Venous thromboembolism prevention in ambulatory oncology: A multi-method evaluation of the Vermont Model to inform adaptation to an oncology-delivered model

Abstract

Background: Despite evidence-based guidelines, venous thromboembolism (VTE) prevention in ambulatory cancer remains low. The "Vermont Model" is a multidisciplinary program wherein oncology nurses conduct VTE risk assessment, VTE patient-education to all patients starting anti-cancer therapy and refer high risk patients to thrombosis specialist to discuss thromboprophylaxis. The Vermont Model successfully improved targeted anticoagulation prophylaxis for high-risk patients, but efforts to reproduce the model in community oncology practices were less successful. The objective of this study was to evaluate stakeholder (clinician and patient) perceptions of the Vermont Model to inform adaptation to a fully oncology-delivered approach.

Methods: We conducted a concurrent multi-method study from September 2024-January 2025, including a clinician survey assessing normalizing of the Vermont Model into clinical practice and semi-structured interviews of participating clinicians and patients.

Results: Ten clinicians and four patients completed interviews. Based on 9 clinician surveys, the Vermont Model is normalized into practice. Factors important to its success reflected in both the survey and interviews data included a strong culture valuing VTE prevention and a local champion. Participants supported a fully oncology-delivered model, yet challenges to success include lapses in intervention education/training, communication among health care team, and relative priority with existing workload.

Conclusion: We found high normalization of the Vermont Model among participating clinicians and highlight opportunities to enhance training, education, and interprofessional communication to scale out to a fully oncology-delivered model.

Keywords: Anticoagulants; Neoplasm; Risk assessment; Thrombosis; Venous thromboembolism; Vermont.