Patient Decision Aid for Extended Duration Thromboprophylaxis for Major Abdominopelvic Cancer Surgery: A Usability Study

Background: Clinical guidelines recommend patients receive extended duration thromboprophylaxis for 30 days following major abdominopelvic cancer surgery. There is equipoise regarding this recommendation amongst providers and patients. We developed a risk-stratified patient decision aid (PtDA) for patients undergoing major abdominopelvic cancer surgery considering extended duration thromboprophylaxis. We previously demonstrated the PtDA was acceptable to patients and clinicians and enhanced decision-making quality. However, the PtDA made was difficult to use in the perioperative setting. The objective of this study was to evaluate and improve the usability of the PtDA in the perioperative setting.

Methods:

We used an iterative process guided by a user-centered design framework. Consecutive patients undergoing major abdominopelvic cancer surgery from two major cancer centers in Canada, The Ottawa Hospital Cancer Center (TOHCC) and CancerCare Manitoba (CCMB), were recruited. Healthcare professionals involved in discharging patients who completed the PtDA were also recruited. Recruitment rate was defined as the number of total patients approached divided by the total eligible patients who consented to be contacted. Eligible and consented patients were invited to complete the PtDA and the Post Study System Usability Questionnaire (PSSUQ), and to record their decision regarding extended duration thromboprophylaxis. Adherence rate was defined as the number of eligible patients thereafter who actually completed the PSSUQ. Usability was also assessed by healthcare professionals discharging patients using the Consolidated Framework for Implementation Research (CFIR) Barrier Buster Tool.

Results:

Across both sites patients were recruited from November 2023 until May 2024. 108 consecutive patients were approached with study details, 22 refused to be contacted and 7 were ineligible The recruitment rate was 73% (79/108). Of the eligible and consented patients, the adherence rate was 25% (20/79). Overall, 15 patients from TOHCC and 5 from CCMB used the PtDA to help their decision regarding extended duration thromboprophylaxis. Eight (40%) patients were males, and 12 (60%) were females.

Out of the 20 patients who used the PtDA, 18 (90%) completed the PSSUQ and reported their decision regarding extended duration thromboprophylaxis: 13 (65%) patients made a decision using our PtDA compared to 5 (25%) who preferred not to decide. Among the 13 who made a decision, 7 (54%) decided not to take extended duration thromboprophylaxis and 6 (46%) decided to take extended duration thromboprophylaxis.

Regarding usability, the overall median score was 2 (range 2 – 6) on the PSSUQ. The usefulness subdomain median score was 3 (range 2 – 7). The median quality of information subdomain score was 2 (1 – 7). The median quality of design score was 2 (1 – 7).

A total of 15 healthcare professionals were involved in discharging patients who used the PtDA and completed the PSSUQ. All healthcare professionals were resident physicians. Eight (53%) were males and seven (47%) were females. All 15 (100%) completed the follow-up CFIR Tool. From the 12 factors evaluated in the CFIR Tool, healthcare professionals identified a median number of six (range 1-11) facilitators and a median number of one (range 0-8) barrier. The factor most commonly identified as a facilitator was that the use of the PtDA is aligned with the healthcare professional’s value, and the factor most commonly identified as a barrier was the lack of access to data to track the changes in outcomes related to the PtDA.

Conclusion:

The PtDA was found to be usable by patients based on PSSUQ scores. Healthcare professionals reported more facilitators than barriers to using the PtDA in the perioperative setting. However, few patients eligible for the study completed the PtDA in both centers, which may suggest ongoing challenges with implementing PtDAs in the perioperative setting. Additional research is required to assess clinical outcomes associated with its use in routine practice for patients, and address implementation barriers for providers.