Affiliation:
1. Institut de recerca Sant Pau (IR Sant Pau)
2. McMaster University
3. Mayo Clinic
4. University of Cincinnati College of Medicine
5. Ramón y Cajal Hospital
6. Hospital de la Santa Creu i Sant Pau. Barcelona
7. Hospital Universitario Vall d'Hebron
8. Mount Sinai Hospital
9. Canary Islands Health Service (SCS)
Abstract
Abstract
Background:
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.
Methods:
Design: Convergent mixed-methods.
Participants: Pregnant women or those planning a pregnancy with VTE recurrence risk.
Intervention: A SDM intervention about thromboprophylaxis with LMWH in pregnancy.
Analysis: Quantitatively, we report preference scores assigned to each of the health states. Qualitatively, we categorized preference attributes using Burke’s pentad of motives framework: scene, agent, agency, act, and purpose. We use mixed-method convergent analysis to report findings using side-by-side comparison of concordance/discordance.
Results:
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’). Women's previous experiences, access to care (scene) and shared decision-making (agent) affected preferences. LMWH's benefits were noted, but substantial drawbacks described (agency). The main goal was avoiding the risk of VTE (purpose). Side-by-side comparisons revealed concordance between motives and DVT and PE health states. Discordance appeared between using daily injections of LMWH and agent- and agency motives and between MOB and the agency motive.
Conclusions:
Mixed-methods provide a nuanced understanding of women's 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.
Publisher
Research Square Platform LLC
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