• Laura Sheard, Hayley Prout, Dawn Dowding, Simon Noble, Ian Watt, Anthony Maraveyas, and Miriam Johnson.
• Department of Health Sciences, University of York, York, UK. laura.sheard@york.ac.uk
• Palliat Med. 2013 Apr 1;27(4):339-48.

BackgroundVenous thromboembolism is common in patients with cancer and the risk increases with advanced disease. Evidence-based treatment is administration of low-molecular-weight heparin daily by subcutaneous injection. Clinical uncertainty exists as to whether treating venous thromboembolism in advanced disease is in the patient's best interests.AimTo explore the barriers faced by doctors when diagnosing and treating patients with cancer-associated thrombosis.DesignQualitative, in-depth interview study using framework analysis.ParticipantsForty-five UK doctors across urban and rural settings, from three specialties, oncology, palliative medicine and general practice, with a mixture of senior and junior staff.ResultsOrganisational constraints served to act as barriers to the diagnosis and treatment of this patient group. Issues were identified around access to diagnostic testing. A cancer-associated thrombosis patient having to wait for a scan as an inpatient was sometimes deemed unnecessary. Patient ambulance transport (especially transportation of hospice patients) was often viewed as inflexible and bureaucratic. Low-molecular-weight heparin prescribing had sometimes led to tension between the acute, community and hospice sectors about whose prescribing responsibility this was, with different areas having divergent 'rules' and practices. Finally, the doctors interviewed discussed the role of nurses.ConclusionsMultiple logistical barriers are hindering best patient care for people with cancer-associated thrombosis. There is scope for some of these barriers to be reduced to improve service delivery and ultimately patient care. The research team proposes practical recommendations, which could yield direct benefit for patients and the health services.

24 keywords...

hide…