Table 1.

Policy Statement Definitions

Serious respiratory illness (6)	A respiratory condition (e.g., chronic obstructive pulmonary disease, pulmonary hypertension, interstitial lung disease, lung cancer, etc.) that carries a high risk of mortality and symptom burden (e.g., dyspnea and depression) and either negatively impacts a person’s daily function or quality of life or negatively impacts their caregivers.
Hospice care	This care is not synonymous with palliative care. Hospice care is specialized care for people who are experiencing a life-limiting illness and their caregivers so that they may live as comfortably as possible. The hospice philosophy accepts death as the final stage of life but does not try to hasten or postpone death. Bereavement services and respite care (i.e., short-term relief) for families are a core component of this care. Settings can include inpatient units, community facilities, and in-home care or a combination of these on the basis of needs. In the United States, the Centers for Medicare and Medicaid Services provides a hospice care program for people with a life expectancy of 6 mo or less.
ACP	This is a process that supports persons “at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. The goal of ACP is to help ensure that people receive medical care that is consistent with their values, goals, and preferences during serious and chronic illness” (7).
GOC discussions	This term is sometimes used in a narrow sense, specifically referring to discussions regarding resuscitation preferences or “code status” during hospitalizations. This policy statement employs a broader definition of this term, meaning any discussions and/or decisions regarding specific treatments, the intensity of care, and future planning for care, including values, goals, and preferences elicitations. GOC discussions are expected to occur across healthcare settings and are considered an important component of ACP.
Informal caregiver or caregiver	A person (e.g., partner, family member, or friend, among others) who provides unpaid support for the medical needs or daily activities of someone living with a serious respiratory illness. This committee acknowledges that this terminology frames these individuals only in terms of the patient and the patient’s needs and does not encompass the totality of caregiver responsibilities, contributions, or their own need for more individualized support and recognition.
Surrogate	A person designated to make decisions related to the health care of an individual in the event that he or she is unable to do so (i.e., the patient is incapacitated). This person could be designated in a legal document called an HCPA. The HCPA refers to both the legal document and the person designated to make healthcare decisions. In lieu of a legal document, there are state-specific guidelines for who is the legally recognized person able to make health decisions (e.g., spouse, adult child, etc.). Surrogate decisions are often guided by the substituted judgment principle, in which a surrogate should attempt to determine what the patient would have wanted under the given circumstances or what the patient would have decided if he or she were competent to choose (8).
Types of palliative care (9, 10)
Primary	Care is provided by clinicians who are trained in basic tenets of palliative care but are not palliative care specialists (e.g., pulmonary and critical care clinicians, primary care clinicians, etc.).
Secondary	Care provided by trained palliative care specialists (e.g., nurses, physicians, advance practice providers, social workers, chaplains, etc.). This care is sometimes referred to as specialist palliative care.
Tertiary	Care provided by trained palliative care specialists at tertiary and quaternary medical centers and includes caring for the most complex patients. This may include care in dedicated palliative care units.

Definition of abbreviations: ACP = advanced care planning; GOC = goals of care; HCPA = medical or healthcare power of attorney.