Patients with advanced blood cancers place far greater importance on access to blood transfusions than on many traditional hospice services, according to new research that highlights why hospice use remains low in this population.
Despite having among the poorest prognoses in oncology, patients with haematological malignancies are less likely than those with solid tumours to enrol in hospice care. One frequently cited barrier is the limited availability of transfusions in hospice settings. The new study provides direct evidence that this concern is central to patients’ decision-making.
Survey Of Hospice Eligible Patients
The multicentre, cross-sectional survey study included 200 adults with blood cancers and a physician-estimated life expectancy of 6 months or less. Participants were recruited between October 2020 and November 2022 from the Dana-Farber Cancer Institute and Yale Cancer Center. Among 331 eligible patients, the response rate was 60.4%.
The median age of respondents was 70.0 years, and 66.5% were male. The most common diagnosis was leukaemia, reported in 36.5% of participants. Researchers used a best-worst scaling instrument to assess how patients prioritised different hospice services, ranging from routine care such as visiting nurses to nonroutine services including transfusion access.
A hierarchical bayesian multinomial logistic regression model was used to generate standardised importance scores, allowing direct comparison of how strongly patients valued each service.
Transfusions Ranked Above Routine Care
Access to blood transfusions emerged as the most highly valued service, with a mean standardised importance score of 20.53. Telemedicine was ranked second, with a mean score of 18.45, reflecting the importance patients placed on ongoing clinical connection and monitoring near the end of life.
In contrast, many routine hospice services were considered relatively less important. Peer support, social work, and chaplaincy were ranked lowest, with mean importance scores of 5.06, 4.35, and 1.80, respectively. These findings suggest that while supportive services remain relevant, symptom management strategies that directly affect physical wellbeing take priority for many patients with blood cancers.
Implications For Hospice Care Models
The authors conclude that the high value placed on transfusion access helps explain low hospice enrolment rates in this group. Without the option of palliative transfusions, patients may perceive hospice as incompatible with their care needs, even when their prognosis is limited.
The findings support the development of new hospice delivery models that integrate access to transfusions alongside palliative care. Such approaches could remove a major barrier to hospice use, improve quality of life, and better align end-of-life care with the priorities of patients with advanced blood cancers.
Reference
Raman HS et al. Perceived value of transfusion access and hospice services among patients with blood cancers. JAMA Netw Open. 2025;8;(11):e2541719.
