Assessing the perception of the concepts of symptomatic and supportive treatment among medical personnel and medical students

Introduction

Nowadays, palliative care and end-of-life medicine are receiving increasing attention from medical professionals. These fields also interest the public and the sociopolitical sphere. It’s challenging to find another area of modern medicine that has developed so significantly in such a short time. The dynamics and versatility of changes in this medical field have had a major impact on society and on how we perceive and experience illness and all its implications. Essential objectives for palliative medicine include the assessment and management of physical, psychological and spiritual suffering faced by patients with life-limiting diseases and their families. Communication and teamwork are also critical skills in this medical branch.

The need for palliative care worldwide is immense. According to the World Health Organization (WHO), noncommunicable diseases now account for the top ten causes of mortality in low-, middle-, and high-income nations. As a result, identifying palliative care requirements is a critical first step in delivering palliative care to these patients with terminal diseases⁽¹⁾.

An increasing number of individuals can be assured that the end of their lives will be marked by dignity, without having to endure unbearable pain. Caring for these individuals is one of the main responsibilities of medical personnel, both doctors and nurses, who are highly specialized, devoted, empathetic and well-trained in palliative care. Although the symptoms’ profile and problems of patients with different chronic progressive conditions are similar, the disease trajectories are likely to vary. Additionally, caring for the elderly, an increasingly large part of the population directed towards palliative care faces specific challenges, particularly iatrogenic disease, multiple pathologies, and prognostic difficulties⁽²⁾.

In the first decades of palliative care development, there was an impressive and global expansion of clinical programs. It soon became evident that palliative care programs needed to expand progressively, yet rapidly and firmly, from the community to major universities. The body of knowledge in palliative care began to grow, and the need for research became evident. The increase in clinical programs, the variety of locations where palliative care was delivered and the expansion of the knowledge base, along with the need for research, led to the development of palliative medicine as a specialty. The move towards accreditation is extremely important, as it allows palliative care practitioners to obtain standardized training and be recognized for their expertise, start clinical programs to establish benchmarks for their operations, institutions and governments to allocate healthcare resources, and researchers to appropriately evaluate the structures, processes and outcomes associated with palliative care services^(3,4).

The number of locations designated for palliative care, hospice locations and other similar facilities is continually increasing, a trend visible over the past few decades. It is extremely problematic that there is no common language to accurately describe what constitutes palliative care service provision, the role of the physician in palliative care, and the limits of their profession. Another example of commonly encountered ambiguity in medical practice is the inconsistency between the use of the terms “supportive treatment” and “symptomatic treatment”, though both approaches are essential in managing patients with chronic or terminal conditions⁽⁵⁾.

Supportive treatment refers to a wide range of therapies intended to improve the patients’ quality of life, providing support for their physical, psychological and social needs, without necessarily having a direct effect on the cause of the disease. On the other hand, symptomatic treatment focuses on alleviating the specific symptoms of the disease, without addressing the underlying cause. Although the goal of both approaches is to improve the well-being of the patient, the discrepancy between them reflects a subtle difference in focus and therapeutic objectives. This distinction is crucial for proper care planning, highlighting the need for a clear understanding of both concepts by healthcare professionals to ensure holistic and personalized care for patients. There is a considerable overlap (without a clear differentiation) between the use of the terms “palliative care” and “supportive care”. However, supportive care should not be used synonymously with palliative care⁽⁶⁾.

Building on the exposition of this issue, the current research aims to explore and critically evaluate the level of knowledge among the care team, as well as among medical students at the Faculty of Medicine of the “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania, focusing on the evaluation of perceptions of symptomatic and supportive treatment notions. The goal is to determine whether there is a correct alignment between the practical experiences of health professionals and the theories presented in the literature relevant to this field.

Materials and method

The original study, conducted between April and May 2022, involved 125 participants. Information was obtained through a questionnaire drafted in Google Forms, which was then distributed to be completed digitally by medical personnel eligible for this study. The questionnaire consisted of eight questions. The inclusion criteria were: individuals working in the medical field as medical staff, nurses, psychologists, and medical students (from all years of study). Data confidentiality was maintained throughout the study, with data being used exclusively for scientific purposes.

Results

The majority of the respondents to this questionnaire were medical students, making up 44.7% of the total responses. Medical staff accounted for 34.1% of the total responses, while the percentage of nurses who participated was 16.3%. The remainder, up to 100%, was represented by psychologists.

Respondents to this questionnaire reported that 48% of them had five years or less than five years of experience in their current profession, while 22.5% claimed to have been in the profession for 5-10 years. Also, 7.8% of the respondents stated that their experience in the current profession totaled 10-15 years, while 21.6% of participants reported having more than 15 years of experience in their respective profession. This distribution of the duration of current professional practice denotes a contrast between the majority of respondents (48%), who do not have extensive experience in the current profession, a transition zone, or a gap for the 5-10/10-15-year interval, and again, a significant proportion of respondents in the last category, with over 15 years of experience. Thus, there was a heterogeneity in the level of lifelong expertise and medical experience, as well as contrasts in the conception of palliative care.

About three-quarters (76.4%) of the respondents considered that symptomatic treatment does not aim to cure the causes of a particular condition, while 23.6% of respondents answered the opposite. This distribution of responses provides information that medical personnel have a predominantly correct perception of the notion of symptomatic treatment.

