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Blood transfusion practice in the UK and Ireland: a survey of palliative care physicians
  1. Karen Neoh1,
  2. Simon Stanworth2 and
  3. Michael I Bennett1
  1. 1Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  2. 2NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Karen Neoh, Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK; karen.neoh{at}doctors.org.uk

Abstract

Objectives Red cell (blood) transfusions are used in palliative care to manage patients with symptomatic anaemia or when patients have lost blood. We aimed to understand current blood transfusion practice among palliative medicine doctors and compare this with National Institute for Health and Care Excellence (NICE) guidance. NICE guidance advocates more restrictive transfusion practice but is based on clinical trials in non-palliative care contexts; the extent to which these findings should be applied to palliative care remains unclear.

Methods Four clinical vignettes of common clinical palliative care scenarios were developed. Members of the Association for Palliative Medicine were invited to complete the survey. Results were compared with acceptable responses based on current NICE recommendations and analysed to determine the influence of respondents’ gender, experience or work setting.

Results 27% of 1070 members responded. Overall, ideal or acceptable responses were selected by less than half of doctors to all four vignettes. Doctors were more liberal in prescribing blood transfusions than NICE guidance would advocate. Senior doctors were less likely to choose an acceptable response than junior colleagues.

Conclusion Palliative care practice is varied and not consistent with a restrictive blood transfusion policy. More recently trained doctors follow less liberal practices than senior colleagues. More direct evidence of benefits and harms of blood transfusion is needed in palliative care to inform practice.

  • supportive care
  • fatigue
  • blood transfusion
  • anaemia
  • hospice care

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Footnotes

  • Contributors KN: concept, design of survey, distribution, analysis/ interpretation of data and write up of paper. MIB: concept, design of survey, analysis/ interpretation of data and write up of paper. SS: design of survey and revision of paper. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Approval was given by the University of Leeds School of Medicine Research Ethics Committee (project number SoMREC15-09)

  • Provenance and peer review Not commissioned; externally peer reviewed.

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