Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
J Palliat Med. 2019 Sep;22(9):1139-1142. doi: 10.1089/jpm.2018.0605. Epub 2019 Mar 21.
Red blood cell transfusion is one therapeutic option for the treatment of anemia. Current transfusion practices and factors influencing the decision to prescribe this therapy are not well understood. To explore current transfusion practices, attitudes, and factors that influence the decision to transfuse among palliative care physicians. Self-administered questionnaire addressing clinical experiences and decision making pertaining to blood transfusion. Specialist palliative care physicians at two Canadian academic centers. Descriptive, presented as the number/proportion of respondents indicating a specific answer. Of 62 physicians surveyed, 29 (47%) responded to the study questionnaire. For patients with solid tumors and hematologic malignancies, respectively, 79% and 82% of respondents reported prescribing blood transfusion; 59% and 46% reported that they would seldom recommend its discontinuation. Factors influential in the decision to transfuse included symptoms of anemia (97%), bleeding (62%), low hemoglobin (52%, of whom 87% indicated a hemoglobin threshold <70 g/L), and pressure from patients/families (48%). Physicians routinely reassessed patients for symptomatic improvement following transfusion, but 72% did not use an objective symptom scale. Twenty-six (90%) respondents believed that transfusion provided symptomatic benefit; the majority had observed adverse reactions to transfusion. Most perceived a lack of evidence to guide transfusion therapy in palliative care, and 79% indicated willingness to enroll their patients in a trial aiming to address this question. Most palliative care specialists consider red blood cell transfusion to have a role in symptom management, but many clinical and nonclinical factors influence their decisions to provide or discontinue transfusions. Prospective clinical trials will likely be needed to inform transfusion practices in this population.
红细胞输注是治疗贫血的一种治疗选择。目前的输血实践以及影响开具这种治疗的决策的因素尚不清楚。 目的 探索姑息治疗医生目前的输血实践、态度以及影响输血决策的因素。 自我管理的调查问卷，涉及与输血相关的临床经验和决策。 加拿大两家学术中心的专科姑息治疗医生。 描述性的，以表示表示特定答案的受访者的数量/比例。 在接受调查的 62 名医生中，有 29 名（47%）对研究问卷做出了回应。分别有 79%和 82%的受访者报告为实体瘤和血液恶性肿瘤患者开具了输血处方；59%和 46%的受访者报告他们很少会建议停止输血。影响输血决策的因素包括贫血症状（97%）、出血（62%）、低血红蛋白（52%，其中 87%的人表示血红蛋白阈值<70g/L）和来自患者/家属的压力（48%）。医生通常会在输血后重新评估患者的症状改善情况，但 72%的人不使用客观症状量表。26 名（90%）受访者认为输血可提供症状缓解；大多数人观察到输血的不良反应。大多数人认为缺乏指导姑息治疗中输血治疗的证据，79%的人表示愿意让他们的患者参加旨在解决这一问题的试验。 大多数姑息治疗专家认为红细胞输注在症状管理中具有作用，但许多临床和非临床因素影响他们提供或停止输血的决策。可能需要前瞻性临床试验来为这一人群的输血实践提供信息。
