Intended for healthcare professionals


Best supportive care in advanced lung cancer—more than a label?

BMJ 2018; 363 doi: (Published 27 December 2018) Cite this as: BMJ 2018;363:k5017
  1. Jo Bowden, consultant in palliative medicine1,
  2. Stephen Fenning, specialty registrar in palliative medicine1,
  3. Brooke Marron, research assistant2 3,
  4. Catriona Macpherson, children and families’ practitioner1,
  5. Steinunn Boyce, consultant in palliative medicine1,
  6. Varrie Wardrope, carer representative,
  7. Karen Campbell, Macmillan associate professor2,
  8. Lucy Johnston, senior research fellow2
  1. 1NHS Fife Specialist Palliative Care Service, Queen Margaret Hospital, Dunfermline, UK
  2. 2Edinburgh Napier University, Edinburgh, UK
  3. 3University of Glasgow, Glasgow, UK
  1. Correspondence to: J Bowden joannabowden{at}

We should be accountable for delivering the right care in the right place for people nearing the end of life, say Jo Bowden and colleagues

Cancer multidisciplinary team meetings are standard clinical practice in the UK and seek to confirm diagnoses and propose appropriate treatment plans through expert consensus. Patients who are too frail for cancer treatment or who choose not to have it are recorded as being “for best supportive care.” In reality though, this plan often serves only as a label and fails to translate into anything meaningful for the patient. The team may agree on who should receive best supportive care but there is little consensus about what it constitutes in practice1 and who should be accountable for its delivery.

The terms best supportive care and palliative care are often used interchangeably but are synonymous only in certain clinical contexts. Palliative care is defined as an approach that improves the quality of life for people, and their families, facing the problems associated with life threatening illness.2 It may be integrated alongside disease modifying treatments or be a plan of care in its own right when such treatment is not possible, so called best supportive care.

A key tenet of quality improvement thinking is that “every system is perfectly designed to get the results it gets.”3 In the context of best supportive care, the absence of a defined standard leads to unwarranted variation in the quality of care that patients receive. Individuals may miss out on the benefits of this care or receive care that is inappropriately medicalised in their last weeks of life. At a system level, this generates inefficiency and, at times, redundancy in the use of healthcare resources.

Mulley and colleagues proposed the concept of high integrity health systems as a sustainable …

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