Based on the results of a multicenter cross-sectional survey study published in JAMA Network Open by Raman et al, patients with blood cancer who were potentially hospice-eligible placed the greatest importance on transfusion access compared with routine hospice services.
“The high value placed on transfusion access suggests that this factor is central to hospice decision-making and highlights the need for novel hospice delivery models that incorporate palliative transfusion access for patients with advanced blood cancers,” the investigators commented.
Study Details
This study was conducted between October 2020, and November 2022 at Dana-Farber Cancer Institute and Yale Cancer Center. Among 331 eligible patients with blood cancer who had a physician-estimated life expectancy of 6 months or less, 200 completed the survey (median age = 70.0 years; male: n = 133 [66.5%]), with a response rate of 60.4%. Leukemia was the most frequently reported diagnosis (n = 73 [36.5%]).
The primary outcome focused on how patients valued routine (eg, visiting nurse) and nonroutine (eg, transfusion access) hospice services, as assessed using a best–worst scaling instrument. Responses were analyzed with a hierarchical Bayesian multinomial logistic regression model to determine the mean standardized importance score (SIS) for each service.
Key Findings
The most important service reported was transfusion access (mean SIS = 20.53, 95% confidence interval [CI] = 19.42–21.63), followed by telemedicine (mean SIS = 18.45, 95% CI = 17.33–19.57). 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) were considered the least important services.
The investigators concluded, “Our analysis suggests that for many patients with advanced hematologic cancers, the ability to maintain access to blood transfusions is the primary factor in deciding whether to enroll in hospice. Given that the majority of hospices in the [United States] do not provide transfusion access, patients with blood cancers are faced with the impossible choice of preserving access to palliative transfusions vs accessing quality home-based hospice care. This dichotomy between transfusion access and hospice care may contribute to the low rate of hospice use in this population.”
Regarding future research directions, they stated, “Our findings underscore the need to develop and test novel hospice delivery models that combine palliative transfusions with routine hospice services to effectively alleviate discomfort and optimize the quality of life of patients with blood cancers near the end of life.”
Oreofe O. Odejide, MD, MPH, of Dana-Farber Cancer Institute, Boston, is the corresponding author of the article in JAMA Network Open.
Disclosure: The study was funded by a grant from the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
