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Social Support

Key Messages

  • The social support of people receiving palliative care is essential to increase feelings of self-worth and to reduce symptoms of distress. [1]
  • Regular screening of distress can be valuable throughout the palliative care journey. [2]
  • Particular attention should be paid to the social support for older adults receiving palliative care, particularly those who are house-bound, living in rural and remote areas, or from a culturally and linguistically diverse (CALD) background. [3,4]
  • Support for older adults to connect with likeminded people can be beneficial. [1,5]
  • Ideally a palliative care team would be multidisciplinary and, where appropriate, interdisciplinary to discuss and consider the many aspects of care. [5]

Background

The health of individuals is partly dependent on their relationships and the social structures in which they live. [3] Palliative care is an approach to healthcare that seeks to optimise quality of life for the individual and their family and carers. A return to a public health approach in delivering palliative care services is suggested to better meet social challenges such as isolation, inequity of access to services and spirituality, while maintaining dignity in dying. [6] It is proposed that social effects of illness and dying may actually be best managed by friends or community members rather than healthcare professionals. [3,6]

This page highlights the benefits of social support systems for palliative care recipients and the need for more robust evidence on this topic.

Readers may also find pages on supporting Family Carers useful.
 

Evidence Summary

A central philosophy to palliative care is the recognition of the family and carers as inclusive to the care approach, however literature suggests the support network should be wider still. Sociological research looking at supportive environments for people with life-limiting illness and their carers have found relationships between community characteristics, health and wellbeing and health access. [3,6] Social support can be represented at a structural level such as organised programs utilising cognitive behavioural or mindfulness techniques; or more informal support groups and services as well as the support offered by individuals within the community.

Arts, cultural, religious and entertainment programs were found to foster trust, social inclusion and self-esteem to the people accessing them. [1-3] Hospice day-care programs were particularly well received, offering an outlet to be ‘normal’ and connect with other likeminded people whilst feeling secure in the environment and availability of medical staff. [1,7] As an alternative, more informal online blogging and networking sites were also successful in fostering social networks and empowering some individuals to be more active in their health management. [3,4]

However, it is important to realise that the availability of social support does not mean social isolation does not still occur. Often formalised support groups or programs are biased towards the dominant culture or language within the health context, marginalising culturally and linguistically diverse (CALD) groups. [3] In addition, individuals from lower socioeconomic groups are more likely to be distrusting and less likely to interact with organised support groups. This compounded by possible age-related barriers and older adults feeling external supports are less physically accessible, while also not possessing the skills to engage in online formats, can mean they continue to feel isolated from external social support. [3] It is therefore important to tailor support to the individual, their budget and needs, and may require additional arrangement for transport and language services. [5]

The National Institute for Health and Care Excellence (NICE) guidelines for ‘Older people with social care needs and multiple long term-conditions’, [5] state that a named coordinator should be responsible for assisting to prioritise the support needs for the individual; and could include psychological, emotional, social, sexual, spiritual and cultural needs or help with sight, hearing and communication or adjustment of their environment. The guidelines identify the importance of people being able to be cared for in their own home, being able to take part in preferred activities and interests which may include linking in with community services. The support plan should aim to be individualised but designed to assist in reducing isolation and distress to the individual. [5]
 

Quality Statement

Overall the evidence contributing to this topic is of poor quality, and of low applicability to older adults in a palliative care setting.

 

Page updated 23 May 2017
 

  • References

  • About PubMed Search

  1. Bradley SE, Frizelle D, Johnson M. Patients' psychosocial experiences of attending Specialist Palliative Day Care: a systematic review. Palliat Med. 2011 Apr;25(3):210-28. Epub 2011 Jan 12.
  2. Artherholt SB, Fann JR. Psychosocial care in cancer. Curr Psychiatry Rep. 2012 Feb;14(1):23-9.
  3. Lewis JM, DiGiacomo M, Luckett T, Davidson PM, Currow DC. A social capital framework for palliative care: supporting health and well-being for people with life-limiting illness and their carers through social relations and networks. J Pain Symptom Manage. 2013 Jan;45(1):92-103. Epub 2012 Jul 11.
  4. Ngwenya NB, Mills S. The use of weblogs within palliative care: a systematic literature review. Health Informatics J. 2014 Mar;20(1):13-21. Epub 2013 Aug 30.
  5. National Institute for Health and Care Excellence (NICE). Older people with social care needs and multiple long-term conditions [Internet]. 2015 Nov [cited 2017 May 4].
  6. Sallnow L, Richardson H, Murray SA, Kellehear A. The impact of a new public health approach to end-of-life care: A systematic review. Palliat Med. 2016 Mar;30(3):200-11. Epub 2015 Aug 12.
  7. Black J. What are patients' priorities when facing the end of life? A critical review. Int J Palliat Nurs. 2011 Jun;17(6):294-300.

Definition

Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc.

This also includes psychosocial support:
MeSH HEADING: PSYCHOSOCIAL SUPPORT SYSTEMS
SCOPE: Organized efforts to address ongoing psychological and social problems of individuals, their partners, families and caregivers.

Search strategy

(social support[mh] OR (((Support[ti] OR network*[ti] OR connect*[ti]) AND (friend*[ti] OR peer*[ti] OR psychosocial[ti] OR social[ti] OR community[ti] OR church*[ti] OR informal[ti] OR neighbo*[ti])) NOT medline[sb]))