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© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 1
Core competencies for palliative care social work
in Europe: an EAPC White Paper – part 2
This White Paper is the culmination of work undertaken by the European Association for Palliative
Care (EAPC) Task Force (hereafter: the task force) set up to examine the diversity of roles, tasks and
education of palliative care social workers in Europe. One of the stated objectives of this group was
to complete a consensus White Paper prior to considering generalist and specialist social work
education curricula. We propose a competencies framework that is applicable to social workers in
any role, but specifically delineates the advanced competencies appropriate to the specialist work
required in palliative and end of life care contexts.
Core competencies in palliative care social work
These competencies draw heavily on the work of the Canadian Social Work Competencies for
Hospice and Palliative Care which were developed in 2008 using a modified Delphi process with
frontline clinicians across Canada.(1) However, we recognise that our European palliative care social
work contexts – whilst varied in themselves – differ from those in Canada and the USA. For that
reason our framework also refers to the recently published EAPC papers on competencies in
palliative care education and that on standards and norms for hospice and palliative care in Europe
and on the interprofessional palliative care competencies developed in the Republic of Ireland.(2) It is
evident that a certain synergy exists between these documents that lends itself to the development
of this competencies framework. Radbruch and colleagues lay the foundation in outlining core
principles in palliative care;(3, 4) Gamondi et al frame these in a more general sense in describing the
basis for palliative care education;(5, 6) and the Canadian and Irish competencies introduce the
specificity and unique quality of the social work contribution.(1, 2) In addition, the Swiss Society for
Palliative Medicine, Care and Support have also recently published a catalogue of competencies for
palliative care specialists.(7) These provide further source material and contribute to the effort to
embed a competencies approach in the development of services and the curricula required to
adequately equip palliative care professionals for the task at hand.
We are particularly grateful to our Canadian colleagues for permission to use their framework
structure and much of their content as the basis for our work below and fully acknowledge that
here.
The ten core competencies
1. Application of the principles of palliative care to social work practice
All social workers should have an understanding of the impact of life threatening illness on the
clients they encounter. In addition, they should have an awareness of the social, psychological and
interpersonal challenges presented by dying and death. They need to develop the capacity to
respond in an empathic and empowering manner taking full account of the diversity and particular
socio-cultural context of the people they work with.
Palliative care social workers should demonstrate advanced knowledge, skills and practice based in
and informed by a set of internalised values and attitudes.(5, 6)
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1.1 Values and attitudes
Possess a thorough awareness of and commitment to the palliative care approach and the
affirmation of living well, until you die
A commitment to client self-determination, supporting and enabling decision making in the
approach to the end of life and beyond
A commitment to consider clients within their cultural, social and family context, recognising
that the definition of ‘family’ may include unconventional forms
An understanding of the need to adapt practice and interventions to the needs and location
of clients
Confidence in recognising when the palliative care approach should be introduced, knowing
that early introduction may facilitate better outcomes
1.2 Knowledge
Of the key concepts in palliative care
Of how social work theory dovetails with theory in palliative care and where points of
difference or contention may arise
Of theories of loss, grief and bereavement
Of holism in palliative care and the interdependent dimensions of physical, psychological,
social and spiritual care
Of appropriate legislation and policy that underpin the provision of palliative and end of life
care services
Of roles within the interdisciplinary team and where social work fits in
Of the current ethical principles and debates within palliative and end of life care
1.3 Skills
Ability and confidence to engage with clients and their families, deploying advanced
communication skills in palliative and end of life consultations
Ability to communicate warmth, empathy and concern to clients and those close to them
Proficiency in collaborative working with the inter-professional team and confident in
promoting the palliative care social work perspective
2. Assessment
Social workers should be able to comprehensively assess the needs of clients and this core skill is
usually a key element of undergraduate social work education.(8) Psychosocial assessment should be
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 3
holistic, taking account of systemic and socio-cultural as well as individual factors. It is an iterative
process that needs to be flexible and responsive to changes in the circumstances of the client.
