Le Calvé Sylvain, Somme Dominique, Prud'homm Joaquim, Corvol Aline
Unité de Soins de Longue Durée, Centre Hospitalier de Saint Malo, La Briantais, 78, boulevard du rosais, 35400, Saint-Malo, France.
CHU de Rennes, Service de gériatrie, Rennes, France.
BMC Fam Pract. 2017 Jul 11;18(1):76. doi: 10.1186/s12875-017-0647-8.
Blood transfusion in chronic anemia is not covered by guidelines specific to older adults. When they consider that this treatment is necessary in elderly patients, French general practitioners (GPs) contact a hospital specialist to plan a transfusion.
Twenty French GPs were questioned individually regarding their approach to blood transfusion using semi-structured interviews. Each interview was recorded, typed up verbatim and then coded using an inductive procedure by theme, in a cross-over design (two researchers) in two phases: analysis and summary, followed by grouping of the recorded comments.
The criteria for transfusion were hemoglobin level < 8 g/dL and cardiac comorbidities. Some geriatric issues, such as cognitive disorder or dependence, were considered, either as aspects of frailty favoring transfusion or as markers of reduced life expectancy that limit care. Falls and fear of an unpleasant death from anemia prompted GPs to order blood transfusion. The patient's family provided guidance, but the patient was not routinely consulted. The specialists were rarely asked to participate in decision making. GPs' perceptions were ambivalent: they considered transfusion to be extraordinary and magical, but also pointless since its effects are transient.
The decision to give a transfusion to an elderly patient with chronic anemia is deemed complex, but GPs seem to take it alone, sometimes guided by the patient's family. The drawing up of an advance care plan could help involve the patient in decision making.
慢性贫血患者的输血治疗不在老年人专用指南范围内。当法国全科医生认为老年患者有必要进行这种治疗时，他们会联系医院专科医生来安排输血。
通过半结构化访谈，对20名法国全科医生关于输血的处理方式进行了单独询问。每次访谈都进行了录音，逐字记录，然后采用归纳法按主题进行编码，采用交叉设计（两名研究人员）分两个阶段进行：分析和总结，随后对记录的评论进行分组。
输血标准为血红蛋白水平<8 g/dL和存在心脏合并症。一些老年问题，如认知障碍或依赖，被视为有利于输血的虚弱方面，或作为限制治疗的预期寿命缩短的标志。跌倒和对贫血导致不愉快死亡的恐惧促使全科医生安排输血。患者家属提供了指导，但未常规征求患者意见。很少要求专科医生参与决策。全科医生的看法很矛盾：他们认为输血是特殊且神奇的，但也毫无意义，因为其效果是短暂的。
决定给老年慢性贫血患者输血被认为很复杂，但全科医生似乎独自做出决定，有时会受到患者家属的指导。制定预先护理计划有助于让患者参与决策。
