Patient inclusion in transfusion medicine: current perspectives

Abstract

Patients may have differing perceptions about blood transfusions based on their backgrounds, values, education levels, or cultural or religious beliefs, which may or may not be accurate. Unfortunately, despite the fact that transfusions are associated with a number of infectious and noninfectious risks, and in spite of the fact that there are ethical, accreditation, and regulatory requirements to provide information regarding transfusion risks, benefits, and alternatives to patients, transfusion consent remains inconsistently obtained. This can partly be attributed to the fact that clinicians may take on a paternalistic approach to transfusion decisions as well as to the fact that many clinicians have knowledge gaps in transfusion medicine that prevent them from obtaining transfusion consent adequately. As a result, unlike the case with other medical and surgical therapies, most patients are not included in the making of informed decisions regarding the need for transfusion versus alternative therapies, leading to many situations in which the transfusions provide little benefit to them. Recently however, a number of organizations, such as the American Association of Blood Banks and The Joint Commission in the US, have promoted multidisciplinary, evidence-based treatment strategies that aim to minimize the need for blood transfusion, the so-called patient blood management (PBM) protocols. PBM strategies are expected to improve blood utilization through optimization of patients who may need blood transfusions via measures such as preoperative anemia management, intraoperative cell salvage, and improved transfusion guidelines. PBM strategies also focus on enhanced requirements for transfusion education and shared decision making, including informed consent and, thus, promote a patient-centered approach as defined by the Institute of Medicine.

Patients' and health care professionals' perceptions of blood transfusion: a systematic review

“…Different health professional groups may perceive transfusion differently from patients and between HCPs, with HCPs' views of transfusion likely to be informed by their knowledge of the relevant clinical evidence and their own clinical experience, as has been demonstrated in respect of other treatments . HCPs' perceptions and knowledge naturally influence clinical decision making, in which patients may be partly involved …”

“…6 HCPs' perceptions and knowledge naturally influence clinical decision making, in which patients may be partly involved. 7 It has been argued that investigating perceptions using recognized theories is important as theory offers a systematic way of understanding events or situations. 8 Blood transfusion is a type of treatment and the investigation of perceptions of transfusion may thus be informed by existing behavioral and psychological theoretical literature of treatment perceptions.…”

Long-term audit of the use of fresh frozen plasma in a university hospital

“…This massive drop in use is most likely due to the increasing awareness about the safety of blood transfusion, particularly the general public's unease and worry about the transmission of HIV by blood transfusion. This HIV “scare” seems to have been widespread among both patients and their treating physicians since the early nineties, which significantly impacted the practice of hemotherapy 23, 24, 25. We have recently reported a similar trend in a long-term survey of the use of packed red blood cells 26 …”

Where now for transfusion: the evolution of a paradigm and its logical progression

“…This paradigm should also feature the inclusion of patients to share the decision‐making process involving transfusion versus alternative approaches, through informed consent of all the issues. Any concerns from the funding authorities regarding the costs of such a program may be alleviated through the demonstration of the decreased transfusion rates achievable with equivalent clinical outcomes…”