Better Access to Transfusion Services Could Improve Hospice Enrollment

Patients with hematologic malignancies who may require blood transfusions may not be able to enroll in hospice care given restrictions on transfusion services in these settings. However, according to findings from a survey study presented at the 2021 ASH Annual Meeting, blood transfusion services are considered the most important hospice-related services for patients who want to access hospice services. The least important factors were access to respite care, social workers, and chaplains.

Researchers administered a web-based survey to patients with blood cancers from two large cancer centers. By study presentation, 102 adult patients with hematologic malignancies had completed the survey. All patients had at least two outpatient visits and had an oncologist-estimated survival prognosis of six months or less.

A literature review, along with a series of patient/caregiver focus group (n = 27) and cognitive debriefing with patients (n = 5), was used to inform survey development. Participants were asked participants about their perceptions of the utility of different services routinely offered in hospice settings, as well as their perceptions of non-routine services, such as transfusion access, transportation, peer support, and telemedicine through videoconferencing.

In the 30 days prior to the survey, most patients did not have more than one transfusion (78.4% vs. 21.6%). Per their responses, patients overwhelmingly rated blood transfusion access as the most important factor regarding hospice utilization (standardized utility score = 21.1). After transfusion access, other factors perceived as important by patients with hematologic malignancies included: telemedicine, transportation to and from medical appointments, and visiting nurses.

The three least important services rated by patients included access to respite care (standardized utility score = 4.7), social workers (standardized utility score = 4.5), and chaplains (standardized utility score = 2.3). 

These results suggest that hospice delivery models incorporating palliative transfusion access could increase hospice use and improve end-of-life care for patients with blood cancers.