Soril Lesley J J, Noseworthy Tom W, Stelfox Henry T, Zygun David A, Clement Fiona M
Departments of Community Health Sciences (Soril, Noseworthy, Stelfox, Clement) and Critical Care Medicine (Stelfox), Cumming School of Medicine, and O'Brien Institute for Public Health (Soril, Noseworthy, Stelfox, Clement), University of Calgary, Calgary, Alta.; Department of Critical Care Medicine (Zygun), Alberta Health Services; Faculty of Medicine and Dentistry (Zygun), University of Alberta, Edmonton, Alta.
CMAJ Open. 2019 Apr 23;7(2):E252-E257. doi: 10.9778/cmajo.20180209. Print 2019 Apr-Jun.
Despite recommendations for restrictive approaches to red blood cell transfusion in the intensive care unit (ICU), variation from best practices persists. The aim of this study was to explore potential facilitators of and barriers to practising a restrictive red blood cell transfusion strategy among intensive care physicians using the theoretical domains framework.
We conducted an online population-based cross-sectional survey of all intensive care physicians in 1 health care system (Alberta). Survey questions were based on 6 key theoretical domains of the theoretical domains framework: Knowledge, Social/professional roles and identity, Motivation and goals, Beliefs about consequences, Social influences and Beliefs about capabilities. The survey was administered between July 27 and Oct. 6, 2017. Descriptive statistics (demographic and Likert scale data) and conventional content analysis (open-ended responses) were conducted.
Forty-two intensive care physicians completed the survey (estimated response rate 56%). The respondents identified knowledge of published evidence, use of guidelines, improved outcomes, physician autonomy, and perceived culture of acceptance and collegial support as facilitators of practising a restrictive transfusion strategy. Identified barriers included potential impact on and cost to other clinical goals, conflicting practices and beliefs of physicians in other clinical specialties, deficits in medical trainees' skills and knowledge, and attitudinal barriers related to denial.
Using the theoretical domains framework, we identified 9 key self-reported facilitators of and barriers to intensive care physicians' transfusion behaviour. Understanding these determinants will help inform development and implementation of interventions within ICUs to encourage optimal use of red blood cell transfusion practices for nonbleeding patients whose condition is stable.
尽管有建议在重症监护病房（ICU）采取限制性红细胞输血方法，但与最佳实践的差异仍然存在。本研究的目的是使用理论领域框架，探讨重症监护医师实施限制性红细胞输血策略的潜在促进因素和障碍。
我们对1个医疗系统（艾伯塔省）的所有重症监护医师进行了一项基于人群的在线横断面调查。调查问题基于理论领域框架的6个关键理论领域：知识、社会/职业角色与身份、动机与目标、对后果的信念、社会影响以及对能力的信念。调查于2017年7月27日至10月6日进行。进行了描述性统计（人口统计学和李克特量表数据）和传统内容分析（开放式回答）。
42名重症监护医师完成了调查（估计回复率为56%）。受访者将已发表证据的知识、指南的使用、改善的结果、医师自主权以及感知到的接受文化和同事支持视为实施限制性输血策略的促进因素。确定的障碍包括对其他临床目标的潜在影响和成本、其他临床专科医师的冲突做法和信念、医学实习生技能和知识的不足以及与拒绝相关的态度障碍。
使用理论领域框架，我们确定了重症监护医师输血行为的9个关键自我报告的促进因素和障碍。了解这些决定因素将有助于为ICU内干预措施的制定和实施提供信息，以鼓励对病情稳定的非出血患者最佳使用红细胞输血实践。
