Shared decision-making for patients with vaccine-related concerns of blood transfusion: A single institution experience.

Abstract

Background: Some patients express concerns regarding receipt of allogeneic blood transfusions from donors potentially vaccinated against SARS-CoV-2 (COVID-19). However, limited information exists about patients' expression of these concerns or how to address them during the blood transfusion consent process. In this study, we describe our experience of working collaboratively with patients with vaccine-related transfusion concerns prior to elective surgery, summarizing treatment decisions and clinical outcomes.

Study design and methods: This observational descriptive study includes patients seen in our Bloodless Medicine and Surgery clinic between June 2022 and June 2024 for vaccine-related transfusion concerns prior to elective surgery. A shared decision-making framework was employed to foster conversation, share information, provide reassurance, reconcile conflict, and match preferences with available care options. Patient characteristics, treatment decisions, and surgical outcomes were reviewed and summarized.

Results: Thirty-five patients were included, with median (1st, 3rd quartile) age of 61 (53, 69) years. Cardiac surgery was the most common type of surgery (29%). Twelve patients (34%) were anemic preoperatively, and all received preoperative treatment. After discussion with a Bloodless Medicine specialist, 24 (68.6%) decided to consent to the use of all blood products, 5 (14.3%) accepted only red blood cells, and 6 (17.1%) declined all blood products. Among 28 patients undergoing surgery, only 4 (14%) received allogeneic transfusion perioperatively.

Conclusion: Many patients concerned about the vaccination status of blood donors may ultimately consent to allogeneic blood products after shared decision-making with a Bloodless Medicine specialist, highlighting the importance of patient empowerment and collaborative care.