Key result
Ambiguous clinical roles and continuation bias hinder end-of-life antithrombotic deprescribing in advanced cancer.
Why the study?
Antithrombotic therapy decision-making near the end of life in advanced cancer involves clinical uncertainty and blurred specialty roles, but clinicians' perspectives remain largely underexplored.
Clinicians face significant challenges and role ambiguity when considering deprescribing antithrombotic therapy in advanced cancer patients at the end of life, leading to a pervasive culture of medication continuation.
Answers are grounded in this paper and cite their sources.
Barriers to deprescribing antithrombotics persist in end-of-life cancer; leaves open whether role clarification or risk tools improve decisions.
Background: Decision making about antithrombotic therapy (ATT) in patients with advanced cancer near the end of life is fraught with clinical uncertainty and can significantly affect care. Despite its importance and complexity, ATT is often deprioritized or guided by legacy prescribing and monitoring patterns. Management spans multiple specialties, with roles and responsibilities frequently blurred. Clinicians' perspectives remain largely underexplored, which are crucial to inform improved care models. Objectives: This study explores clinicians' experiences of current practice of continuing and deprescribing ATT in patients with advanced cancer at the end of life. Methods: Qualitative methodology using semistructured interviews with clinicians involved in ATT management at the end of life, across Denmark, France, Spain, and the United Kingdom. Data were analyzed using Framework Analysis. Results: Eighty clinicians across a range of specialties were interviewed. Two major themes were generated: (1) balancing complexities in ATT management: clinicians reported several challenges, from ambiguity surrounding roles and responsibilities, delicacy around timing, and variance in risk perceptions of ATT, balanced with patient preferences; and (2) culture of continuation: clinicians described a general and ATT-specific culture of continuation and reported a passivity in relation to ATT review. Conclusion: The management of ATT in this context is multifaceted, influenced by many competing factors. These complexities need to be understood and addressed to support decision making related to ATT at the end of life.
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Baddeley et al. (2026) studied Advanced cancer at the end of life (n=80). Antithrombotic therapy management was evaluated on Clinician experiences and qualitative themes surrounding the continuation and deprescribing of antithrombotic therapy. Clinicians reported that decision-making regarding antithrombotic therapy in advanced cancer at the end of life is hindered by ambiguous multidisciplinary roles, competing clinical risks, and an ingrained culture of medication continuation.
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