Supportive care: psychological, social and spiritual aspects

Patients with heart failure are affected in all aspects of their lives, and patients facing a life-limiting illness should receive attention to their spiritual and psycho- social needs, as well as the physical.1 The physical symptoms and disabilities reach out and entangle the way they cope, their emotional buoyancy, their ability to work (and hence their finances), and their role in society and within their family. It spreads to their very meaning of life and affects their family and others caring for them. Conversely, social stability and supports, financial security, liv- ing accommodation and neighbourhood will affect coping and the ease with which help can be accessed. Supportive care is an essential part of management, but its importance has only recently been emphasised alongside that of medical care. In fact, the perception that the doctor has little or no role in anything other than medication can leave the practitioner feeling helpless and frustrated. A realisation that all healthcare professionals can recognise the multi-domain is- sues affecting their patients, deal with what they can and refer to appropriate other agencies or professionals as necessary would lead to such supportive care. Supportive care is defined by the National Council for Palliative Care as care that: … helps the patient and their family to cope with cancer and treatment of it - from pre-diagnosis, through the process of diagnosis and treatment, to cure, continuing illness or death and bereavement. It helps the patients to maximise the benefits of treatment and to live as well as possible with the effects of the disease. It is given equal priority alongside diagnosis and treatment.2 The level and type of support that should be available for adults with cancer is detailed in the NICE guidelines.3 A helpful adaptation of these with reference to patients suffering from heart failure has been produced by the Coronary Heart Disease Collaborative in the UK (recently renamed 'Heart Improvement Project').4 Until recently, most research studies and health service developments for people with heart failure focused on medication to reduce mortality and breathlessness, and interventions to prevent hospital readmissions. However, a number of recent studies have sought to gain an understanding of the lived experience of people with heart failure and their informal and professional carers, which can be used to inform the development of a broader range of services that are suitable, acces- sible and acceptable to patients and carers.5-13 In a recent study in Edinburgh, 20