How do doctors decide whether it is appropriate to investigate and treat
people with VTE and advanced cancer?

Sheard L1, Dowding D2, Noble S3, Prout H3, Maraveyas A4, Watt I1, Johnson MJ4,5.
University of York1, University of Leeds2, University of Cardiff3, University of Hull4, Hull York Medical School5
Background: Long-term low molecular weight heparin Method: Think aloud scenario study with 46 doctors and
(LMWH) is recommended care for good performance
a qualitative in depth interview study conducted with 45 status cancer patients with venous thromboembolism doctors. Participants were oncologists, palliative (VTE). We explored the issues surrounding doctors’ medicine doctors and general practitioners (GPs); senior choice of LMWH or warfarin in the treatment of and training grades in Yorkshire, England and South advanced cancer patients, given a decision to Results: Recurrent CAT and bleeding were seen as significant risks in people with advanced cancer. GPs had less
experience with CAT than either other specialty. All palliative physicians and most oncologists planned to use
LMWH alone. A minority of oncologists would use initial LMWH followed by warfarin.
Easier to control anticoagulation and safer in metastatic disease, especially in the liver secondary care, prescribed in the community) •Good communication needed between secondary care, primary care and hospices with clarity regarding prescribing and monitoring responsibility. Logistical problems were apparent. •Community nurse LMWH administration, if the patient was not able to self-inject, was seen either as a time-consuming burden or a useful daily visit. “So your first question to this patient is, “it’s been shown in multiple studies that patients how much do you want me to do? .” with cancer undergoing treatment either do better or it’s safe to give them LMWH” Oncology consultant, “…I didn’t want this patient to be on defend their decision. It will be a very Conclusions: LMWH is seen as a more effective, safer option than warfarin, but warfarin would still be used by
some doctors, particularly those with less experience of CAT and where there may be budgetary constraints.
Targeted education, clinical protocols for LMWH prescribing and monitoring and better knowledge of patient
outcome preferences (including symptom control and quality of life) would be useful to help guide the doctor in
this complex clinical decision.
Funders: Research for Patient Benefit Programme, National Institute for Health Research. NIHR PB-PG-1207-15033 – “Diagnosis and Management of venous thromboembolism (VTE) in patients with advanced cancer: how do physicians decide?” This presentation presents independent research commissioned by NIHR. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.



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