Intervention procedure
bleeding, death, DVT
BLEEDING, DVT
The intervention was delivered as part of the master program’s module on “Values and Preferences” taught by two of the authors (ML-G, PA-C). It was conducted using a real-time video conferencing platform (Zoom) due to the COVID-19 pandemic. All participants were presented with a case study (Fig. Study caseParticipants were randomly divided (sorted alphabetically based on their last name) into three different virtual groups. We followed an incremental design with varying exposure to the different components: group 1 was exposed to the first component of the SDM intervention, group 2 to two components, and group 3 to all three components. Figure Allocation procedureThe virtual room was divided into three rooms to ensure blinding of participants and to avoid interference between groups. Researchers delivered each component independently to each group as follows:
Group 1: This group received only the evidence-based information component of the intervention. Participants were presented with scenarios for four clinical situations (health states): suffering DVT in pregnancy, suffering PE in pregnancy, suffering major obstetric bleeding (MOB), and the inconvenience of using LMWH in pregnancy; all of which had been previously validated [Group 2: This group first received the evidence-based information, followed by two value elicitation exercises: 1) a ranking exercise in which participants were asked to rank the four health states, from most to least preferred; and 2) a visual analogue scale (VAS) in which participants placed each health state along a “feeling thermometer” that represents the importance of suffering each health state for them, on a scale of 0 (death) to 100 (well in pregnancy). The percentage value placed on the feeling thermometer matches the value filled on the table.Group 3: This group received all three components of the intervention: evidence-based information, value elicitation exercises and a decision analysis recommendation. Their value ratings obtained from the VAS exercise were inputted into a decision analytic model. The decision analytic model is a Markov state transition model developed for the DASH-TOP intervention [
Decision analysis recommendationParticipants were asked how long it took them to complete the intervention. After completing the intervention, participants were asked to complete the DCS and then respond to an open-ended questionnaire regarding their perceptions of the different components and the decision-making process from their perspective as health professionals visiting a woman with this clinical situation (Fig. 