- 1Harborview Medical Center, Department of Medicine , 325 Ninth Ave. , Box 359762 , Seattle, Washington, United States , 98104 , 206-744-6271 , 206-744-8584 ; crysb@uw.edu.
- 2University of Washington, Department of Bioethics and Humanities, Seattle, Washington, United States ; nsjecker@uw.edu.
- 3University of Washington, Division of Pulmonary and Critical Care Medicine , Associate Professor of Medicine , Harborview Medical Ctr./Pulm.&Crit.Care, 325 Ninth Avenue, Box 359762 , Seattle, Washington, United States , 98104 , 206/731-3356 , 206/731-8584 ; jrc@u.washington.edu.
Abstract
Patients with chronic lung diseases suffer higher symptom burden, lower quality of life, and greater social isolation compared to patients with other diagnoses, such as cancer. These conditions may be alleviated by palliative care, yet palliative care is utilized less by patients with chronic lung disease compared to patients with cancer. Underutilization is due, in part, to poor implementation of primary palliative care and inadequate referral to specialty palliative care. Lack of primary and specialty palliative care in patients with chronic lung disease falls short of the minimum standard of competent healthcare, and represents a disparity in healthcare and a social injustice. We invoke the ethical principles of justice and sufficiency to highlight the importance of this issue. We identify five barriers to implementing palliative care in patients with chronic lung disease: uncertainty in prognosis; lack of provider skill to engage in discussions about palliative care; fear of using opioids among patients with chronic lung disease; fear of diminishing hope; and perceived and implicit bias against patients with smoking-related lung diseases. We propose mechanisms for improving implementation of palliative care for patients with chronic lung disease with the goal of enhancing justice in healthcare.
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