"Who am I to say that I'm not going to take it": patient perspectives on decisions about antithrombotic therapy in the context of advanced cancer

Abstract

Introduction: The decision to reconsider antithrombotic therapy (ATT) in cancer patients nearing the end of life is complex given the increasing risk of haemorrhage and thrombosis. A decision support tool (DST) is being developed to facilitate this process. Understanding patients' experiences, values, and perspectives are an essential component, yet remain largely unexplored. Aim: To explore these patients' experiences, values and perspectives regarding ATT use. Methods: Qualitative study using semi-structured interviews with patients with advanced cancer receiving ATT, across Denmark, France, Spain, and the United Kingdom. Data were analysed using Framework Analysis. Results: Sixty patients and 13 relatives participated. Three major themes were generated:such decisions to a clinician, whose role was highly valued. These findings support a need for a DST, to support informed and shared choices in ATT decisions. 1. ATT is important and lifelong: Deprescription was perceived as counterintuitive; continuation was preferred, providing a sense of security. 2. Varying perspectives regarding roles and responsibilities in ATT decision-making: Patients' views regarding their role varied. When a good relationship existed with their clinician, patients trusted them to lead on the decision. Relatives played a key supportive role. 3. Challenges in navigating ATT management in the context of advanced cancer and multiple comorbidities: Decisions relating to ATT were rarely made in isolation. Patients prioritised cancer management and described difficulties navigating multiple health concerns. Conclusion: Patients found decision-making around ATT near the end of life multifaceted, occurring amid a myriad of competing priorities. While patients reported a reticence to discontinuing, ultimately many deferred such decisions to a clinician, whose role was highly valued. These findings support a need for a DST, to support informed and shared choices in ATT decisions.