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Patients’ and healthcare professionals’ perceptions of blood transfusion

Volkmer, B. (2019). Patients’ and healthcare professionals’ perceptions of blood transfusion. (Unpublished Doctoral thesis, City, University of London)

Abstract

Background:
Blood transfusions are frequently provided to patients at risk of severe bleeding or on a repeated basis for patients with anaemia or blood disorders. The treatment perceptions literature indicates that perceptions influence how patients cope with their conditions and adhere to treatment. Healthcare professionals’ (HCPs’) perceptions are likely to influence shared decision-making and their practice. However, how patients and HCPs perceive blood transfusions, and how this may vary across patient groups, is unclear.

Objectives:
This research aimed to explore patients’ and HCPs’ perceptions of blood transfusion. Specific research questions were: 1) which perceptions of transfusion are reported by patients and HCPs in the literature? 2) to what extent do themes of patients’ perceptions correspond with the broader treatment perceptions literature? 3) what are repeatedly transfused haematology patients’ and HCPs’ perceptions of transfusion? 4) to what extent do HCPs recognise patients’ reported perceptions in their practice and are practice changes to improve patients’ experiences required?

Methods:
This was a mixed-methods programme of research involving three studies: Study 1: A systematic review of patients’ and HCPs’ perceptions of blood transfusion and development of a conceptual model of blood transfusion perceptions. This was followed by a theoretical mapping exercise to compare the model to existing treatment perceptions frameworks. Study 2: A semi-structured interview study with 14 haematology patients and 14 HCPs about their perceptions of blood transfusion. Study 3: A focus group (n=3) and questionnaire study of 19 HCPs’ views of haematology patients’ perceptions and their views about potential service improvement strategies, subsequently mapped to a behaviour change framework (Behaviour Change Wheel). HCPs’ reported constraints and enablers to implementing these strategies were mapped to the Theoretical Domains Framework (TDF) of behaviour change.

Results:
Study 1: 41 papers reporting patients’ and HCPs’ perceptions were included in the systematic review (15 patient studies, 26 HCPs). Transfusion was perceived as carrying low to moderate risk, but risk perceptions and negative emotions were associated with the use and consideration of transfusion alternatives. The data were synthesised into six constructs to form a conceptual model: ‘Safety/risk,’ ‘Negative emotions’, ‘Alternatives’, ‘Health benefits’, ‘Necessity’ and ‘Decision making’. Theoretical mapping confirmed these constructs as broadly consistent with constructs from existing treatment perceptions frameworks and models.
Study 2: Patients and HCPs reported views about the benefits of transfusion for haematology patients, yet some patients and HCPs reported concerns about the downsides of transfusion. ‘Organisational constraints’ were raised by HCPs about delivering transfusions in pressurised services and patients discussed the burden of receiving repeated transfusions.
Study 3: 17 service improvement strategies were proposed, corresponding to seven BCW functions: (e.g. ‘Service provision’ (home transfusion), ‘Environmental restructuring’ (remote blood screening)). Constraints/enablers mapped to the TDF: (e.g. ‘Skills’ (HCP communication skills training), ‘Environmental context and resources’ (funding, time)). Potential techniques to address constraints and enablers included providing ‘Information about health consequences’ to address the domain, ‘Beliefs about consequences’.

Conclusion:
This research provides a theoretical and empirical overview of blood transfusion perceptions, including themes shared by patients and HCPs and themes that were unique to one of these groups. There is scope to more greatly involve patients in their transfusions where, in haematology, repeated and lengthy transfusion appointments place burden on patients. The conceptual models provide direction for such consultations. Interventions to enhance haematology patients’ experiences and to remediate service pressures can be developed further.

Publication Type: Thesis (Doctoral)
Subjects: Q Science > QR Microbiology
Departments: Doctoral Theses
Doctoral Theses > School of Health Sciences Doctoral Theses
School of Health Sciences
Date Deposited: 22 Oct 2020 08:52
URI: https://openaccess.city.ac.uk/id/eprint/25137
[img] Text - Accepted Version
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