Brown Crystal E, Jecker Nancy S, Curtis J Randall
1 Harborview Medical Center, and Division of Pulmonary and Critical Care, Department of Medicine, and.
2 Department of Bioethics and Humanities, University of Washington, Seattle, Washington.
Ann Am Thorac Soc. 2016 Mar;13(3):311-6. doi: 10.1513/AnnalsATS.201510-666PS.
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.
与癌症等其他诊断的患者相比，慢性肺病患者承受着更高的症状负担、更低的生活质量以及更大程度的社会隔离。姑息治疗可能会缓解这些状况，然而与癌症患者相比，慢性肺病患者较少使用姑息治疗。使用不足部分归因于初级姑息治疗实施不力以及转介至专科姑息治疗不足。慢性肺病患者缺乏初级和专科姑息治疗，未达到合格医疗保健的最低标准，这代表了医疗保健方面的差距以及社会不公。我们援引正义和充足性的伦理原则来强调这个问题的重要性。我们确定了在慢性肺病患者中实施姑息治疗的五个障碍：预后不确定性；医护人员缺乏进行姑息治疗讨论的技能；慢性肺病患者对使用阿片类药物的恐惧；害怕希望破灭；以及对吸烟相关肺病患者的感知和隐性偏见。我们提出改善慢性肺病患者姑息治疗实施的机制，目标是增强医疗保健中的正义。
