CHEST Guidelines-Patient-Values-and-Preferences-in-Decision-Making-

Patient-Values-and-Preferences-in-Decision-Making-

Pdf Summary

The 9th edition of the ACCP guidelines provides evidence-based recommendations for antithrombotic therapy and thrombosis prevention, emphasizing the importance of understanding patient values and preferences. The guidelines review how patients weigh benefits, harms, costs, and burdens of different therapies, acknowledging that decisions often involve trade-offs, such as reducing thrombosis risk versus increasing bleeding risk.<br /><br />A systematic review was conducted to inform these guidelines, examining patient preferences for antithrombotic prophylaxis and treatment. The study identified 48 eligible studies focused on various conditions, including atrial fibrillation, venous thromboembolism (VTE), and stroke. The studies used different methods to assess patient preferences, revealing significant variability influenced by prior experiences and the strategies used for preference elicitation.<br /><br />Key findings include:<br />1. Patient preferences are highly variable, with significant differences in how individuals value treatment benefits versus risks.<br />2. Patients generally view stroke as having higher disutility than bleeding but accept some bleeding risk to prevent stroke.<br />3. Methods of eliciting preferences, such as visual analog scales, time trade-off, and standard gamble, influence reported preferences.<br />4. Treatment burden related to antithrombotics, including lifestyle changes, monitoring, and side effects, varies across individuals.<br /><br />The guidelines emphasize the need for systematic reviews of patient values in clinical practice guideline development to ensure treatment recommendations align with patient priorities. Challenges include the variability in patient experiences and values, requiring clinicians to tailor their approach to individual patient circumstances. The findings underscore the importance of involving patients in shared decision-making processes, using decision aids where appropriate, to support informed choices tailored to patient preferences.

Keywords

ACCP guidelines

antithrombotic therapy

thrombosis prevention

patient preferences

systematic review

atrial fibrillation

venous thromboembolism

stroke prevention

shared decision-making

clinical practice guidelines