ATS Reading List

Palliative Care

Society Statements & Guidelines

Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med 2008; 36:953-63. Provides an overview of ethical issues as well as a compassionate approach to practical aspects of end-of-life care.
PMID: 18431285

Lanken PN, Terry PB, DeLisser HM, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008;177:912-27. Overlap with above ACCM statement but offers additional worthwhile discussion of hospice eligibility and on timing and settings for palliative care.
PMID: 18390964

Bosslet, GT, Pope T, Rubenfeld GD, et al. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: Responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med 2015; 191:1318-1330. This consensus statement differentiates between the terms, "futile", and, "potentially inappropriate", reserving the former for when "surrogates request interventions that simply cannot accomplish their intended physiologic goal." They also recommend implementing proactive strategies to prevent conflict at the institutional level, while engaging the public to implement change at the health policy and legislative level.
PMID: 25978438

End of Life Discussions with Patients and Families

Clinical Trials

White DB, Evans LR, Bautista CA, et al. Are physicians’ recommendations to limit life support beneficial or burdensome? Bringing empirical data to the debate. Am J Respir Crit Care Med. 2009;180:320-5. This study questions current professional society guidelines’ recommendation for physicians to routinely provide a recommendation regarding limitation of life support. 169 surrogate decision makers of current ICU patients participated in a standardized video conference regarding end of life cares for a hypothetical patient. 42% percent of participants preferred not to receive a physician’s recommendation. Study limitations include possible selection bias, single-center study, and use of a hypothetical encounter, which does not take into account the effect of serial physician-family encounters that typically precede goals of care discussions.
PMID: 19498057

Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 2007; 356:469-78. This French study of family members of 126 patients that died in an ICU found the use of a brochure on bereavement combined with a proactive communication strategy lowered symptoms of anxiety, depression, and PTSD.
PMID: 17267907
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Carson S, Cox C, Wallenstein S, et al. Effect of palliative care–led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA. 2016; 316:51-62. This trial of usual care (ICU-led family meetings + brochure) vs Palliative Care-led conferences + brochure for patients with chronic critical illness and their families found no difference in family anxiety or depression. The Palliative Care intervention group may have increased risk of PTSD. The authors conclude that routine palliative care consult is not indicated, but remains important for select cases.
PMID: 27380343
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Practical Guidance

Tonelli MR. Pulling the plug on living wills. Chest 1996;110:816-22. Discusses the difficulties and limitations of formulating and applying advanced directives.
PMID: 8797430
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Scheunemann LP, Arnold RM, White DB. The facilitated values history: helping surrogates make authentic decisions for incapacitated patients with advanced illness. Am J Respir Crit Care Med. 2012;186(6):480-6 This article offers a practical framework for how best to assist surrogate decision-makers with the challenge of determining, and applying, patients’ values to medical decision-making in this population.
PMID: 22822020

Billings JA, Block SD. The end-of-life family meeting in intensive care part III: A guide for structured discussions. J Palliat Med 2011; 14:1058-64. Offers an explicit step-by-step blueprint for approaching family conferences while recognizing the need for flexibility depending on family and patient circumstances. Provides sample language useful for navigating difficult aspects of decision-making.
PMID: 21910613
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Last Reviewed: June 2017