Abstract
Background: Clinically defined cancer-related anaemia is common in cancer patients but the impact of mild/moderate anaemia is undetermined, when combined with cancer symptoms and/or the side effects of therapy. Blood transfusion is the standard treatment: however there are significant risks and costs. It is important that the decision to give blood is carefully considered but it is not clear how these decisions are made. Purpose: To explore the cultural practices which shape the culture of transfusion; and to identify the key elements, which influence clinical decision making in blood transfusion in haemato-oncology and lung cancer patients. Method: The assessment and decision making processes for blood transfusion were explored using six patient and nine clinician interviews; and observation based on ethnographic methodology. Data were analyzed using thematic analysis. Findings: The findings fell into four main areas. First, the findings suggested that anaemia and transfusion are commonplace in the clinical setting; and because many patients live with anaemia and it may not be viewed as an illness (The ubiquity of anaemia and transfusion). Second, there Is a great deal of uncertainty surrounding the diagnosis and management of this clinical problem; but this uncertainty was acknowledged by both patients and clinicians (Acknowledgement of uncertainty). Third, clinicians and to some extent patients, are socialized into the practice of the sub-discipline (Socialization of practice); and fourth that the haemoglobin level was used as a distinct fragment of information on which to assess for the presence of anaemia and base the decision to treat with blood transfusion (Disaggregation of the body). Conclusion: By understanding the complexity of factors for variation in practice in the clinical context, new models for learning transfusion skills can be developed. Furthermore, different collaborative groups could be organized to develop optimal transfusion practices, for example to include nurse-prescribing of blood components.