Women’s values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review
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Le résumé fourni par la source
BACKGROUND: Venous thromboembolism (VTE) in pregnancy is an important cause of maternal morbidity and mortality. Low-molecular-weight heparin (LMWH) is the cornerstone of prophylaxis and treatment of thrombotic events during pregnancy. LMWH has fewer adverse effects than other anticoagulants, does not cross the placenta, and is safe for the fetus. However, the use of LMWH during pregnancy is sensitive to womens' underlying preferences. The objective of this review is to systematically assess women's values and preferences research evidence on this topic. METHODS: We searched four electronic databases from inception to March 2022, and included studies examining values and preferences of using LMWH among pregnant women at risk of VTE. We followed a convergent integrated mixed-methods design to compare and contrast quantitative outcomes (utility and non-utility measures) and qualitative findings. We assessed the certainty of the values and preferences evidence with the GRADE approach for quantitative findings, and with GRADE-CERqual for qualitative evidence. Results were presented in a conjoint display. RESULTS: We screened 3,393 references and identified seven eligible studies. The mixed methods analysis resulted in four themes. Datasets confirmed each other in that: 1) the majority of women consider that benefits of treatment outweigh the inconveniences of daily injections; and 2) main concerns around medication are safety and injections administration. Quantitative outcomes expanded on the qualitative findings in that: 3) participants who perceived a higher risk of VTE were more willing to take LMWH. Finally, we found a discrepancy between the datasets around: 4) the amount of information preferred to make the decision; however, qualitative data expanded to clarify that women prefer making informed decisions and receive support from their clinician in their decision-making process. CONCLUSIONS: We are moderately confident that in the context of pregnancy, using LMWH is preferred by women given its net beneficial balance. Integrating data from different sources of evidence, and representing them in a jointly manner helps to identify patient's values and preferences. Our results may inform clinical practice guidelines and support shared decision-making process in the clinical encounter for the management of VTE in the context of pregnancy.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Women’s values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review
- Date Crossref
- 05/10/2022
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Universitat Autònoma de Barcelona pays non établi dans la noticeUniversité ou école supérieure
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Hospital de Sant Pau pays non établi dans la noticeÉtablissement de santé
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Biomedical Research Institute pays non établi dans la noticeOrganisation à but non lucratif
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Mayo Clinic in Florida Division of Health Care Delivery Research pays non établi dans la noticeÉtablissement de santé
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Impact pays non établi dans la noticeOrganisation à but non lucratif
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McMaster University Department of Health Research Methods pays non établi dans la noticeUniversité ou école supérieure
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Mayo Clinic pays non établi dans la noticeÉtablissement de santé
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Red de Investigación en Actividades Preventivas y Promoción de la Salud pays non établi dans la noticeStructure de recherche
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Servicio Canario de la Salud pays non établi dans la noticeOrganisme public
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Universidad de Alcalá pays non établi dans la noticeUniversité ou école supérieure
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Instituto Cajal pays non établi dans la noticeStructure de recherche
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University of Cincinnati Division of General Internal Medicine and Center for Clinical Effectiveness pays non établi dans la noticeUniversité ou école supérieure
Universitat Autònoma de Barcelona, Hospital de Sant Pau et Biomedical Research Institute, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.