Defining supportive care - the boundaries and challenges

1. Defining supportive care - the boundaries and challenges Davina Porock RN PhD Professor of Nursing Practice The University of Nottingham

2. Questions • What do we mean by supportive care? • How might we as cancer nurses deliver this in practice?

3. Who is we? • Nursing, medical, social work, allied health perspectives? • One interprofessional/interdisciplinary perspective?

4. Terminology Support Care Supportive care Palliative Care

5. Meaning Support – being supportive Care – being caring (carative) Supportive care – ? Palliative Care – ?

6. Support – scope • Educational • Emotional • Environmental • Financial • Formal • Informal • Informational • Moral • Occupational • Physical • Psychological • Social • Technical

7. Support - definition • to keep from falling • bear, bolster, brace, buttress, carry, hold on, sustain • to help • be a source of strength, cherish, look after, nourish, provide for, take care of • to answer questions and resolve problems • authenticate, corroborate, document, verify, encourage • to back a cause • advocate, aid, assist, boost morale, champion, defend, go along with, stand behind, stand up for

8. Care/caring • 1. A burdened state of mind, as that arising from heavy responsibilities; worry. • 2. Mental suffering; grief. • 3. An object or source of worry, attention, or solicitude • 4. Caution in avoiding harm or danger • 5. a. Close attention; painstaking application b. Upkeep; maintenance • 6. Watchful oversight; charge or supervision • 7. Attentive assistance or treatment to those in need

9. Supportive Care • Services that are provided in addition to curative treatments for cancer patients (Dept of Health 2000) • Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called palliative care, comfort care, and symptom management. (National Cancer Institute, USA)

10. Multinational Association for Supportive Care in Cancer Supportive Care Makes Excellent Cancer Care Possible • …is the prevention and management of the adverse effects of cancer and its treatment. This includes the management of physical and psychological symptoms and side effects along the continuum of cancer experience from diagnosis through ant-cancer treatment to post-treatment care. Enhancing rehabilitation, secondary cancer prevention, survivorship and end of life care are integral to supportive care.

11. MASSC… • Supportive care: • alleviates symptoms and complications of cancer • reduces or prevents toxicities of treatment • supports communication with patients about their disease and prognosis • allows patients to tolerate and benefit from active therapy more easily • eases emotional burden of patients and caregivers • helps cancer survivors with psychological and social problems

12. Support and nursing • Nursing is the use of clinical judgement in the provision of care to enable people to improve maintain, or recover health, to cope with health problems, and to achieve the best quality of life, whatever their disease or disability, until death (RCN, 2003)

13. Boundaries • What • Where • When • Who • How

14. TheCancerTrajectory Survival Diagnosis Remission Treatment Recurrence Recovery Dying HEALTH TIME

15. WHO model of palliative careservices Palliative Care Anticancer Treatment Bereavement Care Diagnosis Death

16. 1st modification WHO model Palliative Phase Anticancer Treatment phase – curative intent Bereavement Phase Diagnosis Death

17. 2nd Modification WHO model Palliative Phase Anticancer Treatment Phase – curative intent Bereavement Phase Diagnosis Death Palliative Treatment – non curative intent

18. SupportiveCare • Patient focused • Support of patients from screening through treatment and into palliative phase • Management of cancer symptoms and side effects of treatment • Acute • Chronic • Holistic intent • Psycho-oncology • Multidisciplinary • Complementary therapies

19. 3rd Modification WHO model Supportive Care Phase Palliative Phase Anticancer Treatment Phase – curative intent Bereavement Phase Diagnosis Death Palliative Treatment – non-curative intent

20. 4th Modification of WHO model DyingCare Supportive Care Phase Palliative Phase Anticancer Treatment Phase – curative intent Bereavement Phase Diagnosis Death Palliative Treatment – non-curative intent Bereavementpreparation

21. 5th Modification of WHO model Palliative Treatment – non-curative intent Dying Care Death Diagnosis Supportive Care Phase Palliative Phase P Anticancer Treatment Phase – curative intent Grieving Phase Other responsibilities C Caregiving Phase Bereavement Caregiving begins Bereavementpreparation

22. Supportive Care Model http://www.health.vic.gov.au/cancer/rscs/supportive-care-model.gif

23. Challenges • Supportive care and cancer nursing practice • Articulate nursing knowledge and its application to cancer practice • Build the evidence base • research and reflection • Nurse