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Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/SWHPN Policy Statement

Research output: Contribution to journalArticlepeer-review

Donald R Sullivan, Anand S Iyer, Susan Enguidanos, Christopher E Cox, Morag Farquhar, Daisy J A Janssen, Kathleen O Lindell, Richard A Mularski, Natasha Smallwood, Alison E Turnbull, Anne M Wilkinson, Katherine R Courtright, Matthew Maddocks, Mary Lynn McPherson, J Daryl Thornton, Margaret L Campbell, Tracy K Fasolino, Patricia M Fogelman, Larry Gershon, Thayer Gershon & 9 more Christiane Hartog, Judy Luther, Diane E Meier, Judith E Nelson, Elliot Rabinowitz, Cynda H Rushton, Danetta H Sloan, Erin K Kross, Lynn F Reinke

Original languageEnglish
Pages (from-to)e44-e69
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume206
Issue number6
DOIs
Published15 Sep 2022

Bibliographical note

Funding Information: Subcommittee Disclosures: D.R.S. received research support from the Sojourns Scholar Leadership Program Award of the Cambia Health Foundation. A.S.I. served as a consultant for AstraZeneca; and received research support from National Institute on Aging and National Institutes of Health. L.F.R. served on a data safety and monitoring board for Hospice & Palliative Nursing Association Board of Directors; served as a speaker for UpToDate; received travel support from University of Utah, College of Nursing, Professional Development Funds; and received research support from Department of Veterans Affairs Health Services. C.E.C. received research and travel support from National Institutes of Health; and served on the data safety and monitoring board for National Institute on Aging. C.H. served as the elected leader of the ethics section of the European Society of Intensive Care Medicine; and received research support from Innovations Fund of the German Federal Joint Committee and European Society of Intensive Care Medicine. D.J.A.J. served as a speaker for Abbott, Boehringer Ingelheim, and Chiesi; served on a data safety and monitoring board for BETTER-B and Wolfson Palliative Care Research Centre Hull U.K.; and received research support from the Netherlands Organization for Health Research and Development and Stichting Astmabestriiding. K.O.L. received research support from U.S. Department of Health and Human Services, National Institutes of Health, and National Institute of Nursing Research; received travel support from the University of Pittsburgh, and Medical University of South Carolina; and holds a patent for A Program of SUPPORTÔ. M.M. received research support from National Institute for Health and Care Research U.K. R.A.M. served as a consultant for eThera; and received research support from and served on an advisory committee for GlaxoSmithKline. E.R. served as a speaker for and received travel support from North American Cystic Fibrosis Conference. N.S. served on the advisory board for Thoracic Society of Australia and New Zealand, and Lung Foundation of Australia; and served as a speaker for Boehringer Ingelheim, GlaxoSmithKline, and Thoracic Society of Australia and New Zealand. J.D.T. served on the data safety and monitoring board for Lift Study; and received research support from National Institutes of Health. A.E.T. served as a consultant for Medical Science Affiliates; and received research support from NHLBI. S.E., M.L.C., K.R.C., M.F., T.K.F., P.M.F., L.G., T.G., E.K.K., J.L., M.L.M., D.E.M., J.E.N., C.H.R., D.H.S., and A.M.W., reported no commercial or relevant noncommercial interests from ineligible companies. Funding Information: research support from the Sojourns Scholar Leadership Program Award of the Cambia Health Foundation. A.S.I. served as a consultant for AstraZeneca; and received research support from National Institute on Aging and National Institutes of Health. L.F.R. served on a data safety and monitoring board for Hospice & Palliative Nursing Association Board of Directors; served as a speaker for UpToDate; received travel support from University of Utah, College of Nursing, Professional Development Funds; and received research support from Department of Veterans Affairs Health Services. C.E.C. received research and travel support from National Institutes of Health; and served on the data safety and monitoring board for National Institute on Aging. C.H. served as the elected leader of the ethics section of the European Society of Intensive Care Medicine; and received research support from Innovations Fund of the German Federal Joint Committee and European Society of Intensive Care Medicine. D.J.A.J. served as a speaker for Abbott, Boehringer Ingelheim, and Chiesi; served on a data safety and monitoring board for BETTER-B and Wolfson Palliative Care Research Centre Hull U.K.; and received research support from the Netherlands Organization for Health Research and Development and Stichting Astmabestriiding. K.O.L. received research support from U.S. Department of Health and Human Services, National Institutes of Health, and National Institute of Nursing Research; received travel support from the University of Pittsburgh, and Medical University of South Carolina; and holds a patent for A Program of SUPPORTÔ. M.M. received research support from National Institute for Health and Care Research U.K. R.A.M. served as a consultant for eThera; and received research support from and served on an advisory committee for GlaxoSmithKline. E.R. served as a speaker for and received travel support from North American Cystic Fibrosis Conference. N.S. served on the advisory board for Thoracic Society of Australia and New Zealand, and Lung Foundation of Australia; and served as a speaker for Boehringer Ingelheim, GlaxoSmithKline, and Thoracic Society of Australia and New Zealand. J.D.T. served on the data safety and monitoring board for Lift Study; and received research support from National Institutes of Health. A.E.T. served as a consultant for Medical Science Affiliates; and received research support from NHLBI. S.E., M.L.C., K.R.C., M.F., T.K.F., P.M.F., L.G., T.G., E.K.K., J.L., M.L.M., D.E.M., J.E.N., C.H.R., D.H.S., and A.M.W., reported no commercial or relevant noncommercial interests from ineligible companies. Publisher Copyright: Copyright © 2022 by the American Thoracic Society.

King's Authors

Abstract

Background: Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes. Goals: This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this. Methods: An international and interprofessional expert committee, including patients and caregivers, achieved consensus across a diverse working group representing pulmonary-critical care, palliative care, bioethics, health law and policy, geriatrics, nursing, physiotherapy, social work, pharmacy, patient advocacy, psychology, and sociology. Results: The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains: 1) delivery models, 2) comprehensive symptom assessment and management, 3) advance care planning and goals of care discussions, 4) caregiver support, 5) health disparities, 6) mass casualty events and emergency preparedness, and 7) research priorities. The recommendations encourage timely integration of palliative care, promote innovative primary and secondary or specialist palliative care delivery models, and advocate for research and policy initiatives to improve the availability and quality of palliative care for patients and their caregivers. Conclusions: This multisociety policy statement establishes a framework for early palliative care in serious respiratory illness and provides guidance for pulmonary-critical care clinicians and policymakers for its proactive integration.

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