Optimising informed transfusion consent

According to the National Safety and Quality Health Care Standards (NSQHS), informed consent is “a person’s decision, given voluntarily, to agree to a healthcare treatment, procedure or other intervention that is made:

• following the provision of accurate and relevant information about the healthcare intervention alternative options available; and
• with adequate knowledge and understanding of the benefits and material risks of the proposed intervention relevant to the person who would be having the treatment, procedure or other intervention.” 

How do you obtain informed consent for transfusion? Do you have a ‘spiel’ when discussing the risks, benefits and alternative options with a patient? Do you use an information sheet or brochure to guide the conversation? 

Using a modified Delphi approach, the Biomedical Excellence for Safer Transfusion (BEST) Collaborative developed a narrative that can be used as a framework to optimise the process for obtaining informed consent for blood transfusion. 

Five rounds, with four surveys and one semi-structured interview, included feedback from transfusion medicine experts, prescribing physicians and lay people. They identified the relevant information to be included in a consent discussion and explored different ways of presenting the information to, and engaging with, the patient.

Ten high level themes were identified, including: style of engagement; the process of transfusion; the reasons for transfusion, including what would happen if no transfusion was received; the benefits of transfusion; and alternatives including the option to refuse. The remaining five themes related to the risks of transfusion. 

A narrative was developed and refined, with final feedback sought from lay people. This group suggested the use of handouts, simple language, reassurance, personalising the discussion, and more detail in most of the key aspects of consent (benefits, risks, alternatives, consequences of refusing) and of the transfusion process.  They emphasised the need to check to make sure the information is understood.  And finally, they expressed an aversion to the commonly used comparison of the risk of being struck by lightning to the risk of contracting HIV, HBV, or HCV from a blood transfusion.

The final narrative can be found in the article, published in Transfusion Medicine Reviews.

Zeller MP, Laureano M, Khandelwal A, et al. Optimizing Informed Consent Discussions: Developing a Narrative for Transfusion Consent. Transfus Med Rev. 2023;37(3):150757. doi:10.1016/j.tmrv.2023.150757