Healthcare provider's perceptions of bleeding in patients with acute leukaemia undergoing induction chemotherapy: A qualitative study.

Autor: Taneja S; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada., Heddle NM; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada., Hillis C; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.; Department of Oncology, McMaster University, Hamilton, Ontario, Canada., Lane S; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada., Karunakaran M; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada., Maze D; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Modi D; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada., Khalaf D; Department of Oncology, McMaster University, Hamilton, Ontario, Canada., Arnold DM; Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada., Zahreddine H; Department of Oncology, Hamilton Health Sciences, Hamilton, Ontario, Canada., Webert K; Department of Medicine and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.; Canadian Blood Services, Ancaster, Ontario, Canada., Hess L; Patient Partner, Hamilton, Ontario, Canada., Cook R; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada., Stanworth S; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; NHSBT, John Radcliffe Hospital, Oxford, UK.; NIHR Blood and Transplant Research Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK., Gernsheimer T; Division of Hematology, University of Washington, Seattle, Washington, USA.; Fred Hutchinson Cancer Center, Seattle, Washington, USA., Vanstone M; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Jazyk: angličtina
Zdroj: Transfusion medicine (Oxford, England) [Transfus Med] 2024 Aug; Vol. 34 (4), pp. 268-277. Date of Electronic Publication: 2024 Jul 20.
DOI: 10.1111/tme.13070
Abstrakt: Background: Bleeding is a primary outcome for many transfusion-related trials in acute leukaemia (AL) patients, typically graded using the World Health Organisation (WHO) bleeding scale (clinically significant bleed (CSB) is ≥grade 2). This composite outcome fails to differentiate minor bleeds that may not be significant, poorly represents the total burden of bleeding and lacks input from healthcare providers (HCPs) and patients. As part of a multi-step project to create a better bleeding tool for trials, our objective was to identify HCPs' perspectives on the components of CSB in AL patients.
Study Design and Methods: Using qualitative description, we interviewed 19 physicians and nurses who care for AL patients undergoing induction chemotherapy. Participants were recruited from professional organisations, networks and social media. An inductive approach to conventional content analysis was used.
Results: HCPs identified features of CSB as the anatomical site of bleeding, amount of bleeding, need for intervention and changes in vital signs. Using these characteristics, bleeding events were categorised into three groups: clinically significant, could evolve into a CSB and not clinically significant. HCPs considered the patient's condition, bleeding history and clinical intuitions when deciding whether a bleed could escalate into serious bleeding.
Discussion: Using data from HCPs, we categorised bleeds as clinically significant, could evolve into a CSB, and not significant. A study of patients' perspectives on the importance of different kinds of bleeding is the next step to creating a bleeding definition that is informed by evidence, clinicians and patients.
(© 2024 The Author(s). Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society.)
Databáze: MEDLINE
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