What is Supportive Care?

Definition

The World Health Organization defines palliative care, or supportive care, as an approach aimed at improving the quality of life of patients and their families facing problems associated with life-threatening illnesses, through the prevention and relief of suffering by means of early identification and impeccable management of pain and other physical, psychological, social, and spiritual problems.

Supportive care, therefore, encompasses a range of therapeutic, diagnostic, and assistance interventions. These interventions are not solely focused on the patient or solely aimed at reducing pain associated with their illness; they also support their emotional and psychological well-being, as well as that of their family.

Generally, supportive care is intended for patients diagnosed with a terminal illness (i.e., an illness no longer responding to any therapy and thus destined for negative progression) with a duration of approximately 12 months. The most frequent cases unfortunately involve oncological diseases, but also often cardiological and respiratory diseases.

Indeed, palliative care is a set of pharmacological and non-pharmacological therapies aimed at improving the patient's quality of life by accompanying and supporting them throughout their illness.

When is it needed?

Palliative or supportive care is primarily intended for individuals who have reached the terminal phase of any chronic and progressive disease. This is why supportive care is most known in oncology, but it's important to remember that it can also be used in cases of certain neurological, respiratory, and cardiological diseases. Palliative care is also intended for individuals still receiving therapies aimed at treating an illness (e.g., chemotherapy) with the goal of improving their quality of life. In this case, we speak of early or concurrent palliative care.

The palliative care strategy addresses people of all ages who, due to cancer or a chronic progressive disease, are in an advanced or terminal phase.

Supportive care should begin in the early stages of diagnosis of a potentially life-threatening illness, concurrently with curative treatments. Similarly, even in the later stages of the disease, where treatment is primarily palliative, curative measures may be attempted. However, bereavement may require care for an extended period.

Thus, the transition from curative to palliative care is often gradual. It should be based on the individual needs of the person rather than a specific expected survival time.

However, bereavement may require support for families over an extended period.

Palliative care cannot exist without pain management, which is often associated with the care of a person facing the final period of their life. Thus, supportive pain care utilizes both pharmacological methods against pain and non-pharmacological support methods (psychological, cognitive, behavioral, acupuncture, massage, physiotherapy, occupational therapy, meditation, art therapy, music therapy, etc.). Pain is, indeed, of all disorders (symptoms), the one that most impairs the patient's physical and psychological integrity and the one that most afflicts and worries loved ones, with a considerable impact on their quality of life. Some recent clinical studies also suggest the use of substances defined as psychedelics for the treatment of mood disorders at the end of life. These include cannabis, lysergic acid diethylamide (LSD), and psilocybin. However, the data obtained from these studies must be validated, and their risk/benefit ratio carefully assessed.

Particularly in oncology, the patient, along with their family and loved ones, consults with a specialist in supportive oncology care to choose the therapeutic approach best suited to their supportive cancer care needs.

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Goals of Supportive Care

The goals of supportive care are to provide the necessary comfort to the patient with an advanced illness and their loved ones. To achieve this, several objectives must be met:

• Relief of pain and other symptoms. Pain relief, provided by supportive pain care in advanced diseases, is a fundamental objective to ensure quality of life;
• Providing adequate information and communication. Another objective of palliative care is to provide information gradually while respecting the person's pace and maintaining open communication with the patient and their loved ones. If this is achieved, it reduces the stress and anxiety that can occur for both the patient and their loved ones;
• Respecting patient autonomy. Patients have the right to receive all information and make their own decisions, at the time or by means of documents such as advance directives. In this way, their autonomy is respected, the expression of their opinions is facilitated, and they are taken into account;
• Supporting and offering emotional support to family members and close relatives. Offering this support is fundamental, as families and loved ones can experience a significant emotional impact. Fear of their parent's suffering, uncertainty, insecurity, and helplessness are the main issues at this time. If healthcare professionals offer emotional support, the family will be calmer, and so will the patient;
• Meeting their spiritual needs. Knowing that palliative care is not limited to symptom control, it is essential to meet the person's spiritual needs. That is, allowing them to complete their own biography with dignity and courage, in harmony with others and to find their fulfillment;
• Assistance throughout the process. Palliative care involves care throughout the end-of-life process. This physical, emotional, social, and spiritual support for patients and their loved ones is offered throughout the process, that is, from information about the advanced illness to the bereavement of loved ones;
• Care for bereaved individuals. The bereavement process is associated with various physical and emotional symptoms. And taking care of them is also part of the work of palliative care professionals. Suffering the pain of losing a loved one, accepting reality, or adapting to the new situation without the person are some of the tasks of this process;

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