Decision-making regarding anticoagulant therapy in the last phase of life: In-depth interview study with healthcare professionals (the OPTIMA trial).
Background: Many patients in the last phase of life use anticoagulants. There is little evidence on the benefits and risks of (dis)continuation of anticoagulant therapy in this phase, leaving healthcare professionals with a complex clinical dilemma. Aim: To gain an in-depth understanding of the expe...
| Publicado en: | Palliative Medicine Vol. 40; no. 1; pp. 105 - 115 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Jan2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=190716697&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 190716697 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02692163 31I jtl: Palliative Medicine issn: 02692163 maglogo: Y pubinfo: dt: Jan2026 vid: 40 iid: 1 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 190716697 189617435 190716697 190716697 10.1177/02692163251394875 190716697 ppf: 105 ppct: 10 formats: tig: atl: Decision-making regarding anticoagulant therapy in the last phase of life: In-depth interview study with healthcare professionals (the OPTIMA trial). aug: au: van Hylckama Vlieg, Marte A. M. de Beukelaar, Karlijn J. I. Spreeuw, Romy H. L. Kruip, Marieke J. H. A. Kuy, P. Hugo M. van der Heide, Agnes van der van der Rijt, Carin C. D. Geijteman, Eric C. T. affil: Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands sug: subj: Anticoagulants Therapeutic Use Decision Making, Clinical Attitude of Health Personnel Work Experiences Terminal Care Human Male Female Adult Middle Age Netherlands Multicenter Studies Qualitative Studies Semi-Structured Interview Uncertainty Purposive Sample Professional Role Job Experience Hospitals Hospices Palliative Care Audiorecording Thematic Analysis Checklists Atrial Fibrillation Thromboembolism Comorbidity Accountability Patient Preference Decision Making, Shared Heparin, Low-Molecular-Weight Vitamin K Antagonists and Inhibitors Physicians, Family Physician Assistants Oncologists Geriatricians Hospice Nurses Nurse Practitioners Cardiologists Neurologists Physicians Funding Source Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background: Many patients in the last phase of life use anticoagulants. There is little evidence on the benefits and risks of (dis)continuation of anticoagulant therapy in this phase, leaving healthcare professionals with a complex clinical dilemma. Aim: To gain an in-depth understanding of the experiences, perspectives, and preferences of healthcare professionals regarding decision-making about anticoagulant therapy in the last phase of life. Design: Semi-structured in-depth interviews were conducted and analyzed using a thematic content analysis. Setting/participants: This study was performed in the Dutch Federation of Anticoagulation Clinics, two hospitals, two hospices, and two palliative home care groups in the Netherlands. Thirty-two healthcare professionals regularly involved in care for patients in the last phase of life were interviewed. Results: Healthcare professionals experienced decision-making regarding anticoagulant therapy in the last phase of life as difficult and multifactorial, due to a lack of knowledge on the incidence of events after (dis)continuing therapy, the uncertain risk trade-off between events with major consequences, the variety of indications for therapy, the variety of comorbidities and patient characteristics, and prognostic uncertainty. As a result, healthcare professionals act defensively when considering discontinuation, due to concerns about being held accountable for potential thrombotic events. Uncertainty in decision-making results in reactive decision-making in response to triggers such as active bleeding, low performance score, recognition of the dying phase, and patient's preference. Conclusions: This study highlighted the complexity of decision-making regarding anticoagulant therapy in the last phase of life. This results, in practice, in reactive instead of proactive decision-making. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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