Are we comfortable managing oral anticoagulation at the end of life? A national survey of secondary care clinicians in the UK

Abstract

AIMS/BACKGROUND: Prior research has demonstrated variation of opinion among physicians regarding management of oral anticoagulation (OAC) at the end of life (EOL). To investigate current practice and attitudes towards OAC at the EOL among secondary care clinicians in the UK, with particular emphasis on how comfortable clinicians feel in making these decisions. METHODS: A digital, self-report survey was designed, validated by experts in relevant fields and then distributed via email to secondary care clinicians in the UK involved in EOL care, utilising the existing mailing lists of national societies and research groups. RESULTS: 186 responses were received across 10 specialties and 47 NHS trusts. 56% of clinicians routinely seek advice from colleagues regarding these decisions. 53% of respondents reported having worried about the medico-legal implications of discontinuing OAC, 52% of whom reported that these worries influence their decision making. Patient characteristics are more commonly considered than anticipated life expectancy in deciding whether to suspend or continue OAC at the EOL (56.5% versus 43.5%), 83% of respondents would feel more confident in broaching this subject if national guidance existed. CONCLUSIONS: Our findings demonstrate a significant variation in practice, a widely reported discomfort and a strong desire for professional guidance regarding the management of OAC at the EOL, among UK-based secondary care clinicians.