Hospice and Hematology - Barriers to hospice access for patients with hematologic malignancies

Hospice care is known to enhance quality of life (QoL) for patients with advanced cancer, yet individuals with hematologic malignancies are disproportionately underrepresented in hospice settings at the end of life (EoL). To explore the reasons for this disparity, a systematic search across four databases identified 19 relevant publications, including qualitative, quantitative, and mixed-methods studies. Several key barriers to hospice referral were identified: unpredictable disease trajectories, strong patient-hematologist relationships, prognostic uncertainty, and widespread misunderstandings about the goals of palliative and hospice care. A particularly modifiable barrier is the limited access to blood transfusions within hospice settings. While hematologists often view transfusion availability as essential and see its absence as a reason to delay referral, evidence shows that this concern is not always shared by patients or caregivers. This review emphasizes the need to adapt hospice care models-particularly by incorporating transfusion services where appropriate-and to promote earlier integration of palliative care in hematologic oncology. Clearer communication and policy reform could help address misconceptions and logistical limitations, supporting more equitable access to hospice. Improving hospice referral for this population not only addresses disparities in cancer care but may also reduce healthcare costs by minimizing late hospital admissions and aggressive EoL interventions. In sum, this review identifies systemic and perceptual barriers to hospice care in hematologic malignancies and highlights actionable steps to improve access and outcomes for this underserved group.