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

## TL;DR

Patients with blood cancers prioritize access to blood transfusions over routine hospice services, suggesting a need for hospice models that include transfusion access.

## Contribution

This study identifies transfusion access as the most valued service among patients with blood cancers, offering insights into hospice decision-making.

## Key findings

- Transfusion access was rated as the most important hospice service by patients with blood cancers.
- Routine services like visiting nurses and social work were considered less important than transfusion access.
- Peer support, social work, and chaplaincy were the least valued hospice services.

## Abstract

What is the importance of access to blood transfusions compared with routine hospice services for patients with blood cancers who are potentially hospice eligible?

In this survey study of 200 patients with blood cancers with a physician-estimated life expectancy of 6 months or less, respondents placed the greatest importance on transfusion access, while routine hospice services were considered relatively less important.

In this study, 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.

This survey study assesses the perceptions of the importance of access to blood transfusions and other routine and nonroutine hospice services among patients with blood cancers who would be eligible for hospice care.

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.

To examine the importance that patients with blood cancers who are potentially hospice eligible place on access to transfusions compared with routine hospice services.

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.

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.

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]).

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.