Red Blood Cell Transfusion in Palliative Care: A Survey of Palliative Care Physicians

Abstract

Background: Red blood cell transfusion is one therapeutic option for the treatment of anemia. Current transfusion practices and factors influencing the decision to prescribe this therapy are not well understood. Objective: To explore current transfusion practices, attitudes, and factors that influence the decision to transfuse among palliative care physicians. Design: Self-administered questionnaire addressing clinical experiences and decision making pertaining to blood transfusion. Setting/Subjects: Specialist palliative care physicians at two Canadian academic centers. Measurements: Descriptive, presented as the number/proportion of respondents indicating a specific answer. Results: Of 62 physicians surveyed, 29 (47%) responded to the study questionnaire. For patients with solid tumors and hematologic malignancies, respectively, 79% and 82% of respondents reported prescribing blood transfusion; 59% and 46% reported that they would seldom recommend its discontinuation. Factors influential in the decision to transfuse included symptoms of anemia (97%), bleeding (62%), low hemoglobin (52%, of whom 87% indicated a hemoglobin threshold <70 g/L), and pressure from patients/families (48%). Physicians routinely reassessed patients for symptomatic improvement following transfusion, but 72% did not use an objective symptom scale. Twenty-six (90%) respondents believed that transfusion provided symptomatic benefit; the majority had observed adverse reactions to transfusion. Most perceived a lack of evidence to guide transfusion therapy in palliative care, and 79% indicated willingness to enroll their patients in a trial aiming to address this question. Conclusions: Most palliative care specialists consider red blood cell transfusion to have a role in symptom management, but many clinical and nonclinical factors influence their decisions to provide or discontinue transfusions. Prospective clinical trials will likely be needed to inform transfusion practices in this population.