Emicizumab and shared medical decision in patients living with hemophilia A.

AIM: Emicizumab is a new prophylactic treatment for patients with severe hemophilia A. This study evaluated patient decisional conflict and physician decisional comfort regarding the switch to emicizumab, identifying the criteria that drive this choice. METHODS: This is an observational, non-interventional, multicenter, retrospective and exploratory study of hemophilia A patients at seven centers in France. The evaluation used the patient's decisional conflict scale and the physician's decisional comfort scale, as well as a questionnaire to determine the criteria for choosing whether to switch to emicizumab. A cluster approach was applied to identify patient subgroups with distinct decisional profiles. RESULTS: A total of 53 patients and their physicians were included in this study: 34 in the emicizumab arm and 19 in the factor VIII arm. Patients in the factor VIII arm reported higher remorse, while physicians in this group felt significantly less comfortable with the decision. While factors influencing the decision were similar between both patients and physicians, illustrating good mutual understanding. Cluster analysis identified a specific subgroup (23%) in the total cohort experiencing high decisional conflict despite their final choice, highlighting a need for targeted clinical support. CONCLUSION: This study highlights the importance of shared decision-making in hemophilia treatment, encouraging open communication between patients and physicians for more personalized care.