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Supportive Care in Cancer

, Volume 17, Issue 5, pp 527–537 | Cite as

Catastrophic bleeds during end-of-life care in haematology: controversies from Australian research

  • Pam McGrath
  • Michael Leahy
Original Article

Abstract

Goals of work

This article seeks to address the lack of information in the literature, by providing preliminary findings on the experience of managing catastrophic bleeds for haematology patients, from the perspective of health professionals involved in the care of such patients and their families.

Materials and methods

Insights from qualitative interviews with seventeen (n = 17) haematological nurses, four (n = 4) palliative care nurses and fifteen (n = 15) haematologists, conducted as part of a 2-year major national study on haematology and palliative care funded by the National Health and Medical Research Council, Australia. The interviews were audio-recorded and transcribed verbatim. The language texts were coded and analysed thematically.

Main results

The findings indicate that there is considerable controversy about the provision of clinical and supportive care to haematology patients who are vulnerable to catastrophic bleeds, including such issues as whether it is possible to identify individuals likely to be affected, the role of blood products, and whether it is wise to warn family or carers. The insights from the health professionals also highlight a number of practical suggestions including: the use of dark towels to reduce the distress of the visibility of the bleed; the importance of advance planning for care; accepting the limits of the situation; reassuring family that the patient is likely to lapse into lack of consciousness and will not be suffering, and the administration of sedation.

Conclusions

The important recommendation from this research is the resounding need for further work on this topic in order to provide clear guideline for best practice in clinical and supportive care.

Keywords

Catastrophic bleeds Haematology Supportive care Qualitative research Palliative care 

References

  1. 1.
    Aderka D, Praff G, Santo M (1986) Bleeding due to thrombocytopenia in acute leukemias and reevaluation of the prophylactic platelet transfusion policy. Am J Med Sci 291:147–151 doi: 10.1097/00000441-198603000-00001 PubMedCrossRefGoogle Scholar
  2. 2.
    Crombie I (1996) Research in health care. Wiley, New YorkGoogle Scholar
  3. 3.
    Gagnon B, Mancini I, Pereira J, Bruera E (1998) Palliative management of bleeding events in advanced cancer patients. J Palliat Care 14:50–54PubMedGoogle Scholar
  4. 4.
    Gaskill D, Henderson A, Fraser M (1997) Exploring the everyday world of the patient in isolation. ONF 24(4):695–700Google Scholar
  5. 5.
    Greenhalgh T, Taylor R (1997) Papers that go beyond numbers. BMJ 315:740–743PubMedGoogle Scholar
  6. 6.
    Krathwohl D (1993) Methods of educational and social science research: an integrated approach. Longman, New YorkGoogle Scholar
  7. 7.
    Lassauniere J, Bertolino M, Hunault M, Zittoun R, Berspieren P, Moh-Klaren J et al (1996) Platelet transfusion in advanced hematological malignancies: A position paper. J Palliat Care 12:38–41PubMedGoogle Scholar
  8. 8.
    McGrath P (2007) Care of the haematology patient and their family—the GP viewpoint. Aust Fam Physician 36(9):799–781 SeptemberGoogle Scholar
  9. 9.
    McGrath P, Holewa H (2006) Missed opportunities: nursing insights on end-of-life care for haematology patients. Int J Nurs Pract 12(5):295–301 doi: 10.1111/j.1440-172X.2006.00585.x PubMedCrossRefGoogle Scholar
  10. 10.
    McGrath P, Holewa H (2006) Haematology and palliative care: towards an integrated practice. NHMRC funded booklet, CQU, RockhamptonGoogle Scholar
  11. 11.
    McGrath P, Holewa H (2007) Special considerations for haematology patients in relation to end-of-life care: Australian findings. Eur J Can Care 16(2):164–171 doi: 10.1111/j.1365-2354.2006.00745.x CrossRefGoogle Scholar
  12. 12.
    McGrath P, Holewa H (2007) A model for end-of-life care in haematology: an Australian nursing perspective. ONF 34(1):79–85 doi: 10.1188/07.ONF.79-85 CrossRefGoogle Scholar
  13. 13.
    McGrath P, Joske D (2002) Palliative care and haematological malignancy: a case study. Aust Health Rev 25(31):60–66PubMedCrossRefGoogle Scholar
  14. 14.
    Pereira J, Phan T (2004) Management of bleeding in patients with advanced cancer. Oncologist 9:561–570PubMedCrossRefGoogle Scholar
  15. 15.
    Pihusch M (2004) Bleeding complications after hematopoietic stem cell transplantation. Semin Hematol 41(1):93–100 doi: 10.1053/j.seminhematol.2003.11.018 PubMedCrossRefGoogle Scholar
  16. 16.
    Polit D, Hungler B (1995) Nursing research: principles and methods, 5th edn.Lippincott, PhiladelphiaGoogle Scholar
  17. 17.
    Prommer E (2005) Management of bleeding in the terminally ill patient. Hematology 10(3):167–175 doi: 10.1080/10245330500093237 PubMedCrossRefGoogle Scholar
  18. 18.
    Sorrell J, Redmond G (1995) Interviews in qualitative nursing research: differing approaches for ethnographic and phenomenological studies. JOAN 21:1117–1122Google Scholar
  19. 19.
    Spiegelberg H (1975) Doing phenomenology. Nijhoff, The HagueGoogle Scholar
  20. 20.
    Stalfelt AM, Brodin H, Pattersson S, Eklof A (2003) The final phase in acute myeloid leukaemia (AML). A study on bleeding, infection and pain. Leuk Res 27:481–488 doi: 10.1016/S0145-2126(02)00262-X PubMedCrossRefGoogle Scholar
  21. 21.
    Streubert J, Carpenter D (1995) Qualitative research in nursing: advancing the humanistic imperative. J. B Lippincott Company, New YorkGoogle Scholar
  22. 22.
    Therapeutic Guidelines Limited (TGL) (2008) Therapeutic Guidelines. Guidelines International Network, North Melbourne, Victoria, (http://www.tg.com.au) accessed 24th March, 2008)
  23. 23.
    Van Manen M (1990) Researching lived experience. State University of New York Press, OntarioGoogle Scholar
  24. 24.
    Young NS, Gerson SL, High KA (2006) Clinical hematology. Elsevier, New York, 393. 25Google Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.International Program of Psycho-Social Health Research (IPP-SHR)CQUniversityKenmoreAustralia
  2. 2.School of Medicine and PharmacyUniversity of Western AustraliaFremantleAustralia
  3. 3.Department of HaematologyFremantle HospitalFremantleAustralia

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