Towards optimal use of antithrombotic therapy of people with cancer at the end of life: A research protocol for the development and implementation of the SERENITY shared decision support tool

• Published in: Thrombosis research 2023-08, Vol.228, p.54-60
• Main Authors: Goedegebuur, J., Abbel, D., Accassat, S., Achterberg, W.P., Akbari, A., Arfuch, V.M., Baddeley, E., Bax, J.J., Becker, D., Bergmeijer, B., Bertoletti, L., Blom, J.W., Calvetti, A., Cannegieter, S.C., Castro, L., Chavannes, N.H., Coma-Auli, N., Couffignal, C., Edwards, A., Edwards, M., Enggaard, H., Font, C., Gava, A., Geersing, G.J., Geijteman, E.C.T., Greenley, S., Gregory, C., Gussekloo, J., Hoffmann, I., Højen, A.A., van den Hout, W.B., Huisman, M.V., Jacobsen, S., Jagosh, J., Johnson, M.J., Jørgensen, L., Juffermans, C.C.M., Kempers, E.K., Konstantinides, S., Kroder, A.F., Kruip, M.J.H.A., Lafaie, L., Langendoen, J.W., Larsen, T.B., Lifford, K., van der Linden, Y.M., Mahé, I., Maiorana, L., Maraveyas, A., Martens, E.S.L., Mayeur, D., van Mens, T.E., Mohr, K., Mooijaart, S.P., Murtagh, F.E.M., Nelson, A., Nielsen, P.B., Ording, A.G., Ørskov, M., Pearson, M., Poenou, G., Portielje, J.E.A., Raczkiewicz, D., Rasmussen, K., Trinks-Roerdink, E., Schippers, I., Seddon, K., Sexton, K., Sivell, S., Skjøth, F., Søgaard, M., Szmit, S., Trompet, S., Vassal, P., Visser, C., van Vliet, L.M., Wilson, E., Klok, F.A., Noble, S.I.R.
• Format: Article
• Language: English
• Subjects: Anticoagulants; Death; Deprescriptions; Fibrinolytic Agents - therapeutic use; Hemorrhage; Humans; Neoplasms; Neoplasms - drug therapy; Palliative Care; Quality of Life; Randomized Controlled Trials as Topic; Thrombosis
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2023.05.008

Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe. SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers. •Antithrombotic therapy (ATT) is rarely discontinued in people with advanced cancer.•ATT can cause excess bleeding and an increased disease burden in people with cancer.•Evidence on deprescribing ATT in people with cancer is lacking.•SERENITY uses various research methods to evaluate ATT use in people with cancer.•A shared decision-making tool will be designed to optimise ATT at the end of life.