Blood, glorious blood: are attitudes to blood transfusions for palliative purposes always positive?

Abstract

Background One in five patients suffering with terminal cancer is given a blood transfusion. However, given that blood is a finite resource, research is currently lacking on healthcare professional's opinions on blood transfusions in terminally ill cancer patients. Aims To explore the views of healthcare staff regarding the value of blood transfusions for symptom management in patients with advanced cancer in the last months of life, and to compare practices and attitudes in palliative care and oncology staff towards palliative blood transfusions. Methods A web-link to an online questionnaire was distributed to 120 healthcare assistants, nurses and doctors working in either oncology or palliative care. 46 completed the questionnaire, which contained questions about the use and indications of blood transfusions in their specialty. It also asked about their views on the subject of blood transfusions in terminally ill cancer patients. Responses were compared using means, medians and percentages. Results Both groups of healthcare professionals thought that blood transfusions in terminally ill patients were ‘sometimes appropriate’ (3.91(4), 3.90(4)), and no oncology nurses, or doctors in either group thought blood should be withheld from them. However, some nurses in palliative care thought blood transfusions should be withheld (n=2). Less palliative care healthcare professionals than oncology healthcare professionals thought that suffering was an appropriate reason for blood transfusions (74% and 90%, respectively). Conclusions There is a lack of current guidelines outlining when to give terminally ill cancer patients a blood transfusion, due to the fact that every patient needs to be individually assessed. Generally, attitudes towards blood transfusions were positive; most thought that suffering was an appropriate reason for a blood transfusion. The large majority did not think that blood transfusions should be withheld. Attitudes towards blood transfusions with palliative intent were slightly more positive in oncology compared to palliative care healthcare professionals.