A qualitative exploration of the factors influencing the decision to transfuse elective platelets in cancer care

© 2021 John Wiley & Sons, Inc. All rights reserved. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1111/ecc.13407Objectives: To explore factors contributing to decisions to transfuse platelets in cancer care outside guidelines using case study methods. Methods: Two case studies were examined, using instrumental case study methodology, to qualitatively explore factors that influence the decision to transfuse platelets. Interviews (n=10) were conducted around cases in haematology and critical care. In-depth review of documentary evidence was undertaken and propositions were developed to provide rigour during the investigation. Thematic analysis and triangulation of documents was undertaken to find specific factors, and propositions analysed, as per instrumental case study methods. Results: Both cases emphasised how patient complexity, and individual response to platelet administration, was an influencing factor. Other themes included uncertainty of clinical situations coupled with uncertainty about platelet availability. Other factors worthy of further investigation include the concept of professional safety and the trustworthiness of platelet thresholds against platelet monitoring for bleeding episodes. Conclusion: The findings indicated several factors influence decisions to transfuse, including clinical context, and individual ability to trust guidelines and assume any perceived risks.Peer reviewe

Insights from developing and evaluating the NHS blood choices transfusion app to support junior and middle-grade doctor decision making against guidelines.

Objectives: To: 1. Develop a CE-marked smartphone App to support doctors' concordance with transfusion guidelines in non-bleeding adult patients, emphasising informed consent and anaemia management. 2. Test App accuracy and potential to improve user decisions. Background: Studies have shown inappropriate use of blood components and that most junior doctors own smartphones with medical apps. Methods: A multidisciplinary team developed App screens and logic through an iterative process based on national guidelines. Thirty medical or surgical transfusion scenarios were developed based on national guidelines and each sent to Consultant Haematologist experts in Transfusion Medicine. To obtain a clinical consensus and exclude ambiguous scenarios, their independent decisions and associated certainty were compared. The consensus clinical decision was then compared with guidance from the App. To explore potential App impact on simulated user decisions, 26 junior doctors responded to five transfusion scenarios before and after access to the App. Results: The Blood Choices App agreed with 91% (95% CI: 72%–99%) of expert decisions with a sensitivity of 100% (69% to 100%) and specificity of 85% (55%–98%). Excluding one malfunction scenario, the App had the potential to increase correct decisions by junior doctors from 83% (73%–90%) pre-App use to 96% (88%–99%) post (p-value 0.013), with 90% (67%–99%) saying they would use it in practice. Conclusions: Transfusion guidelines can be converted into an App with potential to improve guideline concordance. However, evaluating such Apps is essential to understand their limitations, detect malfunctions and prevent harm