Table 2 Conjoint display
Mixed-methods themes [ref] | Quantitative outcomes | Qualitative findings | Mixed-methods findings (Confirmation, Expansion, Discordance) | Certainty of the evidence | ||
|---|---|---|---|---|---|---|
Pregnancy with LMWH prophylaxis [Bates 2016 [41], Eckman2015 [47]; Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] | Utility Value: Mean VAS scale (0–100) [ref] | Certainty of evidence | Theme(s) [ref], representative quote | Certainty of evidence | ||
| Attitude towards the decision -making of using LMWH [Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] LMWH injections with “minimal side effects, and that, compared to the emotional pain with loss, a little bit of physical pain from a needle is small potatoes] |
| Confirmation Both datasets confirm the relief of having LMWH as an option far outweighed any temporary discomfort caused by the injections, and reduced anxiety towards the disease |
Moderate | ||
Experience of using LMWH during pregnancy [Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] Although it wasn’t fun injecting myself it was part of the ritual. …It felt like I was doing something instead of just waiting there to see if I would miscarry. …It felt like I at least had a very, very, very small hand in helping] |
Moderate | |||||
Willingness to take heparin [Bates 2016 [41], Eckman 2015 [47]; Hordern 2015 [42]; Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] | Non-utility: Proportion (%) of women willing to take heparin (instrument [ref]) | Certainty of evidence | Theme(s) [ref], representative quote | CERQUAL assessment | ||
-78.86 (direct choice) [Bates 2016 [41], Eckman2015 [47]] -94.5 (RSQb) [Hordern 2015 [42]] |
| Attitude towards the decision -making of using LMWH [Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] When you want to have a baby … nothing will stop you Definitely gives me piece of mind during pregnancy; without it I would feel very nervous about developing another DVT |
Moderate | Expansion Women accepted uncertainty regarding the pregnancy outcome and were willing to take heparin as it was felt they were taking- action on the management of their condition. Most of the women from the qualitative data were using LMWH to prevent pregnancy loss, hence higher risk perception than when used to prevent DVT (as shown by the non-utility values; women at lower risk were less willing to take the medication). Risk perception is correlated with willing to take LMWH |
Moderate | |
Non-utility: Median (%) of risk reduction of LMWH to be willing to take (instrument [ref]) | ||||||
3 (probability trade-off) |
| |||||
Beliefs towards medication [Guimicheva 2019 [40]; Patel 2012 [44]; Hordern 2015 [42]; Anderson 1993 [43]; Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] | Non-utility: Mean (± a) Necessity- concerns differential (instrument [ref]) | Certainty of the evidence | Theme(s) [ref], representative quote | CERQUAL assessment |
Moderate | |
+ (BMQ- Scale) |
| Concerns about medication [Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] I wanted a baby so bad, I was like I don’t care, I’ll do it… the chance of it harming me… |
| Confirmation Patients focused on safety issues. Women place a higher priority on the impact LMWH has on the unborn baby compared with any impact the medicine may have on them | ||
Non-utility Values: Reasons for not being adherent when using LMWH (% of women) (instrument [ref]) | Certainty of the evidence | Theme(s) [ref], representative quote | CERQUAL assessment | |||
-Bruising (25 (RSQb) [Hordern 2015 [42]] -Forgetting (16.6(RSQb [Hordern 2015 [42]] -Fear or dislike of needles (16.6(RSQb) [Hordern 2015 [42]] |
Very Low | Concerns about medication [Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] So, then you’ re worried because labor it isn’ t always planned, right, and what if … I mean what if I went into labor at 33 [weeks] and I took [LMWH] yesterday or I took it today and I would worry that I would go into labor; what would ultimately happen, being on the medication and going into labor |
Moderate | Expansion Other concerns provided by the qualitative data were regarding withholding injections before delivery and a scheduled labor |
Moderate | |
Non-utility Values: Preference for route of administration (Instrument, % of women) ([ref]) | Certainty of the evidence | Theme(s) [ref], representative quote | CERQUAL assessment | |||
Teflon catheter (RSQb) = 83.3 [Anderson 1993] [43] |
| Experience of using LMWH during pregnancy [Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] If there was a way to get injections for enoxaparin via an epipen type device it would be much more tolerable |
Moderate | Confirmation Women from both datasets agreed that they preferred devices that would facilitate administration of injections |
Moderate | |
Preferred amount of information regarding LMWH [Hordern 2015 [42]; Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] | Non-utility Values: Adequate information regarding LMWH (Instrument, % of women) ([ref]) | Certainty of the evidence | Theme(s) [ref], representative quote | CERQUAL assessment | ||
Whether woman had received enough information regarding LMWH (RSQb) = 83.8 [Hordern 2015 [42]] |
Very Low | Information needs to inform the decision [Martens 2007 [45]; Patel 2012 [44]] I have no issues injecting if it is safeguarding mine and the baby’s health but I lack some faith in the safety/side-effects/ general effects of the medicine. Published information on Clexane seems to be contradictory |
Low | Discordance While quantitative data showed that patients felt well-informed about their decision; in qualitative data the majority of women felt they had not received enough information to address their concerns. Women expressed feeling confused about how VTE could affect their baby, how it could compromise their own health and why it was particularly relevant during pregnancy |
Low | |
Patient involvement in the decision-making [Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44] ] I do not have a problem doing injections and was aware of the possibility of the injections before becoming pregnant. However, I think other women might benefit from more time and support around the use of Clexane in their pregnancy | ||||||
Patient involvement in the decision-making [Skeith 2021 [46]; Martens 2007 [45]; Patel 2012 [44]] I felt pretty involved. I didn’t feel like pressured into taking [LMWH] if I did get pregnant. It was really up to me to say I want to take the injections or not… I felt involved in the decision |
Moderate | Expansion Qualitative data informed that women felt involved in the decision-making; healthcare professionals are an important role in support the decision-making process |
Moderate | |||
Would have liked more information or training before leaving hospital (RSQb) = 16.6 [Hordern 2015 [42]] |
Very Low | Information needs to inform the decision [Martens 2007 [45]; Patel 2012 [44]] No, I don’t remember being given any information and you are insecure about the whole subject, so you are not prepared to ask questions because you don’t know what to ask |
Low | Discordance Datasets are in discordance in whether it was an informed decision-making process. Injection administration technique was an important need of information |
Low | |
Very Low
Moderate
Very Low
Very Low
Very Low
Very Low
Moderate
Very Low
