Study finds doctors and patients interested in environmental impact of health care decisions

Concerns about the environmental impact of health care decisions rarely enter into conversations between patients and physicians. However, evidence from a new study led by researchers at Dana-Farber Cancer Institute shows there's broad interest in changing that.

In a series of focus groups conducted in different areas of the United States, doctors and patients expressed openness to considering environmental factors when discussing treatment options. The findings, presented in a paper published in Nature Climate Change, suggest that educating physicians about the environmental costs of treatment—and how those costs may be reduced while continuing to deliver excellent care—can be a first step toward that goal.

"Studies have shown that the U.S. health care industry is responsible for 8.5% of national greenhouse gas emissions and about 25% of health care emissions worldwide," said Andrew Hantel, MD, a faculty member in the Divisions of Leukemia and Population Sciences at Dana-Farber Cancer Institute who led the study with Dana-Farber colleague Gregory Abel, MD, MPH. "The downstream health consequences of these emissions are responsible for the same level of loss of life as pancreatic cancer or colon cancer every year.

"If health care emissions are contributing to climate change that is resulting in this level of harm, we wanted to assess if and how physicians view their responsibility to address this issue," he continues. "We also asked patients how willing they would be to make changes in their care that might reduce emissions and limit harm to others."

Researchers conducted seven focus groups—three made up of physicians, four of patients—involving 46 people in all. Patients, on the whole, were interested in talking about these issues and learning about treatment alternatives that are equally effective but less damaging to the environment.

"Asthma or COPD [chronic obstructive pulmonary disease], for example, can be managed in part using powdered or aerosolized inhalers," Hantel relates. "For many patients they're equally effective medications, but powdered inhalers have significant environmental benefits."

Roughly two-thirds of the focus group participants identified as members of racial and ethnic minority groups, who often experience the harshest effects of climate change despite being less responsible for those effects than other groups. Many of them were interested in making environmentally conscious health decisions, but wanted to ensure that the main contributors to climate change were also held accountable, researchers found. Some participants expressed a concern that physicians' paternalism might be a deterrent to having climate-informed discussions with patients.

Many of the physicians in the focus groups incorrectly assumed that patients were not interested in discussing the environmental consequences of health choices, researchers found. Even if patients were interested, physicians said their medical school education hadn't prepared them to address the subject adequately.

At the same time, physicians felt their ability to act in a climate-informed fashion was limited by a health care culture oriented toward consumption of natural resources.

"There was a sense of systemic headwinds against the kind of changes that can be beneficial for patients as well as the environment," Hantel observes.

Physicians and patients generally agreed that patients' immediate health should be prioritized over environmental concerns. In situations where there's co-benefit, however, both groups were open to actions that reduce environmental impact.

"Our findings point to the need to better educate physicians and health professionals about changes they can make, as well as those they can advocate for within their institutions, which benefit patients but also are less toxic to the environment," Hantel comments. "The goal isn't to shift the burden of climate-informed health care decisions onto patients, but to engage with them on these issues and make sure they're a normal part of conversations with their doctors."