Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Protocol for a European Delphi study

Thrombosis Update, vol. 19, pp. 100209

Abstract

ABSTRACT Introduction To develop a European shared decision support tool (SDST), a Delphi process will be used to reach consensus about aspects relating to the continuation or deprescribing of antithrombotic therapy (ATT) in cancer patients at the end of life. As part of the SERENITY project, this study corresponds to work package (WP) 4. Methods Findings from SERENITY WPs 1-3 (realist review, flash mob research, epidemiological and qualitative studies) informed the Delphi study. The WP4 steering committee had two objectives. (1) to build a representative expert panel comprising physicians, pharmacists, nurses and psychologists from eight European countries; and (2) to advise on the content of the Delphi form, divided into four sections: context, content, SDST design and trial outcomes. The form was reviewed by the SERENITY patient and public involvement group to ensure that it met patients’ needs. The Delphi study will take place in three rounds held at 6-week intervals, involving experts from eight countries. Consensus will be reached on items with at least 70% agreement. The steering committee will review and validate the results across the different rounds. Results Through this Delphi study, the following aspects will be defined: characterisation of candidate patients for discussion about ATT deprescribing; healthcare team roles in ATT decision-making; specific information and communication requirements for patients when making deprescribing decisions; SDST content priorities; and optimal outcomes for the planned clinical trial. Conclusion This study will feed directly into the development and evaluation of the SDST, aimed at reducing complications and improving quality-of-life in end-of-life cancer patients receiving ATT.

Authors 25

1. Imène Deneche

   Assistance Publique – Hôpitaux de Paris · Hôpital Bichat-Claude-Bernard

   Affiliation as printed

   Department of Epidemiology, Biostatistics and Clinical Research, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France

2. Camille Couffignal

   Assistance Publique – Hôpitaux de Paris · Hôpital Bichat-Claude-Bernard

   Affiliation as printed

   Department of Epidemiology, Biostatistics and Clinical Research, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France

3. Anette Arbjerg Højen

   Aalborg University Hospital

   Affiliation as printed

   Danish Center for Health Services Research, Aalborg University Hospital and Aalborg University Aalborg, Denmark

4. Carme Font

   Hospital Clínic de Barcelona

   Affiliation as printed

   Medical Oncology Department. Hospital Clinic de Barcelona, Barcelona, Spain

5. Stavros Konstantinides

   University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

6. Marieke J. H. A. Kruip

   Erasmus MC

   Affiliation as printed

   Department of Hematology Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands

7. Luigi Maiorana

   Società per l’Assistenza al Malato Oncologico Terminale

   Affiliation as printed

   Societa per l’Assistenza al Malato Oncologico Terminale Onlus (S.A.M.O.T.) Ragusa Onlus, Ragusa, Italy

8. Sebastian Szmit
   Affiliation as printed

   Department of Cardio-Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland

9. Denise Abbel Aachen Department of Internal Medicine Section of Gerontology and Geriatrics

   Leiden University Medical Center

   Affiliation as printed

   Department of Internal Medicine, Section of gerontology and geriatrics, Leiden University Medical Center, Leiden, the Netherlands

10. Laurent Bertoletti

    Inserm · Mines Saint-Étienne · Centre Hospitalier Universitaire de Saint-Étienne · Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne · SAnté INgenierie BIOlogie Saint-Etienne · Université Jean Monnet

    Affiliation as printed

    Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, CIC 1408, Saint-Etienne, France

11. Adrian Edwards

    Cardiff University

    Affiliation as printed

    Cardiff University, Department of Primary Care and Public Health, Cardiff, United Kingdom

12. Jacobijn Gussekloo Aachen Department of Medicine — Internal Medicine and Geriatrics

    Leiden University Medical Center

    Affiliation as printed

    Department of Medicine — Internal Medicine and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands

13. Miriam J. Johnson

    University of Hull · Hull York Medical School

    Affiliation as printed

    Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom

14. Rashmi Kumar

    Cardiff University

    Affiliation as printed

    Cardiff University, Department of Primary Care and Public Health, Cardiff, United Kingdom

15. Johan Langendoen
    Affiliation as printed

    TodayTomorrow, Rotterdam, The Netherlands

16. Kate Lifford

    Cardiff University

    Affiliation as printed

    Wales Centre for Primary and Emergency Care Research (PRIME Centre Wales), Division of Population Medicine, Cardiff University, Cardiff, United Kingdom

17. Eric Ligtenberg
18. Simon P. Mooijaart
19. Mark Pearson
20. Johanneke E. A. Portielje
21. Kathy Seddon
22. Stella Trompet
23. Frederikus Albertus Klok
24. Simon I. R. Noble
25. Isabelle Mahé corresponding