Perceived Value of Transfusion Access and Hospice Services Among Patients With Blood Cancers

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Importance: Although patients with blood cancers have the lowest rates of hospice use in oncology, there are sparse data regarding their perceptions of the services that hospice can provide. Lack of transfusion access in hospice has been posited as a key barrier to enrollment; however, data are limited regarding patients' assessment of the importance of transfusions compared with routine hospice services. Objective: To examine the importance that patients with blood cancers who are potentially hospice eligible place on access to transfusions compared with routine hospice services. Design, Setting, and Participants: This multicenter, cross-sectional survey study using a best-worst scaling instrument was conducted from October 1, 2020, to November 1, 2022, at the Dana-Farber Cancer Institute (Boston, Massachusetts) and the Yale Cancer Center (New Haven, Connecticut). Adult patients (aged 18 years or older) diagnosed with blood cancers who had a physician-estimated life expectancy of 6 months or less were included. Main Outcomes and Measures: The main outcome was the importance that patients placed on routine hospice services (eg, visiting nurse) and nonroutine services (eg, transfusion access) using a best-worst scaling instrument. A hierarchical bayesian multinominal logistic regression of participants' responses was fit to assess the mean standardized importance score (SIS) for each service. Results: Among 331 eligible patients, 200 completed the survey (median age, 70.0 years [IQR, 62.5-76.0 years]; 133 [66.5%] male), with a response rate of 60.4%. The most common diagnosis was leukemia (73 [36.5%]). Transfusion access was considered the most important service (mean SIS, 20.53 [95% CI, 19.42-21.63]), followed by telemedicine (mean SIS, 18.45 [95% CI, 17.33-19.57]). The 3 least important services reported were peer support (mean SIS, 5.06 [95% CI, 4.10-6.02]), social work (mean SIS, 4.35 [95% CI, 3.53-5.16]), and chaplaincy (mean SIS, 1.80 [95% CI, 1.21-2.39]). Conclusions and Relevance: In this survey study of patients with blood cancers who were potentially hospice eligible, access to blood transfusions had the highest importance relative to routine hospice services. The high value placed on transfusion access suggests that this factor plays a crucial role in hospice decision-making and argues that innovative hospice models that incorporate access to palliative transfusions may increase hospice use and improve end-of-life care for this patient population.

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