Social Support

People who are aware that their lives have been shortened by life limiting diagnoses face enormous alterations and challenges to many aspects of their lives. [1-3] Professional and family and community-based support can make a difference to the quality of people’s lives and an opportunity for people to remain in their homes and to minimize institutional admissions to hospital, hospice or nursing homes. [4-5]

However there is little agreement in the literature about the definition of what constitutes social support. [6] Some research conceptualises and quantifies social support; such as the numbers of relationships for example. [7] The patient’s perception of the quality of social support is recognised as important too. [7] Whereas more formal psychosocial intervention delivered by health professionals is also interpreted as support – as is support provided by family and friends. [8-9] Furthermore social support is conceptualised as instrumental support including both financial and assistance with tasks, emotional / appraisal support, information, companionship, and self-esteem support. [10]

What seems to be important when considering social support is understanding the patient’s perception of support.

Social support: the palliative context

  • Whether the patient with cancer has support or feels supported are major factors in how they manage socially, spiritually, physically and emotionally. [9]
  • Certain points along someone’s life, including transition from active or curative care to palliative care, requires further information appraisal by both themselves and family caregivers. [9]
  • Tearfulness, fear and anger are common emotional reactions to living with a life threatening illness and professional staff may be challenged to discussing concerns with patients as they may feel out of their depth. [9]

Important contributing factors

  • Patients from rural and isolated communities who have travelled for treatments and services may have experienced greater disruption of family and social life. [9]
  • Past history of mental illness and substance abuse can limit social support availability. [11]
  • Family distress or dysfunction can undermine effective social support. [11]
  • Families need adequate information and support in the early phase of patient’s serious illness and treatment. [12]
    When they do not receive this, they have greater needs, less trust and confidence in the health care system. [13-14]
  • The kind of support required by patients can include attention to their spiritual needs as integral elements of their care. [15]
  • Health professionals, particularly physicians, are perceived as important sources of support for patients and their families in time of serious illness. [16-18]
  • Family caregivers can be helped to seek support for themselves from other family members and friends and health professionals. [3]

What is known

Any patient who perceives that they have inadequate support are likely to experience greater psychosocial distress. [9]

Children and partners of patients can experience equal or even higher levels of distress in relation to patients with cancer. [9]

Men and women may require different types of support strategies. [9]

Peer support groups are effective at increasing perception of social support for patients who feel unsupported. [9]

Community services that support the patient and family at home must be provided early in order to enable optimum quality of life and quality of care. Timely assessment is therefore crucial. [1-19]

There is an association between specific personality types, coping styles and psychological distress and HIV progression – but no relationship between social support and HIV progression. [10]

Active research areas / controversies

  • Multidisciplinary agreement is needed on the conceptualisation of the term ‘social support’. [20]
  • More research is needed to understand which peer support programs are effective for which populations. [21]
  • Few studies examining the impact of daily living assistance, formal and informal on the quality of life of patients and their caregivers have been undertaken in Australia. The relationship of the type and quality of social care offered within the local community has only rarely been charted. [22]
  • Understanding the perspectives of problems and needs of children and adolescents is still being researched. [23]

