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Defining supportive care - the boundaries and challenges. Davina Porock RN PhD Professor of Nursing Practice The University of Nottingham. Questions. What do we mean by supportive care? How might we as cancer nurses deliver this in practice? . Who is we?.
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Defining supportive care - the boundaries and challenges Davina Porock RN PhD Professor of Nursing Practice The University of Nottingham
Questions • What do we mean by supportive care? • How might we as cancer nurses deliver this in practice?
Who is we? • Nursing, medical, social work, allied health perspectives? • One interprofessional/interdisciplinary perspective?
Terminology Support Care Supportive care Palliative Care
Meaning Support – being supportive Care – being caring (carative) Supportive care – ? Palliative Care – ?
Support – scope • Educational • Emotional • Environmental • Financial • Formal • Informal • Informational • Moral • Occupational • Physical • Psychological • Social • Technical
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
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
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)
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.
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
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)
Boundaries • What • Where • When • Who • How
TheCancerTrajectory Survival Diagnosis Remission Treatment Recurrence Recovery Dying HEALTH TIME
WHO model of palliative careservices Palliative Care Anticancer Treatment Bereavement Care Diagnosis Death
1st modification WHO model Palliative Phase Anticancer Treatment phase – curative intent Bereavement Phase Diagnosis Death
2nd Modification WHO model Palliative Phase Anticancer Treatment Phase – curative intent Bereavement Phase Diagnosis Death Palliative Treatment – non curative intent
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
3rd Modification WHO model Supportive Care Phase Palliative Phase Anticancer Treatment Phase – curative intent Bereavement Phase Diagnosis Death Palliative Treatment – non-curative intent
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
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
Supportive Care Model http://www.health.vic.gov.au/cancer/rscs/supportive-care-model.gif
Challenges • Supportive care and cancer nursing practice • Articulate nursing knowledge and its application to cancer practice • Build the evidence base • research and reflection • Nurse