Expert review of hematology · 2025
Clinical decisions and factors influencing the management of persons with hemophilia requiring antithrombotic therapy: a qualitative study.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Uminski Kelsey, Cowley Lindsay, Wang Tzu-Fei, Tinmouth Alan, Khalife Roy
Аннотация
BACKGROUND: Persons with hemophilia face challenges when requiring antithrombotic therapy due to competing bleeding and thrombosis risks. The absence of robust evidence complicates clinical decision-making, relying on expert opinions and consensus.
RESEARCH DESIGN AND METHODS: To explore the decision-making processes of physicians managing antithrombotic therapy in persons with hemophilia, identify key factors shaping clinical judgment, and develop a decision-making framework to improve patient care and research. We conducted a qualitative study grounded in constructivist methodology, recruiting seven Canadian physicians with expertise in hemophilia and/or thromboembolic disorders. Three virtual focus groups were held and analyzed using reflexive thematic analysis. Themes were developed iteratively to identify key components.
RESULTS: Participants described five themes involving initial and continuous risk assessment of bleeding and thrombosis, selection of safe antithrombotic therapies or alternatives, and development of hemophilia-specific treatment plans. They highlighted the need for periodic reassessment of strategies and emphasized individualized, co-produced care. Each framework element encompassed multiple factors influencing decision-making toward patient-centered care.
CONCLUSIONS: This study provides a decision-making framework to guide antithrombotic therapy in persons with hemophilia. By integrating risk assessments, individualized care, and shared decision-making, the framework addresses this high-risk context. Future research should validate the framework and incorporate patient perspectives to enhance practice.
RESEARCH DESIGN AND METHODS: To explore the decision-making processes of physicians managing antithrombotic therapy in persons with hemophilia, identify key factors shaping clinical judgment, and develop a decision-making framework to improve patient care and research. We conducted a qualitative study grounded in constructivist methodology, recruiting seven Canadian physicians with expertise in hemophilia and/or thromboembolic disorders. Three virtual focus groups were held and analyzed using reflexive thematic analysis. Themes were developed iteratively to identify key components.
RESULTS: Participants described five themes involving initial and continuous risk assessment of bleeding and thrombosis, selection of safe antithrombotic therapies or alternatives, and development of hemophilia-specific treatment plans. They highlighted the need for periodic reassessment of strategies and emphasized individualized, co-produced care. Each framework element encompassed multiple factors influencing decision-making toward patient-centered care.
CONCLUSIONS: This study provides a decision-making framework to guide antithrombotic therapy in persons with hemophilia. By integrating risk assessments, individualized care, and shared decision-making, the framework addresses this high-risk context. Future research should validate the framework and incorporate patient perspectives to enhance practice.