What is Supportive Care?
Supportive care is a multidisciplinary approach aimed at improving health-related quality of life for patients and their families facing serious illness through prevention and relief of suffering via early identification, assessment, and treatment of physical, psychosocial, and spiritual problems—provided alongside disease-directed therapies at any stage of illness, not just at end of life. 1
Core Definition and Conceptual Framework
The term "supportive care" is preferred over "palliative care" by both patients and healthcare professionals, though they share similar philosophical underpinnings. 1 The World Health Organization defines palliative care as an approach that improves quality of life through prevention and relief of suffering by means of early identification and treatment of pain and other problems—physical, psychosocial, and spiritual. 1 However, supportive care is the broader, more acceptable terminology in clinical practice. 1
Supportive care can be provided concurrently with life-prolonging treatments such as chemotherapy, dialysis, or other disease-modifying therapies—it is not limited to patients near death. 1 This distinguishes it from hospice/end-of-life care, which typically focuses on patients believed to be within months of death. 1
Key Components of Supportive Care
Supportive care encompasses several essential domains:
Physical Symptom Management
- Systematic assessment and treatment of symptoms including pain, dyspnea, fatigue, nausea, and other physical complaints using validated screening tools. 1
- Regular symptom screening redirects treatment toward patient-centered care models and facilitates discussions about appropriate care options. 1
- Both pharmacologic and non-pharmacologic interventions should be employed, with evidence suggesting that nursing interventions, counseling, and psychotherapeutic approaches can improve quality of life. 1
Psychosocial and Emotional Support
- Universal distress screening, monitoring, and treatment is now a standard of care, with implementation required by accrediting bodies. 1
- Assessment should occur at critical points in the disease trajectory including new diagnosis, completion of treatment, and relapse. 1
- Counseling may improve coping with emotional distress, and the importance of a supportive, empathic relationship with appropriately trained professionals is central to intervention success. 1
Spiritual and Cultural Dimensions
- Comprehensive assessment must address spiritual well-being and cultural factors that influence patient and family preferences. 1
- Care should align with patients' values, preferences, and goals. 1
Caregiver Support
- Family members and caregivers experience high levels of fatigue, worry, and distress that directly impacts patient well-being, making caregiver assessment and support an integral component of comprehensive patient care. 1
- Engaging in relationship maintenance during early treatment periods may help build more resilient relationships as disease progresses. 1
Delivery Models and Team Approach
Supportive care is typically delivered by an interdisciplinary team that may include medical oncologists, nephrologists, organ specialists, geriatricians, palliative care clinicians, pain specialists, nutritionists, psycho-oncologists, social workers, physiotherapists, nurses, and allied health workers. 2, 3
The field distinguishes between:
- Primary supportive care: Skills all clinicians should possess, including management of uncomplicated pain/symptoms and essential discussions about prognosis, goals, code status, and quality of life. 1
- Secondary/tertiary supportive care: Specialized services provided by palliative care teams and other specialists for complex symptom management. 4, 3
Clinical Application Across Disease Trajectories
Supportive care should be a core component of care at all stages of illness, regardless of prognosis, beginning at diagnosis and continuing through treatment, survivorship, and end of life. 1
Key Clinical Touchpoints
- Shared decision-making and advance care planning discussions. 1
- Pain and symptom management throughout the disease course. 1
- Assistance with treatment decisions, including the option of medical management without aggressive interventions when appropriate. 1
Common Pitfalls to Avoid
Do not artificially separate psychological and physical aspects of symptoms—an integrated approach matching patients' and families' needs, wishes, and circumstances is essential. 1 The link between emotions and physical health provides theoretical basis for interventions that improve both psychological and physical functioning simultaneously. 1
Avoid delaying supportive care referrals until patients are near death. 1 The evidence demonstrates that early integration of supportive care improves outcomes and quality of life throughout the illness trajectory. 1, 2, 3