Thematic analysis of respondents’ open-ended responses elaborating on amenability of intensive care unit to practising a restrictive transfusion strategy
| Theme | Relevant theoretical domains framework domain | Illustrative quote |
|---|---|---|
| Facilitators | ||
| Physician autonomy | Beliefs about capabilities | “There is relative freedom in decision-making.” [R5] |
| Culture of acceptance and collegial support | Environmental context and resources | “The [physician] group has pretty consistent practices, so if [an] approach is adopted, it tends to be followed.” [R40] “Culture that accepts restrictive transfusion strategy.” [R15] |
| Multidisciplinary approach to education | Knowledge; behavioural regulation | “Multidisciplinary education surrounding guidelines for transfusion have diminished requests for transfusion when not indicated.” [R6] |
| Use of clinical guidelines | Social/professional role and identity; behavioural regulation | “We have a local guideline supporting restrictive red blood cell transfusion practices.” [R26] |
| Barriers | ||
| Conflict between clinical specialties | Social influences | “No significant barriers among intensivists, but consulting services at times at odds.” [R29] |
| Knowledge and skills of medical trainees | Knowledge; skills | “Our [intensive care unit] is staffed by residents at night, and they don’t always adhere to restrictive transfusion strategies.” [R12] |
| Perceived nonissue | Optimism | “This [is] really NOT a problem, so why bother expanding on an answer to a question that did not need to be asked?” [R11] |