title: Survey of Provider Transfusion Practices for Oncology Patients in an Academic Medical Center.
abstract: OBJECTIVE
  Hospitalized oncology patients receive care from a variety of professionals, each of whom plays a role in decisions related to blood transfusions. We sought to examine differences in transfusion practices based on professional role, years of experience, and patient clinical scenario.
  
  
  METHODS
  We surveyed general medicine residents, hospitalists, and oncologists caring for inpatients at a large academic medical center between August 2013 and June 2014. Respondents reported transfusion practices in three different patient scenarios: a generally healthy patient, a patient with solid tumor malignancy, and a patient with hematologic malignancy. We also assessed rationale for transfusion practices. Bivariate comparisons of respondent characteristics and transfusion threshold were conducted using the Fisher exact test. Multivariate logistic regression was performed to assess the relative relations among professional role, years in practice, clinical scenario, and transfusion threshold <7 g/dL.
  
  
  RESULTS
  Of 158 physicians surveyed, 97 responded (61.4%). In bivariate analyses, fewer oncologists than residents or hospitalists used a threshold of <7 g/dL, but the result was significant for only one of three scenarios. The multivariate odds of transfusing at a threshold <7 g/dL were significantly higher among nononcologists (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.03-4.28). Residents and practitioners in practice for <4 years also were more likely to use a threshold <7 g/dL (OR 1.82, 95% CI 0.99-3.33). Providers were less likely to use a restrictive threshold when an underlying malignancy was present (solid tumor OR 0.31, 95% CI 0.15-0.64; hematologic malignancy OR 0.34, 95% CI 0.16-0.70).
  
  
  CONCLUSIONS
  Transfusion thresholds differed based on professional role, years in practice, and patient scenario. Further research is needed to determine the optimal transfusion threshold for oncology patients.
authors.affiliation: From the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, and the Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Buck
authors.affiliation: From the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, and the Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Kelley N
authors.initials: KN
authors.lastname: Wachsberg
authors.affiliation: From the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, and the Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: A Charlotta
authors.initials: AC
authors.lastname: Weaver
authors.affiliation: From the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, and the Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Luke O
authors.initials: LO
authors.lastname: Hansen
authors.affiliation: From the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, and the Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: McMahon
authors.affiliation: From the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, and the Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Dombrowski
authors.affiliation: From the Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, and the Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: O'Leary
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002641:Chicago; D003430:Cross-Sectional Studies; D058006:General Practice; D019538:Health Care Surveys; D020445:Hospitalists; D006760:Hospitalization; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008495:Medical Oncology; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*