A “PalliPulm” Framework to Improve Palliative Care Education and Practice in Pulmonary-Critical Care Medicine: An Official American Thoracic Society Workshop Report

Abstract Despite numerous calls to action, palliative care remains inadequately integrated into pulmonary-critical care medicine (PCCM) practice and is de-emphasized in PCCM education. Barriers to specialty palliative care demonstrate a clear need for efficient and effective primary palliative care delivered by PCCM clinicians with advanced training. This American Thoracic Society Workshop Report builds on our policy statement on the proactive integration of palliative care in serious respiratory illness with two goals: 1) Develop a scalable “PalliPulm” framework to improve palliative care education and practice in PCCM, and 2) Inform palliative care-focused education and training programs to guide future PCCM initiatives. We convened an interdisciplinary and interprofessional group of experts between May 2024-February 2025 over 4 phases: 1) Hybrid workshop; 2) Virtual breakout groups; 3) Nominal group technique and rapid qualitative analysis; and 4) Workshop report development. We identified core primary palliative care skills that PCCM trainees and clinicians should obtain and prioritized the most essential skills, ie, symptom management, serious illness communication, and caregiver support in ambulatory settings and serious illness communication, symptom management, palliative care fundamentals, and end of life care in inpatient settings. We describe pragmatic ways to integrate palliative care into PCCM education and offer advanced educational resources. We provide recommendations for framing palliative care to patients and caregivers, illustrate ways to deliver culturally appropriate palliative care, and offer guidance for the future. This report guides PCCM leaders, trainees, and clinicians to establish scalable PalliPulm educational and practice initiatives and improve its integration into practice.