Women's values and preferences for thromboprophylaxis during pregnancy: a comparison of direct-choice and decision analysis using patient specific utilities.
Women's values and preferences for thromboprophylaxis during pregnancy: a comparison of direct-choice and decision analysis using patient specific utilities.
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DOI：
10.1016/j.thromres.2015.05.020
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发表时间：
2015-08
影响因子：
7.5
通讯作者：
Bates SM
中科院分区：
文献类型：
--
作者：
Eckman MH;Alonso-Coello P;Guyatt GH;Ebrahim S;Tikkinen KA;Lopes LC;Neumann I;McDonald SD;Zhang Y;Zhou Q;Akl EA;Jacobsen AF;Santamaría A;Annichino-Bizzacchi JM;Bitar W;Sandset PM;Bates SM
有静脉血栓栓塞 (VTE) 病史的女性在怀孕期间复发风险增加。低分子量肝素 (LMWH) 可降低这种风险，但成本昂贵、负担重，并且可能增加出血风险。怀孕期间开始血栓预防的决定取决于女性的价值观和偏好。我们的目标是使用整体方法来比较女性的选择，其中向她们提供所有相关信息（直接选择）与个性化决策分析，其中数学模型结合了她们的偏好和 VTE 风险来提出治疗建议。多中心、国际研究。结构化访谈的对象是有 VTE 病史且已怀孕、计划或考虑怀孕的女性。女性根据使用 VTE 复发和出血风险的个性化估计的情况表示愿意接受血栓预防。我们还使用视觉模拟量表获得了女性对健康结果的价值观。我们对每个参与者进行了个性化的决策分析，并将模型建议与直接选择练习时做出的决策进行了比较。在参与研究的 123 名女性中，决策模型建议 51 名女性使用 LMWH，而建议 72 名女性不使用 LMWH。决策模型建议进行血栓预防的女性中有 12% (6/51) 选择不服用 LMWH；在决策模型建议反对血栓预防的女性中，72% (52/72) 选择了 LMWH。我们观察到直接选择练习中的决策与决策模型建议之间存在高度不一致。尽管哪种方法最能体现个人的真实价值观仍不确定，但基于个性化风险和价值观呈现结果的个性化决策支持工具可能会改善决策。
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. 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. 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. 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.