Blood transfusion in acute and chronic pediatric settings: beliefs and practices.
BACKGROUND
Blood has been imbued with powerful connotations through history and across cultures. Currently bestowed with scientific meaning, blood nevertheless carries symbolic resonance. This study examines these representations among practitioners and sheds light on the clinical and nonclinical factors that guide blood transfusion (BT) decision-making in Quebec, Canada.


METHODS
With a qualitative exploratory study design, data were collected in the pediatric intensive care unit and the hematology-oncology unit of Sainte-Justine Hospital in 2009. A total of fifteen 1-hour-long semistructured interviews were conducted with physicians.


RESULTS
Physicians affirm that the symbolic connotations of blood found in the lay population do not influence their transfusion decisions. However, there are other "social" and "cultural' aspects that influence these practices. Also, BT strategies remain diverse across units. Practitioners perceive these situations as resulting from insufficient training and by the existence of an "oral tradition" and a professional culture that are resistant to change.


CONCLUSIONS
BT practices differ within and across units. Many dimensions intervene in the decision to transfuse, from individual clinical appreciation and local unit "culture" to formal and ad hoc training. Consistent change in BT can only occur with the implementation of norms and guidelines that are endorsed by key influential figures. An extensive multicentered study is necessary to better understand how social and cultural factors affect BT practices. This knowledge will sustain an enlightened clinical practice and lead to the recognition that peer practices are also embedded in professional cultures.
Anthropology and, Université De Montréal and Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada.|Pediatrics, Université de Montréal, Montreal, Quebec, Canada.|Sainte-Justine, Hospital Research Center.
Sylvie
S
Fortin
Anthropology and, Université De Montréal and Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada.|Sainte-Justine, Hospital Research Center.
Liliana Gomez
LG
Cardona
Anthropology Department, Cégep Edouard-Montpetit, Montreal, Quebec, Canada.
Martin
M
Latreille
Pediatrics, Université de Montréal, Montreal, Quebec, Canada.|Sainte-Justine, Hospital Research Center.
Marisa
M
Tucci
Pediatrics, Université de Montréal, Montreal, Quebec, Canada.|Sainte-Justine, Hospital Research Center.
Jacques
J
Lacroix
D000208:Acute Disease; D000328:Adult; D060432:Anthropology, Medical; D001291:Attitude of Health Personnel; D001803:Blood Transfusion / Q000523:psychology*; D002648:Child; D002908:Chronic Disease; D000066491:Clinical Decision-Making; D003469:Culture; D005260:Female; D019983:Guideline Adherence; D006405:Hematology; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010372:Pediatrics; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D011792:Quebec