Relationship described by bereaved caregivers (BCGs) between blood transfusions and hospice utilization for loved-ones (LOs) who died from acute myeloid leukemia (AML).

Abstract

e24002 Background: Patients with AML may under-utilize hospice due to a reluctance to discontinue potentially life-sustaining transfusions. Transfusions while on hospice are a proposed solution. Methods: Nineteen BCGs completed brief surveys and participated in semi-structured interviews. Interviews were audio-recorded, transcribed and qualitatively analyzed for content related to transfusions and hospice enrollment. Results: Surveys: Four out of 16 BCGs reported their LOs received transfusions until death. The time between last transfusion and death was within 2 weeks (12/19) and more than 1 month (3/19). BCGs reported the purpose of transfusions in the last month of life was to live longer (6) and/or to feel better (10). Interviews: The research team identified 5 points relevant to any connections between transfusions and hospice enrollment: 1. Only 2 of 19 BCGs described a decision to delay hospice enrollment due to inability to continue transfusions while on hospice. Both reported gaining enhanced knowledge about their LOs prognosis and coming to agreement that transfusions were burdensome and not justified. 2. The majority of BCGs described becoming aware that the doctor discontinued transfusions rather than reporting that the discontinuation of transfusions was a decision made by their LO. 3. BCGs described a “logical” and accepted transition from chemotherapy and transfusions to transfusions alone to no transfusions. 4. BCGs’ perspectives on transfusions evolved from transfusions as necessary to may be helpful to no longer indicated. They recall experiencing and accepting this progression rather than discussing the transition with providers. 5. Several impediments to hospice unrelated to transfusions were identified: rapid decline of LO, no perceived need for hospice, equating hospice with a home-based service, and bias against hospice due to past experiences. Conclusions: The desire for ongoing transfusion support is not a major impediment to hospice enrollment in the experience of BCGs. Providing transfusions on hospice may not address the low rates of hospice utilization.