Am J Respir Crit Care Med. 2022 Sep 15;206(6):e44-e69. doi: 10.1164/rccm.202207-1262ST.
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. 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. 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. The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains: ) delivery models, ) comprehensive symptom assessment and management, ) advance care planning and goals of care discussions, ) caregiver support, ) health disparities, ) mass casualty events and emergency preparedness, and ) 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. 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.
患有严重呼吸系统疾病的患者及其护理人员承受着巨大的负担，姑息治疗是任何有需要的人的基本权利。然而，绝大多数患者在生命结束前都没有得到及时的姑息治疗，尽管有大量证据表明姑息治疗可以改善预后。美国胸科学会（ATS）和合作学会的这份政策声明倡导在严重呼吸系统疾病患者及其护理人员的护理连续体中尽早整合高质量的姑息治疗，并为临床医生和政策制定者提供实现这一目标的框架。一个由国际和跨专业专家组成的委员会，包括患者和护理人员，在一个代表肺危重病学、姑息治疗、生物伦理学、卫生法和政策、老年医学、护理、物理治疗、社会工作、药学、患者宣传、心理学和社会学的多样化工作组中达成了共识。该委员会制定了在严重呼吸系统疾病护理中整合姑息治疗的基本价值观、原则和政策建议，涵盖七个领域：）交付模式，）全面症状评估和管理，）预先护理计划和目标讨论，）护理人员支持，）健康差异，）大规模伤亡事件和应急准备，）研究重点。这些建议鼓励及时整合姑息治疗，促进创新的初级和二级或专科姑息治疗交付模式，并倡导研究和政策举措，以改善患者及其护理人员姑息治疗的可及性和质量。这项多学会政策声明为严重呼吸系统疾病中的早期姑息治疗建立了框架，并为肺危重病学临床医生和政策制定者提供了积极整合的指导。
