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. 2021 Aug 11;5(5):e12545.
doi: 10.1002/rth2.12545. eCollection 2021 Jul.

A mixed-methods study to evaluate a patient-designed tool to reduce harm from cancer-associated thrombosis: The EMPOWER study

Elin Baddeley  1 , Anna Torrens-Burton  1 , Alisha Newman  1 , Annmarie Nelson  1 , Nikki Pease  2 , Rosie Nelson  3 , Simon Noble  1
Affiliations

A mixed-methods study to evaluate a patient-designed tool to reduce harm from cancer-associated thrombosis: The EMPOWER study

Elin Baddeley et al. Res Pract Thromb Haemost. .

Abstract

Introduction: Venous thromboembolism (VTE) is a common and serious complication of systemic anticancer therapies. Delays in presentation increase risk of death or long-term morbidity.

Background: A patient charity developed an information video for patients receiving systemic anticancer therapy including what to do if they developed symptoms of VTE. This was introduced into clinical practice in a regional cancer center and its impact compared with a district general hospital where the video was not used.

Methods: A mixed-methods approach was used, comprising clinical audit data, patient surveys, and key informant interviews. The time between development of VTE symptoms and seeking medical evaluation was routinely recorded on patients attending a regional cancer-associated thrombosis service with systemic anticancer therapy-provoked VTE. The video was then embedded into clinical practice at the regional cancer center for 3 months. The primary outcome was the difference in time to presentation with VTE symptoms, between patients attending the regional cancer center and the district general hospital (which acted as control). Other outcomes included impact on radiology resources, patient knowledge, and perspectives of chemotherapy nurses.

Results: Addition of the video was associated with a lower mean time to presentation from 8.9 to 2.9 days (0.33 hazard ratio; 95% confidence interval, 4.5-7.4; P < .0001). This may reflect greater awareness of VTE, resulting in earlier clinical presentation when they developed attributable symptoms.

Conclusion: The video was associated with reduced delays in diagnosis of systemic anticancer therapy-associated VTE by 6 days, thereby reducing long-term complications.

Keywords: cancer‐associated thrombosis; mixed methods; patient information; qualitative; venous thromboembolism.

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Figures

FIGURE 1
FIGURE 1
Summary of methods
FIGURE 2
FIGURE 2
Risk factors for VTE. VTE, venous thromboembolism
FIGURE 3
FIGURE 3
Top three side effects patients report they associate with systemic anticancer therapy. N&V, nausea and vomiting
FIGURE 4
FIGURE 4
Severe side effects associated with systemic anticancer therapy reported by patient participants. N&V, nausea and vomiting
FIGURE 5
FIGURE 5
Themes and subthemes from key informant interview
See this image and copyright information in PMC

References

    1. Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer‐associated venous thrombosis. Blood. 2013;122(10):1712‐1723. - PubMed
    1. Noble S, Pease N, Sui J, et al. Impact of a dedicated cancer‐associated thrombosis service on clinical outcomes: a mixed‐methods evaluation of a clinical improvement exercise. BMJ Open. 2016;6(11):e013321. - PMC - PubMed
    1. Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007;5(3):632‐634. - PubMed
    1. Seaman S, Nelson A, Noble S. Cancer‐associated thrombosis, low‐molecular‐weight heparin, and the patient experience: a qualitative study. Patient Prefer Adherence. 2014;8:453‐461. - PMC - PubMed
    1. Noble S, Nelson A, Scott J, et al. Patient experience of living with cancer‐associated thrombosis in Canada (PELICANADA). Res Pract Thromb Haemost. 2019;4(1):154‐160. - PMC - PubMed