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Access to Transfusions Plays Crucial Role in Hospice Decision-Making

January 13, 2022

Mid-January 2022

Blood transfusion services are considered the most important hospice-related services for patients with hematologic malignancies who are considering hospice care, according to findings from a survey study presented during the 2021 ASH Annual Meeting by Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute in Boston. These findings suggest that hospice delivery models that include palliative transfusion access could increase hospice use and improve end-of-life care for patients with blood cancers.

The investigators explained that patients with hematologic malignancies largely underuse hospice services, and those who enroll do so within the last three days of life. Lack of access to transfusions in hospice settings may represent a barrier to hospice use in these patients; however, data on the perceptions of these services among patients are lacking.

To close this research gap, Dr. Odejide and colleagues performed a web-based survey of patients with blood cancers from two large cancer centers. A total of 102 patients with hematologic malignancies had completed the survey as of July 2021, with a response rate of 64.6%. All patients were 18 years of age are older, 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. In the survey, investigators included a best-worst scaling (BWS) section which evaluated a respondent’s perceptions of the utility of different services routinely offered in hospice settings. These routine services included those offered by a visiting nurse, case manager, home health aide, chaplain, social worker, and respite care. Additionally, the survey assessed patients’ perceptions regarding the utility of non-routine services, such as transfusion access, transportation, peer support, and telemedicine through videoconferencing.

Patients with hematologic malignancies largely underuse hospice services, and those who enroll do so within the last three days of life.

Also, the investigators asked survey respondents to envision a program used to support quality of life for patients with hematologic malignancies. The participating patients were presented with 10 questions that featured varying combinations of the services in groups of four. Patients then selected the services they believed were “most important” and “least important” in their decision to sign up for and participate in the program. A hierarchical Bayesian analysis was used to determine a standardized utility score assigned to each service.

The median age of patients who participated in the web-based survey was 71 years. Most patients were male (63.7%) and older than 65 years of age (68.6%). Patients had a diagnosis of either leukemia (38.2%), lymphoma (30.4%), myeloma (17.7%), or myelodysplastic syndrome/myeloproliferative neoplasms (13.7%). In the 30 days prior to the survey, most patients did not have more than one transfusion (78.4% vs. 21.6%).

According to the survey, patients overwhelmingly rated blood transfusion access as having the highest importance to hospice utilization (standardized utility score = 21.1). After transfusion access, other factors perceived as important by patients with hematologic malignancies included:

  • telemedicine (standardized utility score = 19.4)
  • transportation to and from medical appointments (standardized utility score = 13.4)
  • visiting nurses (standardized utility score = 10.8)

 

In contrast, 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).

Any conflicts of interest declared by the authors can be found in the original abstract.

Reference

Odejide OO, Huntington SF, Shi E, et al. Perceptions of Hospice and Transfusion Access Among Patients with Advanced Blood Cancers: Results from a Best-Worst Scaling Survey. Abstract #3020. Presented at the 2021 American Society of Hematology Annual Meeting, December 12, 2021.

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