Healthcare Providers' knowledge and attitudes toward venous thromboembolism prophylaxis in multiple myeloma: A cross-sectional survey

Abstract

Abstract Background: Venous thromboembolism (VTE) remains a major complication in multiple myeloma (MM), despite the recommended predictive risk stratification scores (RSS), including IMWG (Palumbo et al.), IMPEDE (Sanfilippo et al.), SAVED (Li et al.), and PRISM (Chakraborty et al.). A recent local cohort study (Ghasoub et al.) showed a 9.8% VTE incidence among newly diagnosed MM patients, with wide variation in RSS use and thromboprophylaxis practices. These discrepancies may reflect differences in knowledge and attitude or a lack of standardized protocols. This survey was conducted at the National Center for Cancer Care and Research (NCCCR) in Qatar to assess the knowledge, attitudes, and practices of VTE prophylaxis in MM among healthcare providers to better design future educational interventions. Methods: A descriptive, cross-sectional, anonymous web-based survey (SurveyMonkey®) was conducted among hematologists and pharmacists involved in MM care at NCCCR in Qatar between June and July 2025. The survey was adapted from a validated questionnaire, with additional knowledge items based on updated MM guidelines, and was piloted to ensure clarity and relevance. The final survey included four domains: demographics, VTE knowledge, clinical decision-making scenarios, and attitudes toward prophylaxis through multiple-choice and Likert-scale items. Knowledge scores were classified as good (≥80%), moderate (50–79%), or low (<50%), while an attitude score above 50% was considered positive. A sample size of 45 participants was calculated a priori to achieve a 95% confidence level with a 5% margin of error. Data were analyzed using SPSS v25, with descriptive statistics reported and associations tested by chi-square and t-tests (significance set at p<0.05). Results: Forty-nine healthcare professionals participated in the survey, including physicians (n=18) and pharmacists (n=31). Most respondents were aged 30–39 years (43.8%) and had more than five years of clinical experience (87.8%). The mean knowledge score was 58.7% (SD±14.0), with most participants (67.3%) classified as having moderate knowledge, 28.6% as low, and 4.1% as good. Physicians had a slightly higher mean knowledge score (61.5%) than pharmacists (55.9%), but the difference was not statistically significant (p=0.648). The mean attitude score was 65.7% (SD±18.2), with 79.6% of participants demonstrating a positive attitude and 20.4% showing a negative attitude. A moderate positive correlation was observed between knowledge and attitude scores (r=0.43, p=0.002), indicating that higher knowledge was associated with a more favorable attitude toward VTE prophylaxis. No statistically significant associations were found between knowledge or attitude scores and participants' age (p=0.857 and p=0.730, respectively) or years of clinical experience (p=0.246 and p=0.163, respectively). Almost half of the respondents reported awareness of the VTE risk assessment tools (51%), and 55.1% felt capable of identifying VTE risk factors. Notably, awareness of VTE assessment tools was significantly associated with higher knowledge and positive attitude scores (p=0.003 and p=0.031, respectively). Similarly, those who could identify VTE risk factors had significantly higher knowledge (66.3% vs. 49.3%, p<0.001) and attitude scores (73.5% vs. 56.2%, p=0.001). Among respondents using RSS, 73.1% followed international guidelines (e.g., IMWG, NCCN), 46.2% followed hospital protocols, and 24.5% reported not using any stratification method. The most frequently used scores were IMPEDE-VTE (53.8%) and SAVED (46.2%). Among physicians, aspirin was the most prescribed VTE prophylaxis agent (55.6%), followed by direct oral anticoagulants (27.8%), low-molecular-weight heparin (11%), and warfarin (5.6%). Most respondents estimated the incidence of deep vein thrombosis (43.8%) and pulmonary embolism (37.5%) in MM patients to be 1%–5% and 6%–10%, respectively. Conclusion: This study reveals substantial variability in VTE risk assessment and prophylaxis practices in MM care. Although most participants exhibited moderate knowledge and positive attitudes, notable inconsistencies remain in risk stratification and clinical practice. These findings highlight the need for targeted educational interventions and practice standardization. Qualitative methods, such as focus groups, may also help elucidate underlying barriers to guideline adherence and inform strategies for optimizing thromboprophylaxis in MM care.