Le Calve S, et al. – This research encompassed the assessment of the general practitioners' (GP) attitudes towards blood transfusion in elderly patients with chronic anemia. It was illustrated that the decision of transfusion to an elderly patient with chronic anemia was complex. However, GPs appeared to take it alone, sometimes guided by the patient’s family. The drawing up of an advance care plan would facilitate the involvement of the patient in decision making.

Methods

• 20 French GPs were questioned individually about their approach to blood transfusion via semi-structured interviews.
• Each interview was recorded, typed up verbatim and then coded using an inductive procedure by theme, in a cross-over design (two researchers) in two phases: Analysis and summary, followed by grouping of the recorded comments.

Results

• The criteria involved hemoglobin level < 8 g/dL and cardiac comorbidities.
• Some geriatric issues, such as cognitive disorder or dependence, were regarded as aspects of frailty favoring transfusion or as markers of reduced life expectancy that limit care.
• Falls and fear of an unpleasant death from anemia prompted GPs to order blood transfusion.
• The patient’s family gave guidance.
• However, the patient was not routinely consulted.
• The specialists were asked to participate in decision making, on rare occassions.
• GPs’ perceptions were ambivalent: They regarded transfusion to be extraordinary and magical, along with being pointless.
• This was attributed to its transient effects.