title: Inadequate Palliative Care in Chronic Lung Disease. An Issue of Health Care Inequality.
abstract: Patients with chronic lung diseases suffer higher symptom burden, lower quality of life, and greater social isolation compared with patients with other diagnoses, such as cancer. These conditions may be alleviated by palliative care, yet palliative care is used less by patients with chronic lung disease compared with patients with cancer. Underuse 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 health care, and represents a disparity in health care 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 health care.
authors.affiliation: 1 Harborview Medical Center, and Division of Pulmonary and Critical Care, Department of Medicine, and.
authors.forename: Crystal E
authors.identifier: http://orcid.org/0000-0002-1223-7422
authors.initials: CE
authors.lastname: Brown
authors.affiliation: 2 Department of Bioethics and Humanities, University of Washington, Seattle, Washington.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Jecker
authors.affiliation: 1 Harborview Medical Center, and Division of Pulmonary and Critical Care, Department of Medicine, and.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D002908:Chronic Disease; D054625:Healthcare Disparities; D006801:Humans; D008171:Lung Diseases / Q000628:therapy*; D010166:Palliative Care / Q000592:standards*; D011788:Quality of Life; D012017:Referral and Consultation
keywords: chronic lung disease; healthcare equality; justice in healthcare; metastatic cancer; palliative care