Towards Cancer Patient Empowerment for Optimal Use of Antithrombotic Therapy at the End of Life

尽管抗血栓治疗（ATT）在癌症患者生命的最后一年对他们的健康几乎没有甚至是负面影响，但在临床实践中停止ATT是罕见的。相反，ATT通常持续至死亡，导致出血过多，医疗费用增加和疾病负担增加。SERENITY将开发一个信息驱动的姑息治疗共享决策过程，该过程由用户友好、易于访问、基于网络的共享决策支持工具（SDST）实现，该工具将促进癌症患者在生命末期适当使用ATT的治疗决策。SERENITY将采用一种综合的方法，包括现实主义的审查，快闪研究，在荷兰，英国和丹麦的三项流行病学研究，以及定性访谈。这些研究的结果将用于德尔菲过程，以就干预措施的最佳设计达成共识。利用德尔菲过程中达成的共识，SDST将设计为患者特异性，并适应性别、癌症相关、文化和社会经济因素。接下来，SDST将在随机临床试验中进行测试和优化。将制定有针对性的实施和开发计划，以便在整个欧洲使用SERENITY方法，并将其纳入国家和泛欧临床指南和政策。该干预措施最终将导致ATT的适当使用，预防出血并发症，并节省大量费用，此外还将提高患者、其护理人员和相关医疗保健专业人员的生活质量和治疗满意度。干预将赋予癌症患者及其护理人员权力，使他们能够做出自己的选择。该干预措施将减少欧盟所有地区每年接受姑息治疗的数十万癌症患者的疾病负担。

Despite the fact that antithrombotic therapy (ATT) has little or even negative effects on the well-being of cancer patients during their last year of life, stopping ATT is rare in clinical practice. In contrast, ATT is often continued until death, resulting in excess bleeding, higher healthcare costs, and increased disease burden. SERENITY will develop an information-driven, palliative care shared decisionmaking process enabled by a user-friendly, easily accessible, web-based shared decision support tool (SDST) that will facilitate treatment decisionsregarding appropriate use of ATT in cancer patients at the end of life. SERENITY will use a comprehensive approach consisting of a combination of realist review, flash mob research, three epidemiologic studies in NL, UK, and DK, and qualitative interviews. The results of these studies will be used in a Delphi process to reach consensus on the optimal design of the intervention. Using the consensus reached in the Delphi process, the SDST will be designed to be patient-specific with adaption to gender, cancer-related, cultural, and socioeconomic factors. Proceeding, the SDST will be tested and optimised in a Randomised Clinical Trial. A targeted implementation and exploitation plan will be developed to enable the use of the SERENITY approach across Europe, as well as incorporation in national and pan-European clinical guidelines and policies. The intervention will ultimately lead to appropriate use of ATT, prevention of bleeding complications, and considerable cost savings in addition to improved quality of life and treatment satisfaction of patients, their carers, and involved healthcare professionals. The intervention will empower cancer patients and their carers, enabling them to make their own choices. The intervention will reduce the disease burden of hundreds of thousands of people living with cancer receiving palliative care each year, throughout all EU regions.