Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks

Abstract

Purpose: Commonly used terms such as "supportive care," "best supportive care," "palliative care," and "hospice care" were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms.

Methods: We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched.

Results: Nine of 32 "SC/BSC," 25 of 182 "PC," and 12 of 42 "HC" articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. "SC" focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, "HC" focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both "PC" and "SC/BSC" were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for "SC/BSC," "PC," and "HC," respectively. "SC/BSC" was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings.

Conclusion: We identified defining concepts for "SC/BSC," "PC," and "HC" and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.

Fig. 1

Search strategy for articles that defined “palliative care,” “supportive care,” “best supportive care,” and “hospice care”

Fig. 2

A conceptual framework toward understanding “supportive care,” “palliative care,” and “hospice care.” Based on our systematic review, the stage of disease was a key distinguishing factor among “best/supportive care,” “palliative care,” and “hospice care.” Thus, the different stages of disease are depicted at the bottom, with solid arrows showing that patients can shift from one stage to another. The patient population and scope of service for “supportive care,” “palliative care,” and “hospice care” is shown by the horizontal bars above. Under this model, “hospice care” is part of “palliative care,” which in turn, is part of “supportive care.” Importantly, the dashed boxes illustrate the evolving nature of these definitions to expand their scope of service. For instance, in addition to providing care to patients on treatment, some of the definitions of “supportive care” also included a more comprehensive description involving cancer survivors and the bereaved. Similarly, an increasing number of articles suggest that “palliative care” should start from the time of diagnosis. Other distinguishing features among the three terms are listed on the right hand side