An exploration of the influences on clinical decision making and the culture of blood transfusion practise in cancer-related anaemia using an ethnographic methodology
- 151 Downloads
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.
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.
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).
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.
KeywordsAnaemia Blood transfusion Cancer, neoplasms Culture Decision making
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.
- 1.Ludwig H, Van Belle S, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P, Kosmidis P, Krazkowski M, Nortier J, Olmi P, Shneider M, Schrijvers D (2004) The European Cancer Anaemia Survey (ECAS): a large multinational, prospective survey defining the prevalence, incidence and treatment of anaemia in cancer patients. Eur J Cancer 40:2293–2306PubMedCrossRefGoogle Scholar
- 2.Bokemeyer C (2005) Therapy related causes of anaemia in cancer patients. In: Bokemeyer C, Ludwig H (eds) anaemia in cancer, 2nd edn. Elsevier Ltd, London, pp 45–83Google Scholar
- 14.Wigton RS, Hoellerich VL, Patil KD (1999) How physicians use clinical information in diagnosing pulmonary embolism: an application of conjoint analysis. In: Dowie J, Elstein A (eds) Professional Judgment: a reader in clinical decision making, 6th edn. Cambridge University Press, Cambridge, pp 130–149Google Scholar
- 17.Spradley JP (1980) Participant Observation. Thomson Learning, BelmontGoogle Scholar
- 18.Hammersley M, Atkinson P (2007) Ethnography: principles in practice, 3rd edn. Routledge, LondonGoogle Scholar
- 19.Atkinson P (1995) Medical talk and medical work. Sage Publications, LondonGoogle Scholar
- 20.Foubert J, Wujcik D (2005) Nursing assessment and management of anaemia and fatigue. In: Bokemeyer C, Ludwig H (eds) Anaemia in cancer, 2nd edn. Elsevier Ltd, London, pp 105–121Google Scholar
- 21.Eddy DM (1999) Variations in physician practice: the role of uncertainty. In: Dowie J, Elstein A (eds) Professional judgment: a reader in clinical decision making, 6th edn. Cambridge University Press, Cambridge, pp 1–45Google Scholar
- 22.Eraut M, Hirsch J (2007) The significance of workplace learning for individuals, groups and organizations. Economic and Social Research Council http://www.skope.ox.ac.uk/. Accessed 2 Dec 2008
- 23.Giddens A (2006) Sociology. Polity Press, LondonGoogle Scholar
- 24.Manley K, Mc Cormack B (2008) Person-centred care. Nurs Manage 15:12–13Google Scholar