Supportive, or palliative, care has moved into medicine's mainstream with well-known and studied benefits but continues to be inadequately utilized in many health care environments particularly intensive care units (ICUs). With diverse patient populations in the various ICU settings, the supportive care team must adapt and mold their goals-of-care discussions and relationship building based on the ICU culture and individuals involved. Despite the differences in disease processes, early supportive care involvement in the ICU provides much needed emotional support and symptom management to patients and families in addition to identifying the patient's goals of care early in the hospital stay. The purpose of this article is to provide a general overview of the history of supportive care and clarify current misperceptions, particularly related to hospice, surrounding the specialty. The types of supportive care consults will be explained and their uses in the various ICU settings, and illustrate the advantage of early involvement to not only patients and families but the medical team as well.