Catastrophic bleeds during end-of-life care in haematology: controversies from Australian research
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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.
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.
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.
KeywordsCatastrophic bleeds Haematology Supportive care Qualitative research Palliative care
- 2.Crombie I (1996) Research in health care. Wiley, New YorkGoogle Scholar
- 4.Gaskill D, Henderson A, Fraser M (1997) Exploring the everyday world of the patient in isolation. ONF 24(4):695–700Google Scholar
- 6.Krathwohl D (1993) Methods of educational and social science research: an integrated approach. Longman, New YorkGoogle Scholar
- 8.McGrath P (2007) Care of the haematology patient and their family—the GP viewpoint. Aust Fam Physician 36(9):799–781 SeptemberGoogle Scholar
- 10.McGrath P, Holewa H (2006) Haematology and palliative care: towards an integrated practice. NHMRC funded booklet, CQU, RockhamptonGoogle Scholar
- 16.Polit D, Hungler B (1995) Nursing research: principles and methods, 5th edn.Lippincott, PhiladelphiaGoogle Scholar
- 18.Sorrell J, Redmond G (1995) Interviews in qualitative nursing research: differing approaches for ethnographic and phenomenological studies. JOAN 21:1117–1122Google Scholar
- 19.Spiegelberg H (1975) Doing phenomenology. Nijhoff, The HagueGoogle Scholar
- 21.Streubert J, Carpenter D (1995) Qualitative research in nursing: advancing the humanistic imperative. J. B Lippincott Company, New YorkGoogle Scholar
- 22.Therapeutic Guidelines Limited (TGL) (2008) Therapeutic Guidelines. Guidelines International Network, North Melbourne, Victoria, (http://www.tg.com.au) accessed 24th March, 2008)
- 23.Van Manen M (1990) Researching lived experience. State University of New York Press, OntarioGoogle Scholar
- 24.Young NS, Gerson SL, High KA (2006) Clinical hematology. Elsevier, New York, 393. 25Google Scholar