Women's values and preferences for thromboprophylaxis during pregnancy: a comparison of direct-choice and decision analysis using patient specific utilities

Thromb Res. 2015 Aug;136(2):341-7. doi: 10.1016/j.thromres.2015.05.020. Epub 2015 May 22.

Abstract

Background: Women with a history of venous thromboembolism (VTE) have an increased recurrence risk during pregnancy. Low molecular weight heparin (LMWH) reduces this risk, but is costly, burdensome, and may increase risk of bleeding. The decision to start thromboprophylaxis during pregnancy is sensitive to women's values and preferences. Our objective was to compare women's choices using a holistic approach in which they were presented all of the relevant information (direct-choice) versus a personalized decision analysis in which a mathematical model incorporated their preferences and VTE risk to make a treatment recommendation.

Methods: Multicenter, international study. Structured interviews were on women with a history of VTE who were pregnant, planning, or considering pregnancy. Women indicated their willingness to receive thromboprophylaxis based on scenarios using personalized estimates of VTE recurrence and bleeding risks. We also obtained women's values for health outcomes using a visual analog scale. We performed individualized decision analyses for each participant and compared model recommendations to decisions made when presented with the direct-choice exercise.

Results: Of the 123 women in the study, the decision model recommended LMWH for 51 women and recommended against LMWH for 72 women. 12% (6/51) of women for whom the decision model recommended thromboprophylaxis chose not to take LMWH; 72% (52/72) of women for whom the decision model recommended against thromboprophylaxis chose LMWH.

Conclusions: We observed a high degree of discordance between decisions in the direct-choice exercise and decision model recommendations. Although which approach best captures individuals' true values remains uncertain, personalized decision support tools presenting results based on personalized risks and values may improve decision making.

Keywords: Decision making; Decision support techniques; Heparin; Pregnancy; Venous thromboembolism.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Decision Support Systems, Clinical / statistics & numerical data*
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Internationality
  • Middle Aged
  • Patient Participation / psychology
  • Patient Participation / statistics & numerical data*
  • Patient Preference / psychology
  • Patient Preference / statistics & numerical data*
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / epidemiology
  • Pregnancy Complications, Cardiovascular / prevention & control*
  • Pregnancy Complications, Cardiovascular / psychology
  • Prevalence
  • Quality of Life / psychology
  • Social Values
  • Utilization Review
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / prevention & control*
  • Venous Thromboembolism / psychology
  • Young Adult

Substances

  • Fibrinolytic Agents