PubMed Searches

Social Support
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Review Collection
  1. Hancock K, Clayton JM, Parker SM, Wal der S, Butow PN, Carrick S, et al. Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review. Palliat Med. 2007 Sep;21(6):507-17.
  2. Burns CM, Craft PS, Roder DM. Does emotional support influence survival? Findings from a longitudinal study of patients with advanced cancer. Support Care Cancer. 2005 May;13(5):295-302. Epub 2004 Dec 7.
  3. McMillan SC. Interventions to facilitate family caregiving at the end of life. J Palliat Med. 2005;8 Supp 1:S132-9.
  4. Gomes B, Higginson IJ. Factors influencing death at home in terminally ill patients with cancer: systematic review.  BMJ. 2006 Mar 4;332(7540):515-21. Epub 2006 Feb 8.
  5. Stoltz P, Uden G, Willman A. Support for family carers who care for an elderly person at home - a systematic literature review. Scand J Caring Sci. 2004 Jun;18(2):111-9.
  6. Gallant MP. The influence of social support on chronic illness self-management. Health Educ Behav. 2003 Apr;30(2):170-95.
  7. Patient Reported Outcome Measurement Information System (PROMIS). Project Domain definitions [Internet]. Silver Spring, MD: PROMIS.
  8. Devine EC, Westlake SK. The effects of psychoeducational care provided to adults with cancer: meta-analysis of 116 studies. Oncol Nurs Forum. 1995 Oct;22:1369-81.
  9. National Breast Cancer Centre and National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults with cancer. Camperdown, NSW: National Breast Cancer Centre; 2003. (838kb pdf)
  10. Chida Y, Vedhara K. Adverse psychosocial factors predict poorer prognosis in HIV disease: A meta-analytic review of prospective investigations. Brain Behav Immun. 2009 May;23(4):434-45. Epub 2009 Jan 29.
  11. Lictenthal W, Kissane D. The management of family conflict in palliative care. Progr Palliat Care. 2008 Feb;16(1):39-45.
  12. Clayton JM, Hancock KM, Butow PN, Tattersall MH, Currow DC; Australian and New Zealand Expert Advisory Group, et al. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust. 2007 Jun 18;186(12 Suppl):S77, S79, S83-108.
  13. Andershed B. Relatives in end-of-life care – part 1: a systematic review of the literature the five last years, January 1999-February 2004. J Clin Nurs. 2006 Sep;15(9):1158-69.
  14. Ohlen J, Andershed B, Berg C, Frid I, Palm CA, Ternestedt BM, et al. Relatives in end-of-life care- part 2: a theory for enabling safety. J Clin Nurs. 2007 Feb;16(2):382-90.
  15. Hayley DC, Sachs GA. A brief history and lessons learned from twin efforts to transform medicine. Clin Geriatr Med. 2005 Feb;21(1):3-15, vii.
  16. Wenrich MC, Curtis R, Ambrozy DA, Carline JD, Shannon SE, Ramsey PG. Dying patients’ need for emotional support and personalized care from physicians: perspectives of patients with terminal illness, families, and health care providers. J Pain Symptom Manage. 2003 Mar;25(3):236-46.
  17. Kristjanson LJ, White K. Clinical support for families in the palliative care phase of hematologic or oncological illness. Hematol Oncol Clin North Am. 2002 Jun;16(3):745-62, xi.
  18. Skilbeck J, Payne S. Emotional support and the role of Clinical Nurse Specialists in palliative care. J Adv Nurs. 2003 Sep;43(5):521-30.
  19. Thielemann P. Educational needs of home caregivers of terminally ill patients: literature review. Am J Hosp Palliat Care. 2000 Jul-Aug;17(4):253-7.
  20. Nausheen B, Gidron Y, Peveler R, Moss-Morris R. Social support and cancer progression: a systematic review. J Psychosom Res. 2009 Nov;67(5):403-15. Epub 2009 Mar 3.
  21. Hoey LM, Ieropoli SC, White VM, Jefford M. Systematic review of peer-support programs for people with cancer. Patient Educ Couns. 2008 Mar;70(3):315-37. Epub 2008 Jan 10.
  22. Burns CM, Dixon T, Smith WT, Craft PS. Patients with advanced cancer and family caregivers' knowledge of health and community services: a longitudinal study. Health Soc Care Community. 2004 Nov;12(6):488-503.
  23. Ruland CM, Hamilton GA, Schjødt-Osmo B. The Complexity of symptoms and problems experienced in children with cancer: a review of the literature. J Pain Symptom Manage. 2009 Mar;37(3):403-18. Epub 2008 Aug 9.

Last updated 18 January 2017