Venous Thromboembolism (VTE) Education Preferences Amongst Physicians and Patients: A Qualitative Needs Assessment

Introduction: Venous thromboembolism (VTE) is the leading cause of preventable deaths in hospitalized patients. Prior studies have demonstrated that increasing patient education about VTE increases medication adherence. Thus, standardizing VTE education is an important priority in optimizing patient care. In this regard, online education offers unique advantages as it can be accessed by patients anywhere and anytime. However, an effective VTE educational tool remains elusive as little research has been done to determine what information patients should know or how such information can be delivered most effectively. We performed a qualitative study of hematologists and VTE patients to understand these issues, with the goal of utilizing this information to create an online educational tool for VTE that addresses the needs of both clinicians and patients.

Methods: We conducted semi-structured interviews with physicians in the Section of Hematology at Yale School of Medicine (YSM) and VTE patients in the outpatient Benign Hematology Clinic at Yale Cancer Hospital. Adult patients with a pulmonary embolism or deep venous thrombosis, who were on or off anticoagulation, and who were seen in the outpatient clinic either as new patients or for follow-up visits were all included. Providers were asked about what strategies work best when communicating to patients and important aspects of VTE they felt patients should know. Patients were asked about their understanding of VTE and how an educational tool would best address their concerns. All interviews were audio recorded and transcribed. Data were analyzed with grounded theory, and each transcript was double-coded until thematic saturation was achieved.

Results: Five physicians participated in the study: one with a focus in benign hematology, three with a focus in benign and malignant hematology, and one who had been a private practice hematology/oncology provider and then transitioned into a clinical appointment on the YSM Hematology faculty. Qualitative analysis from the physician interviews revealed important themes. In particular, physicians believed that an online resource for VTE should: 1) provide visual animation to facilitate conceptual understanding; 2) be readily accessible and as concise as possible; and 3) follow a standardized format that addresses classification of VTE (provoked vs. unprovoked), signs and symptoms of VTE, treatment options, and long-term management.

Eight patients were interviewed for the study, 4 with a first episode of VTE and 4 with recurrent VTE. Of these, 7 were on anticoagulation and 1 was not. Most patients indicated that their major source of online health education was through websites - most notably "WebMD." Patients identified websites as helpful in providing background information, but felt that websites were limited in their ability to provide personalized patient-based recommendations. Many also found website text lengthy and felt that concepts could be better conveyed if explained visually in a concise manner.

Conclusion: Based on the physician and patient interviews, an optimal online educational tool about VTE should address the pathophysiology, natural history, management, recurrence risk, and prevention of VTE, in a concise and personalized manner, utilizing visual stimuli. We plan on synthesizing this information to create a 5-10 minute animated video about VTE that addresses all of these issues; we then hope to study the efficacy of the video through a randomized control trial.