Information for Supportive Palliative Care Providers

Supportive palliative care (SPC) is patient-centered and family-focused care that provides a patient of any age with relief from the symptoms, pain and stress of a serious illness. It addresses complex symptom management including assistance with pain – be it emotional, social and/or spiritual -  often associated with serious illness. SPC may be offered to patients alongside treatments intended to cure or treat the illness, may replace those treatments, and serve as a transition to hospice services.

For more information on the types of care that can be offered, visit HHSC's Supportive Palliative Care services page.

National Consensus Project for offering palliative care are available at the National Coalition for Hospice and Palliative Care website.

What are Supportive Palliative Care Services?

SPC services are defined in Texas Health and Safety Code §142A.0001 as “physician-directed, interdisciplinary patient- and family-centered care provided to a patient with a serious illness without regard to the patient's age or terminal prognosis that:

  • May be provided concurrently with methods of treatment or therapies that seek to cure or minimize the effects of the patient's illness; and
  • Seeks to optimize the quality of life for a patient with a life-threatening or life-limiting illness and the patient’s family through various methods, including methods that seek to:
    • Anticipate, prevent, and treat the patient's total suffering related to the patient's physical, emotional, social, and spiritual condition; 
    • Address the physical, intellectual, emotional, cultural, social, and spiritual needs of the patient; and
    • Facilitate for the patient regarding treatment options, education, informed consent, and expression of desires”.

How Is Supportive Palliative Care Different Than Hospice Care?

Both SPC and hospice professionals focus on relieving the symptoms of serious illness, while also helping the patient, family, and other health care professionals plan for the future. SPC is appropriate at any stage of a serious illness because the patient may maintain treatments intended to cure or cause remission. Early SPC involvement is associated with improved survival in at least some conditions. Hospice may only become involved when no further attempts at cure or remission are being made and hospice care planning is focused almost exclusively on the patient’s death. 

To see which care is best suited for your client or patient’s needs, please see the comparison chart provided below:

Supportive Palliative Care Vs. Hospice Care (PDF).

Who is Part of the Supportive Palliative Care Team?

Collaboration with other professionals and placing the patient at the center of treatment and comfort care makes SPC an effective service. The following people can be part of interdisciplinary SPC teams:

  • Physicians
  • Psychologists and psychotherapists
  • Advanced practice providers, such as advanced practice registered nurses and physician assistants
  • Social workers
  • Nurses
  • Pharmacists
  • Dieticians
  • Chaplains
  • Child life specialists
  • Family members of the patient
  • Other health care providers, such as respiratory therapists, physical therapists and occupational therapists

Patient Qualifications for Supportive Palliative Care Services

Patients may qualify for SPC services based on many situations. The ones below are some that are included in the clinician referral guide from the Center to Advance Palliative Care’s website, Get Palliative Care.

Presence of a Serious or Chronic Illness, defined by:

  • Weight loss
  • Multiple hospitalizations
  • Do-not-resuscitate order conflicts
  • Limited social support due to factors such as homelessness or chronic mental illness
  • Severe symptom burdens
  • Patient or family psychological or spiritual distress

Intensive Care Unit (ICU) History, including:

  • Two or more ICU admissions within the same hospitalization
  • Multi-organ failure
  • Family distress that impairs surrogate decision making
  • Prolonged or difficult ventilator withdrawal
  • Consideration of patient transfer to a long-term ventilator facility

Oncology Criteria

Metastatic or locally advanced cancer that is progressing despite systemic treatments with or without weight loss and functional decline.

Note: The American Society of Clinical Oncology recommends palliative care consultation within eight weeks of diagnosis for metastatic cancer. 

Emergency Department Criteria:

  • Multiple recent prior hospitalizations with the same symptoms and problems
  • Long-term-care patient with do not resuscitate or comfort care orders
  • Patient previously enrolled in a home or residential hospice program
  • Consideration of ICU admission or mechanical ventilation in a patient

Communicating with Patients & Families about Supportive Palliative Care

Having a conversation about SPC services can be a challenge depending on the severity of the patient's illness. Providers must understand and differentiate between types of services when recommending either SPC or Hospice.

Quick Guideline for Palliative Care Communications

The acronym COMFORT, developed through the Pain and Palliative Care Resource Center at City of Hope, is an easy way to remember seven key principles when having conversations with patients and their families:

  • Communication is patient-centered and family-focused.
  • Orientation and Opportunity takes into account health literacy and stresses cultural competency.
  • Mindfulness emphasizes empathy and actively listening to the patient and family.
  • Family takes into consideration family dynamics and their needs.
  • Opening up allows for free and open communication. 
  • Relating to the patient and families helps a clinician work alongside families.
  • Team values include clinical collaboration.

Various publications on COMFORT principles and palliative care communication skills can be found on the City of Hope website.

Supportive Palliative Care Performance Scales and Tools

The following tools will help providers determine if hospice is appropriate for the patient.

Measurement and Evaluation

Learn more about Measurement and Evaluation tools used by providers to assess the need for Palliative Care service.

Pain and Symptom Management

Functional Status

  • Karnofsky Performance Scale  
    Commonly used for assessing terminally ill patients, often used to determine appropriateness of hospice referral.
  • Palliative Performance Scale version 2 (PPSv2)  
    Measures the functional status of a patient and assigns a Palliative Performance Value; serves as a communication tool for quickly describing a patient's current functional level.

Psychological Care

  • Caregiver Strain Index  
    A tool that measures strain related to care provision. Used to assess individuals who have assumed the role of caregiver for an older adult.
  • Hamilton Depression Scale  
    Provides an indication of depression and, over time, provides a guide to progress.
  • Blessed-Roth Dementia Scale (DS)  
    A brief behavioral scale based on the interview of a close informant. The DS has proved to be a sensitive and specific screening test for dementia.

Caregiver Assessment

  • Caregiver Strain Index  
    A tool that measures strain related to care provision. Used to assess individuals who have assumed the role of caregiver for an older adult.
  • FAMCARE Scale  
    A 20-item scale measuring family satisfaction with health care given to the patient and to them.

Supportive Palliative Care in a Home or Community Setting

SPC services that are delivered in the home or in community settings, such as in assisted living facilities, are currently governed by HSC Chapter 142 (relating to Home and Community Support Services Agencies (HCSSA)). A HCSSA license is required. For additional information on how to obtain a HCSSA license, please visit the HCSSA webpage or contact the Policy and Rules Section by email at or call (512) 438-3161.

For additional information on how to provide SPC services, see Provider Letter 2021-35 relating to (Licensing Requirements for In-home Supportive Palliative Care).

Professional Resources: