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Recent Advances in Chest Medicine |

Palliative Care in Advanced Lung DiseasePalliative Care in Advanced Lung Disease: The Challenge of Integrating Palliation Into Everyday Care

Graeme M. Rocker, DM, MHSc, FCCP; A. Catherine Simpson, PhD, MDiv; Robert Horton, MD
Author and Funding Information

From the Division of Respirology (Dr Rocker), Implementing a Novel and Supportive Program of Individualized Care for Patients and Families Living With Respiratory Disease (INSPIRED) COPD Outreach Program (Drs Rocker and Simpson), and the Division of Palliative Medicine (Dr Horton), Capital Health Integrated Palliative Care, Halifax, NS, Canada.

CORRESPONDENCE TO: Graeme M. Rocker, DM, MHSc, FCCP, Dalhousie University/QEII Health Sciences Centre, # 4457 Halifax Infirmary, 1796 Summer St, Halifax, NS, B3H 3A7, Canada; e-mail: gmrocker@dal.ca


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(3):801-809. doi:10.1378/chest.14-2593
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The tendency toward “either/or” thinking (either cure or comfort) in traditional biomedical care paradigms does little to optimize care in advancing chronic illness. Calls for improved palliation in chronic lung disease mandate a review of related care gaps and current clinical practices. Although specialist palliative services have their advocates, adding yet another element to an already fragmented, often complex, care paradigm can be a challenge. Instead, we propose a more holistic, patient-centered approach based on elements fundamental to palliative and best care practices generally and integrated as needed across the entire illness trajectory. To support this approach, we review the concept of primary palliative care competencies, identify vulnerability specific to those living with advanced COPD (an exemplar of chronic lung disease), and describe the need for care plans shaped by patient-centered communication, timely palliative responsiveness, and effective advance care planning. A costly systemic issue in the management of chronic lung disease is patients’ increasing dependency on episodic ED care to deal with preventable episodic crises and refractory dyspnea. We address this issue as part of a proposed model of care that provides proactive, collaborative case management and the appropriate and carefully monitored use of opioids. We encourage and support a renewed primary care resolve to integrate palliative approaches to care in advanced lung disease that, in concert with judicious referral to appropriate specialist palliative care services, is fundamental to what should be a more sustainable systematic improvement in palliative care delivery.

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