Regarding the linguistic overlap and synonymy concerning the notion of supportive treatment, 41.5% of respondents believed that “comfort care” is an alternative term, synonymous with supportive treatment. Similarly, 31.7% of respondents said this about “symptom management”, which is also true. A large part of those who responded to this questionnaire (i.e., 49.6% of people) said that the notions of “supportive treatment” and “palliative care” are superimposable. Finally, only 26% of the respondents stated that the notions of supportive treatment and symptomatic treatment were equivalent.

Continuing to explore the linguistic boundaries of the notion of supportive treatment, 63.4% of the respondents said that this notion is not equivalent to palliative care. Concurrently, 36.6% of the questionnaire sample stated the opposite. This fact once again denotes the ambivalence of respondents regarding these notions, which are superimposable up to a point but have fundamentally different causes, approaches, and implications.

When asked about the moment when patients should receive palliative care, the responses provided were surprising and very telling: 63.4% of the respondents believed that palliative care begins when curative treatments can no longer be applied, along with another 10.6% of the respondents who considered that it begins in the final stage of the disease. Only a percentage of 26% considered that palliative care begins with the diagnosis – i.e., as early as possible. This distribution of responses suggests that the respondents associate the concept of palliative care with the end of all curative solutions and, in the majority’s conception, the tendency is to initiate it as late as possible. This can cause communication errors with the patients, subjecting them to physical and emotional suffering that could potentially be avoided or alleviated if palliative care were initiated early in the disease’s progression.

To the question “Have you noticed that the proportion of patients receiving supportive treatment has increased in the last five years in your profession?”, 60.2% of the respondents said they noticed an increase in the number of patients benefiting from supportive treatment, while the rest (39.8%) stated the opposite. This type of response suggests that the number of people suffering from such conditions is increasing, and this trend is likely to continue in the future, given that, globally, birth rates are decreasing, and the world’s population is undergoing an accelerated ageing process, despite a significant increase in the average life expectancy to about 80 years old.

Discussion

Throughout the centuries, healers have been called upon to alleviate, or “make better”, countless sufferings. Only in the last century has the idea emerged that our main goal is to identify and cure diseases, thereby extending life and, possibly, preventing painful symptoms and associated suffering. The volume of knowledge targeting palliative care is extremely vast, yet its existence in its entirety often goes unnoticed. Generally, as a society, we neglect the needs of the chronically ill and dying. Supportive treatment is any intervention for the patient that does not directly aim to cure their disease, but it rather focuses on helping the patient and their family go through the illness in the best possible state⁽⁶⁾.

Obviously, this type of assistance should have a broad scope and be as varied as the people who request it. Others have used the concept of supportive treatment in a narrower sense to describe the management of treatment-related adverse effects, such as chemotherapy-induced nausea and vomiting, oral mucositis, peripheral neuropathy, and skin rashes⁽⁷⁾.

One study conducted among medical oncologists and midlevel providers at the University of Texas MD Anderson Cancer Center revealed a clear preference for the term “supportive care” over “palliative care” when referring to patients. This preference is attributed to the perception that the name “palliative care” is associated with increased distress and a reduction of hope among patients and families, as highlighted in the results. Moreover, the research indicates that this preference is consistent across different demographic groups, as there were no significant associations found between the perception of the two names and factors such as age, sex, or prior training in palliative care⁽⁸⁾.

Based on the study conducted through the questionnaire, we can firmly assert the following statements: regarding the differentiation of symptomatic from supportive treatment, the distinction is correct and clear for the study’s respondents. This also holds true when referring to the purpose of symptomatic treatment. Although the individuals involved in completing the questionnaire agreed that the notions of palliative care and supportive treatment are not equivalent, there is a significant rate of confusion (49.6% of respondents) regarding the linguistic overlap between these two notions. Also, we consider it a major warning sign that 74% of respondents believe that patients should only benefit from palliative care when curative treatments can no longer be applied or in the final stage of the disease.

One study from France aimed to assess the prevalence of access to inpatient palliative care among cancer patients diagnosed in 2013 who died between 2013 and 2015. The study found that 57% had access to inpatient palliative care, and the median time from accessing palliative care to death was only 29 days, indicating that palliative care is typically introduced very late in the disease trajectory. These findings underscore the need for earlier integration of palliative care into the treatment plans of cancer patients to better manage their physical and psychological suffering⁽⁹⁾. In our research, only a percentage of 26% of people supported the fact that patients can benefit from palliative care from the diagnosis. This indicates insufficient knowledge of the rights that patients can benefit from and what palliative care essentially entails. A large part of the respondents (60%) supported the idea that the number of people benefiting from palliative care services has increased considerably in the last five years. This fact confirms once again the increasing incidence of disabling and incurable noncommunicable diseases.

Conclusions

Although the level of palliative care provided in the last 30 years in our country has undergone constant and sustained development, both nationally and globally, there is the possibility to improve the provision of palliative care services through continuous education of the general population and active community involvement in support initiatives for people facing disabling conditions. Moreover, we must invest in training, educating and perfecting medical personnel to understand the distinctions and commonalities between “supportive care” and “symptomatic treatment”. This is essential for both clinical practice and research, as it fosters clearer communication, and it could lead to better standardization of care.   

Corresponding author: Eliza-Maria Froicu E-mail: eliza-maria.froicu@umfiasi.ro

Conflict of interest: none declared.

Financial support: none declared.

This work is permanently accessible online free of charge and published under the CC-BY licence.