Evidence map›Paper›PMID 39243049›Full record

ArticleThrombosis journal2024

Values and preferences towards the use of prophylactic low-molecular-weight heparin during pregnancy: a convergent mixed-methods secondary analysis of data from the decision analysis in shared decision making for thromboprophylaxis during pregnancy (DASH-TOP) study.

Montserrat León-García, Brittany Humphries, Feng Xie, Derek L Gravholt, Elizabeth Golembiewski, Mark H Eckman, Shannon M Bates, Ian Hargraves, Irene Pelayo, Sandra Redondo López and 8 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in Thrombosis journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Montserrat León-GarcíaInstitut of Research Sant Pau (IR Sant Pau), Barcelona, Spain. monselg8@gmail.com.
Brittany HumphriesDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Feng XieDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Derek L GravholtDepartment of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
Elizabeth GolembiewskiDepartment of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
Mark H EckmanDivision of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Shannon M BatesDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Ian HargravesDepartment of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
Irene PelayoDepartment of Obstetrics and Gynecology, Ramón y Cajal Hospital, Madrid, Spain.
Sandra Redondo LópezDepartment of Angiology and Vascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
Juan Antonio Millón CañoHemostasis and Thrombosis Unit. Hospital de La Santa Creui, Sant Pau, Barcelona, Spain.
Milagros A Suito AlcántaraHemostasis and Thrombosis Unit, Hematology Service. Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Rohan D'SouzaDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Nadine ShehataDepartments of Medicine, Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, ON, Canada.
Susan M JackDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Gordon GuyattDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Lilisbeth Perestelo-PerezService for Evaluation and Planning of the Canary Islands Health Service (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.
Pablo Alonso-CoelloInstitut of Research Sant Pau (IR Sant Pau), Barcelona, Spain.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundVenous 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.

methodsDesign: Convergent mixed-methods.

participantsPregnant women or those planning a pregnancy with VTE recurrence risk.

interventionA 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: 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.

resultsWe 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.

conclusionsMixed-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.

Indexed as

Low-molecular-weight heparinPreferencesPregnancyShared decision-makingValuesVenous thromboembolism

Identifiers

PMID39243049
PMCPMC11380320

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.