
- 22 Kline JA, Kahler ZP, Beam DM. Outpatient treatment of low-risk venous thromboembolism with monotherapy oral anticoagulation: patient quality of life outcomes and clinician acceptance. Patient Prefer Adherence 2016; 10: 561-569
- 23 Lutsey PL, Horvath KJ, Fullam L. et al. Anticoagulant preferences and concerns among venous thromboembolism patients. Thromb Haemost 2018; 118 (03) 553-561
- 24 de Winter MA, Remme GCP, Kaasjager KHAH, Nijkeuter M. Short-term versus extended anticoagulant treatment for unprovoked venous thromboembolism: a survey on guideline adherence and physicians' considerations. Thromb Res 2019; 183: 49-55
- 25 Locadia M, Bossuyt PMM, Stalmeier PFM. et al. Treatment of venous thromboembolism with vitamin K antagonists: patients' health state valuations and treatment preferences. Thromb Haemost 2004; 92 (06) 1336-1341
- 26 Wild D, Murray M, Donatti C. Patient perspectives on taking vitamin K antagonists: a qualitative study in the UK, USA and Spain. Expert Rev Pharmacoecon Outcomes Res 2009; 9 (05) 467-474
- 27 Kasper J, Heesen C, Köpke S, Fulcher G, Geiger F. Patients' and observers' perceptions of involvement differ. Validation study on inter-relating measures for shared decision making. PLoS One 2011; 6 (10) e26255