| Title: |
Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Results of a European Delphi study |
| Authors: |
Mahé, Isabelle; Haviari, Skerdi; Mohammed, Nassima Si; Højen, Anette Arbjerg; Font, Carme; Konstantinides, Stavros; Kruip, Marieke J.H.A.; Maiorana, Luigi; Szmit, Sebastian; Abbel, Denise; Bertoletti, Laurent; Edwards, Adrian; Edwards, Michelle; Gava, Alessandra; Gussekloo, Jacobijn; Johnson, Miriam J.; Kumar, Rashmi; Langendoen, Johan; Lifford, Kate J.; Mooijaart, Simon; Pearson, Mark; Portielje, Johanneke; Seddon, Kathy; Trompet, Stella; Helfer, Hélène; Klok, Frederikus A.; Noble, Simon; Couffignal, Camille |
| Publisher Information: |
Elsevier |
| Publication Year: |
2026 |
| Collection: |
Cardiff University: ORCA (Online Research @ Cardiff) |
| Description: |
Introduction: To develop a European shared decision-support tool (SDST), a two-round Delphi process was used to achieve consensus on aspects relating to the antithrombotic therapy (ATT) deprescribing discussions and process in end-of-life cancer patients. Methods: Conducted between September 2024 and March 2025, the Delphi survey was developed by a multidisciplinary 24-member steering committee (SC), including medical specialists in oncology, hematology, palliative care, primary care, geriatrics, and vascular medicine. The survey involved 188 experts from these specialties across eight European countries. Consensus was defined with pooled items as ≥70 % agreement with a final decision by the SC. Themes covered deprescribing timing, stakeholders, reassessment and clinical drivers of patients with ATT, SDST, and choice of outcomes for a randomized controlled trial (RCT) to evaluate the SDST. Results: Round 1 reached consensus for seven pooled questions (37 %), especially the reassessment of ATT deprescribing. Considering these results, the SC reformulated round 2 to reduce ambiguity and move toward consensus. The SC made the final decision. Three medical specialties should be involved in ATT deprescribing: palliative care specialists, oncologists, and general practitioners after a triggering circumstance such as clinical triggers or at 3-month prognosis. For the SDST design, the findings confirmed that this tool would be meaningful to clinicians. Eleven predefined outcomes were selected for a future RCT. Conclusion: These results succeeded in shaping the content of the future SDST and mapping its useability in palliative care clinical pathways across Europe, with the perspective to support informed decision-making, reduce complications, and improve quality of life in this population. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
https://orca.cardiff.ac.uk/id/eprint/183601/1/Pj1.Manuscript_R1_20251212-Track.pdf; Mahé, Isabelle, Haviari, Skerdi, Mohammed, Nassima Si, Højen, Anette Arbjerg, Font, Carme, Konstantinides, Stavros, Kruip, Marieke J.H.A., Maiorana, Luigi, Szmit, Sebastian, Abbel, Denise, Bertoletti, Laurent, Edwards, Adrian https://orca.cardiff.ac.uk/view/cardiffauthors/A029488L.html orcid:0000-0002-6228-4446 orcid:0000-0002-6228-4446, Edwards, Michelle https://orca.cardiff.ac.uk/view/cardiffauthors/A2208800U.html orcid:0000-0001-7432-2828 orcid:0000-0001-7432-2828, Gava, Alessandra, Gussekloo, Jacobijn, Johnson, Miriam J., Kumar, Rashmi, Langendoen, Johan, Lifford, Kate J. https://orca.cardiff.ac.uk/view/cardiffauthors/A007942T.html orcid:0000-0002-9782-2080 orcid:0000-0002-9782-2080, Mooijaart, Simon, Pearson, Mark, Portielje, Johanneke, Seddon, Kathy, Trompet, Stella, Helfer, Hélène, Klok, Frederikus A., Noble, Simon https://orca.cardiff.ac.uk/view/cardiffauthors/A1063216.html orcid:0000-0001-5425-2383 orcid:0000-0001-5425-2383 and Couffignal, Camille 2026. Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Results of a European Delphi study. Thrombosis Research: Vascular Obstruction, Hemorrhage and Hemostasis 258 , 109573. 10.1016/j.thromres.2025.109573 https://doi.org/10.1016/j.thromres.2025.109573 file https://orca.cardiff.ac.uk/id/eprint/183601/1/Pj1.Manuscript_R1_20251212-Track.pdf |
| DOI: |
10.1016/j.thromres.2025.109573 |
| Availability: |
https://orca.cardiff.ac.uk/id/eprint/183601/; https://doi.org/10.1016/j.thromres.2025.109573 |
| Rights: |
cc_by_4_0 |
| Accession Number: |
edsbas.E5236621 |
| Database: |
BASE |