TOWARDS CANCER PATIENT EMPOWERMENT FOR OPTIMAL USE OF ANTITHROMBOTIC THERAPY AT THE END OF LIFE

Advance care planning for patients with terminal and life limiting illness has become the standard of care across many European countries. One component of this multi-professional process includes rationalization of pharmacotherapy, including the deprescribing of medicines that are no longer necessary and/or potentially harmful.
In patients receiving end-of-life care, deprescribing is an important practice to avoid greater polypharmacy and its consequences.
The decision whether to continue antithrombotic therapies such as anticoagulants and antiplatelet medicines in cancer patients at the end of life, is particularly complex and unclear due to lack of evidence.
In cancer patients in the last phase of life, clinically apparent cardiovascular complications as well as relevant bleeding complications are both reported to occur in 10% of patients, with about one fifth of bleedings contributing to death, while the impact of cardiovascular complications is less with no association with increased mortality.

SERENITY aims to develop and evaluate a shared decision tool to support patients, their companions and healthcare professionals make evidence based and informed decisions regarding antithrombotic medicines near the end of life.
This will be achieved through a series of work packages including:

• a realist literature review
• a flash mob audit of current practice
• epidemiological database analysis of current practice in 3 countries
• qualitative interviews with patients, their companions, and clinical stakeholders
• a Delphi exercise top inform the content and design of the App
• development of a shared decision-making tool to be used as an App
• evaluation of the tool against standard practice