Vte treatment planning: A mixed-method analysis of clinical challenges, knowledge, and confidence gaps in selecting evidence-based treatment

Document Type

Conference Proceeding

Publication Date

10-1-2021

Publication Title

Research and Practice in Thrombosis and Haemostasis

Abstract

Background : Studies have revealed underutilization of direct oral anticoagulants (DOACs) in the treatment of venous thromboembolism (VTE) despite being addressed in guidelines, including those specific to patients with cancer. Evidence identifies complexity of patient profiles as a potential barrier to the uptake of optimal VTE treatment. Aims : This study aimed to identify barriers, practice gaps, and causalities related to secondary prevention of VTE in patients with a first occurrence, as well prevention, treatment, and management of risks associated with VTE in cancer. Findings on underutilization of DOACs are presented here. Methods : A mixed-methods study (semi-structured interviews and quantitative survey) was conducted with physicians from 5 specialties in U.S. community practice settings. Qualitative data was thematically analyzed and survey data was analyzed using Chi-squares and Kruskal Wallis H tests. Results : A total of 262 healthcare providers (HCPs) participated in the study, 21 completed interviews and 241 completed surveys. Findings showed a conservative approach to treatment (avoiding DOACs), driven by lack of knowledge and perceived uncertainty of optimal management from guidelines among non-VTE specialists. Qualitative data clarified low knowledge and confidence levels, revealing HCPs' underlying doubts regarding: DOACs safety, clarity of antithrombotic guidelines, and applicability to cancer. HCPs lacked confidence using patient profile information to guide treatment decisions. Emergency Department (ED) physicians, community oncologists, and primary care providers lacked knowledge about new treatments compared with professionals specialized in VTE and weighed risks of complication heavily. HCPs' conservative approach regarding DOACs was prevalent when caring for patients with comorbidities or in ED settings. Conclusions : This study demonstrates the need for education supporting HCPs' decision-making using DOACs for treating VTE in cancer patients and in acute settings. While HCPs generally understand the benefits of DOACs, they lack confidence in guidelines and can overweight the risks of complication in more constrained and potentially riskier scenarios.

PubMed ID

Not assigned.

Volume

5

Issue

SUPPL 2

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