Transfusion in Hospice-Palliative Care.

Area of Science:

• Palliative Care
• Hematology
• Medical Ethics

Background:

• Anemia is prevalent in terminally ill patients, causing significant symptom burden including fatigue and dyspnea.
• Red blood cell transfusion offers potential short-term symptom relief but has limited impact on survival and can be transient.
• Clinical practices regarding transfusion in hospice and palliative care are inconsistent due to differing views on its role.

Purpose of the Study:

• To explore the complexities of red blood cell transfusion in hospice and palliative care.
• To highlight the impact of transfusion on symptom management and patient/family decision-making in terminal illness.
• To advocate for an individualized, goal-concordant approach to transfusion decisions.

Main Methods:

• Case study of an 88-year-old male with myelodysplastic syndrome requiring transfusion-dependent care.
• Analysis of the patient's experience with fatigue, symptom control, and hospice admission decisions.
• Discussion of institutional barriers and logistical constraints affecting transfusion access in hospice settings.

Main Results:

• Transfusion significantly impacted the patient's fatigue and influenced decisions regarding hospice care, delaying admission.
• The case illustrates that transfusion can be clinically significant for symptom relief and shaping patient preferences, not just survival.
• Access to transfusion services varied, posing challenges for hospice and home care settings.

Conclusions:

• Transfusion in hospice and palliative care necessitates a case-by-case evaluation.
• Decisions should be based on symptom burden, prognosis, patient values, treatment burden, feasibility, and ethical principles.
• Shared decision-making and ongoing reassessment are essential for goal-concordant care.