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Supportive Care in Cancer

, Volume 19, Issue 2, pp 203–210 | Cite as

An exploration of the influences on clinical decision making and the culture of blood transfusion practise in cancer-related anaemia using an ethnographic methodology

  • Liz Bishop
  • Sara Faithfull
  • Helen Allan
Original Article

Abstract

Purpose

This study seeks to explore the cultural practises, which shape the culture of transfusion, and to identify the key elements, which influence clinical decision making in blood transfusion in haemato-oncology and lung cancer patients.

Methods

The assessment and decision making processes for blood transfusion were explored using fieldwork observation, six patient and nine clinician interviews based on ethnographic methodology. Data were analysed using thematic analysis.

Results

First, the findings suggested that despite anaemia and transfusion being ubiquitous in this cancer setting, it sits low in the hierarchy of clinical concerns (The unimportance of anaemia). Second, there is a great deal of uncertainty surrounding the diagnosis and management of this clinical problem; but this uncertainty was acknowledged by both patients and clinicians (Acknowledging uncertainty). Third, clinicians and to some extent patients, are socialised into the practise of the sub-discipline (Socialisation in practise). Fourth, the haemoglobin level was used as a distinct fragment of information on which to assess for the presence of anaemia and base the decision to treat with blood transfusion (Disaggregation of the body).

Conclusion

The management of anaemia is not a priority in this setting; however, by understanding the complexity of factors for variation in practise in the clinical context, new models for learning transfusion skills can be developed. Furthermore, different collaborative groups could be organised to develop optimal transfusion practises, for example to include nurse-prescribing of blood components or by developing patient-centred decision making systems.

Keywords

Anaemia Blood transfusion Cancer, neoplasms Culture Decision making 

Notes

Acknowledgements

The authors would like to thank Guy’s and St Thomas’ NHS Foundation Trust for funding the research and Professor Sara Faithfull and Dr. Helen Allan of Surrey University for their supervision of this study. This study was undertaken as part of a Doctorate in Clinical Practice.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Guy’s and St Thomas’ NHS Foundation TrustGuy’s HospitalLondonUK
  2. 2.European Institute of Health and Medical SciencesUniversity of SurreyGuildford, SurreyUK

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