Evaluation of the red blood cell and plasma transfusion guidelines.

Objectives: To determine physicians' preferred content and format for the Guidelines for Red Blood Cell and Plasma Transfusion for Adults and Children before development in order to guide the development process. To obtain physicians' recommendations about the Guidelines' content, format, dissemination and future directions after development to guide future work on the Guidelines.

Design: Pre-post Guidelines qualitative design using 20 focus groups (nine pre and 11 post).

Study Participants: One hundred and seven physicians (5-11 per group) who used at least 1 unit of blood over the past 6 months; with a minimum of 1 year in practice and not retired. A total of 24 physicians attended both pre and post focus groups. In general, specialties of participants included: general practice, surgery pediatrics, obstetrics/gynecology and hematology/oncology. Years of practice ranged from 1 to 35 years (mean = 7 years).

Main Outcome Measures: Pre Guidelines focus groups made recommendations on the content and format of the Guidelines; post Guidelines focus groups made recommendations on the same areas along with dissemination and future directions.

Results: Three main components of the Guidelines were evaluated: content, format and dissemination. The content, which followed as much as possible that recommended by pre Guidelines focus groups, was deemed appropriate by post Guidelines focus groups, with minor gaps noted (e.g. information on alternatives to blood products). The format addressed many of the concerns raised by pre Guidelines focus groups; however, the post Guidelines focus groups were concerned about the lack of visual aids and categorization of information. The dissemination strategy was successful at diffusing the Guidelines, with some concerns expressed about reaching specific physician target groups.

Conclusion: The pre-post focus group method was useful in conducting an evaluation of the Guidelines and this method which examined content, format and dissemination could contribute to evaluations of other guidelines.