Recent research found that improved access to blood transfusions could lead more patients to elect hospice. Researchers indicated that the prospect of losing access to transfusions is causing some patients and families to forego hospice, particularly those with blood cancers. Incorporating palliative transfusion into delivery models could bolster hospice utilization and improve end-of-life care for these patients.

Recent research from the American Society of Hematology indicates that patients with hematologic malignancies have low rates of hospice utilization, and they often enroll during the last three days of life.

Spanning from Oct. 2020 to July 2021, researchers surveyed patients with blood cancers from two large cancer centers about their perceptions of different services routinely offered in hospice settings, as well as others that are less routine such as transfusion access, transportation, peer support and telemedicine.

Among the 102 participants, 78.4% indicated that they did not have more than one transfusion, with patient responses “overwhelmingly” rating blood transfusion access as the most important factor in their hospice decisions, according to researchers.

“We asked patients to imagine a program developed to support quality of life for patients with blood cancers just like them,” said researchers. “Patients with hematologic malignancies have low rates of hospice use, and when they do enroll, they often do so in the last three days of life. We sought to characterize the utility of transfusions and hospice services from the perspective of patients with advanced blood cancers, who would potentially be eligible for hospice care.”

Researchers hailed from the Dana-Farber Cancer Institute, the Yale Cancer Center at the Yale University School of Medicine and the Duke University School of Medicine. Eligible patients were at least 18 years old, had at least two outpatient visits to one of the cancer centers, and had a physician-estimated prognosis of six months or less.

Patients used a point scoring system to identify which services were considered most or least important in their decision to enroll in hospice. Results showed that access to blood transfusions was of the highest importance among patients, outranking other services such as telemedicine, transportation to and from medical appointments and visiting nurses.

“The high value placed on transfusion access suggests that this factor plays a crucial role in hospice decision-making,” researchers concluded. “Accordingly, lack of transfusion access in many hospices likely reduces the propensity of patients with blood cancers to choose hospice. Innovative hospice delivery models that include access to palliative transfusions may have strong potential to increase hospice use and optimize end-of-life care for this patient population.”

Bipartisan legislation introduced in the Senate in July could help hospices to offer greater access to transfusions. If enacted, the Improving Access to Transfusion Care for Hospice Patients Act of 2021 would allow hospices to bill Medicare for transfusion services separate from their usual per diems. Proponents of the bill have argued that the ability for patients to receive transfusions during their final days is essential to maintaining their quality of life.