RecommendationBefore starting VTE prophylaxis, offer patients and/or their families or carers verbal and written information on:
Relative values of different outcomesReducing the risk of venous thromboembolism and its associated short and long term consequences; and reducing unwanted effects of thromboprophylaxis methods are the most important outcomes. Increased patient awareness, adherence and correct use of prophylaxis methods could lead to a reduction in these VTE outcomes as well as improving the patient’s experience and satisfaction.
Trade off between clinical benefit and harmsThe Guideline Development Group considered that it was important that patients are fully aware of their VTE risks and the methods of reduction available. Opportunities for discussing and addressing any concerns about methods of thromboprophylaxis and associated risks must also be given. An informed patient would be better able to balance the benefits of thromboprophylaxis against the inconvenience or concerns. There is potential for harm if this information is not provided, for example resulting in low concordance with prophylaxis or delaying seeking medical help due to lack of symptom awareness. Improved understanding of how to reduce the risk of VTE also has the potential to reduce anxiety and improve patient participation.
Economic considerationsInformation provision comes with its associated costs, such as time of health care professionals and costs associated with producing materials. However, the potential benefits of improving thromboprophylaxis adherence and reducing subsequent VTE events are likely to be cost-effective.
Quality of evidenceAll studies were quality assessed using quality checklists appropriate to the study design where available. Where appropriate study design checklists were not available, attempts were made to ensure the results of the included studies were as free from bias as possible.
There is not a large body of evidence to support the recommendations.
The setting, population studied and type of intervention used are important factors which could affect the relevance of studies about provision of patient information to the various subpopulations of patients in this guideline.
Only two UK qualitative studies provided some relevant evidence about the potential issues in two intervention methods. Both studies were consistent in pointing out that patients may not be aware of signs and symptoms of VTE. An observational study was conducted in the United States and it is uncertain how applicable this evidence is.
It is particularly difficult to interpret studies on the impact of information provision. Information provision could only be expected to be effective if the information is relevant, acceptable to patients and provided using an effective medium. The study which provided limited information did not show any improvement in adherence. This could be due to limited amount of information provided or ineffective method of delivery.
Other considerationsDespite limited evidence, the Guideline Development Group considered that it was good practice and important to provide patients with information about the risk of VTE and what general methods they can do to reduce it such as early mobilisation, the importance of using prophylaxis correctly and information on the use any prophylaxis that they have been provided with..
Language barriers should not be a reason for non-provision of information. Provision on a national basis of translated documents should be undertaken.

From: 32, Provision of information to patients and planning for discharge

Cover of Venous Thromboembolism
Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital.
NICE Clinical Guidelines, No. 92.
National Clinical Guideline Centre – Acute and Chronic Conditions (UK).
Copyright © 2010, National Clinical Guideline Centre - Acute and Chronic Conditions.

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