Anticoagulation Therapy on Discharge to Hospice Care

<h3>Project Summary</h3>

The goal of this qualitative study was to better understand antithrombotic decision making on discharge to hospice care. This study was part of a larger mixed-methods study which examined the frequency and indication for antithrombotic prescriptions on discharge to hospice care. We recruited physicians who recently (<1 week) discharged a patient to hospice care between July 2015-March 2016. Potential participating physicians were identified prospectively using discharge disposition data from the Department of Care Management. Within one week of the discharge date, we identified and emailed discharging physicians and invited them to participate in the study. In order to capture variation in the perspectives and opinions regarding prescribing antithrombotic therapy on discharge to hospice, we are purposefully sampled three different physician groups: 1) those that continued antithrombotic therapy, 2) those that discontinued antithrombotic therapy, and 3) those that de-escalated antithrombotic therapy (e.g. warfarin to aspirin) on discharge to hospice care.

<h3>Methods</h3>

Participants were recruited by email and were centered around decision making for a specific patient that they cared for in the previous weeks. Interviews were conducted using a semi-structured interview guide and field notes were taken. We screened 80 discharges to hospice care and identified 27 discharges in which a decision to continue or discontinue antithrombotic therapy was made. We emailed the attending physician on these admissions and invited them to participate in an interview. We interviewed 2 physicians who continued antithrombotic therapy on discharge and 6 physicians who discontinued antithrombotic therapy on discharge.