How experienced ICU specialists make decisions on prophylactic platelet transfusions-A qualitative study.

Background: Platelet transfusions are frequently used in the Intensive Care Unit (ICU) as prophylaxis against bleeding complications. Several guidelines exist on when to administer platelet transfusions in the ICU, but studies indicate that these guidelines are not necessarily followed. The aim of this qualitative study was to understand how experienced ICU physicians make decisions on prescribing prophylactic platelet transfusions and to gain insight into their general concerns and views on blood product transfusions.

Design: Descriptive qualitative study using semi-structured, in-depth interviews with clinicians working in ICUs in Austria, Denmark, France, Germany, Spain, and the United Kingdom. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis.

Results: We identified four main themes influencing the decision to prescribe prophylactic platelet transfusions: Guidelines, social and cultural aspects (including religion), previous personal experiences, and fear of consequences.

Discussion: Most doctors expressed uncertainty about balancing benefits and harm. Platelet transfusions were often used to prevent bleeding despite uncertainty on the effect and were typically triggered by fear of consequences when performing a procedure, which was an important driver. The departmental culture and colleagues' attitudes were far more important influencers on decision-making than guideline recommendations. Most doctors thought it was possible for blood products to transfer unknown and potentially harmful substances to patients, although this did not appear to influence their daily practice.