Decision analysis is a quantitative approach to decision-making that could bridge the gap between decisions based solely on evidence and the unique values and preferences of individual patients, a feature especially important when existing clinical evidence cannot support clear recommendations and there is a close balance between harms and benefits for the treatment options under consideration. Low molecular weight heparin for the prevention of venous thromboembolism (VTE) during pregnancy represents one such situation. The objective of this thesis is to explore the use of a decision analysis intervention for shared decision-making for thromboprophylaxis during pregnancy.
This thesis begins with a scoping review that explores the ways in which decision analysis has been used to inform shared decision-making encounters, highlighting key challenges for implementing and evaluating this type of intervention. This is followed by a protocol that presents the methodology of an explanatory sequential mixed methods pilot study for the Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP) tool. This tool was pilot tested through interviews of eligible women in Canada and Spain who were facing the treatment decision for the prevention of VTE in the antenatal period. While the tool was well received by patients, more effective ways of obtaining patient preferences and presenting the decision analysis results are required to enhance shared decision-making interactions. Finally, this thesis concludes with a reflection on the lessons learned from developing and evaluating a decision analysis intervention for shared decision-making.
The insights from this research have informed the development of an integrated online shared decision-making tool for VTE in the antenatal period, which the DASH-TOP team plans to evaluate in a randomized controlled trial. It is hoped that this information will also provide guidance to researchers interested in developing or evaluating decision analysis interventions for other clinical decisions. / Dissertation / Doctor of Philosophy (PhD)
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/26946 |
| Date | January 2021 |
| Creators | Humphries, Brittany |
| Contributors | Xie, Feng, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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