2.1 Values and attitudes
Psychosocial assessment is an on-going, collaborative process
A recognition that people know themselves and their situations
An awareness of the balance to be struck between professional knowledge and individual
self-determination
A recognition of psychosocial assessment values, strengths and resources
Self-awareness and an ability to consider own assumptions and bias
A recognition that carers have needs too; due consideration are given to these in the
assessment process
2.2 Knowledge
Of illness trajectories and basic treatments
Of theories of loss, grief, adjustment and the impact of disability
Of assessment models, including those used by other professions
Of the impact of diversity and discrimination including gender, culture, ethnicity, age,
sexuality, religion and social class on the clients situation
Of the specific needs of those with learning disability or mental health issues
Of crisis intervention and family systems theories
2.3 Skills
Advanced communication skills
Ability to build trust and rapport
Individual and family interviewing skills
The capacity to ask difficult questions
The ability to gather comprehensive and complex information
Skills of containment: the ability to ‘hold’ the difficult thoughts and feelings of another
The ability to identify and respond to changing need
Comprehensive report writing skills
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3. Decision making
Social workers generally work with an understanding and belief that people should be given
sufficient information and support to make informed choices that best suit their particular
circumstances. But decision making is complex, particularly for those faced with the uncertainty and
challenge of incurable illness. Information gathered during on-going assessment should be used to
facilitate client decision making.
3.1 Values and attitudes
A non-judgemental approach
A commitment to client self-determination and autonomy
A commitment to the identification and protection of vulnerable people
A willingness to accept that some decisions of clients may run counter to the opinions of
professionals
A recognition of complexity, changeability and uncertainty in decision making for the client
and professional
3.2 Knowledge
Of the impact of progressive illness on decision making capacity
Of the impact of power and other psychosocial issues on decision making
Of ethics in decision making
Of the country specific legislative framework around mental capacity
Of the legal and procedural requirements of systems in place to protect vulnerable adults and
children
3.3 Skills
Ability to weigh competing interests and to challenge
Ability to assist clients in the decision making process
Ability to arbitrate and collaborate in situations of family conflict
Ability to identify and address deficits in information or understanding that limit an
individual’s decision making capacity
4. Care planning and delivery
Social workers should view care planning as a collaborative process drawing on client resources and
networks as well as looking to other sources of professional or community support. Care plans –
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 5
particularly in palliative and end of life care, where circumstances can change rapidly – should be
regularly reviewed and adjusted accordingly.
4.1 Values and attitudes
A holistic, collaborative approach that is client and family centred
A recognition that care plans need to be realistic, achievable, flexible and responsive to
changing need
A recognition that care plans and services provided are based on informed client choice
Care planning and delivery is sensitive to issues of changing capacity
Carers needs are accounted for in care planning and service delivery
Client confidentially and dignity are paramount and due attention is afforded these principles
in the transfer and sharing of information about them
4.2 Knowledge
Of available resources both within and external to the client and carer network
Of provider agency constraints and processes in service delivery
Of the changing needs of clients, their families and carers along particular disease trajectories
Of family dynamics theories and how these may influence care planning and utilisation of
services
Of the goals, strengths and weaknesses of particular care plans
Of country specific legal requirements relating to data storage and protection
Of the legal and procedural requirements of systems in place to protect vulnerable adults and
children
4.3 Skills
Ability to formulate care plans that are collaborative, flexible, adaptable to changing need
and facilitate continuity of care
Ability to build and maintain therapeutic relationships
Ability to negotiate effectively with provider agencies and professionals
Ability to coordinate and evaluate care packages
Ability to deal with family conflict, anger and frustration in an appropriate manner that seeks
to strengthen and sustain functioning relationships
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 6
Ability to deal calmly and effectively with crisis
Ability to manage self and maintain appropriate boundaries when faced with sorrow, pain
and suffering
Ability to maintain accurate and comprehensive records
5. Advocacy
Social workers work from a social justice values base and in a palliative care context, should support
the contention that end of life care is a human right.(9) As such, they should seek to advocate
strongly on behalf of clients, carers and families facing life threatening disease to ensure that needs
are identified and appropriate measures taken to address them.
5.1 Values and attitudes
A respect for client autonomy and self-determination
An awareness of and sensitivity to diversity
A willingness to work creatively within health and social care systems and structures to
achieve effective client support
A willingness to address discrimination
5.2 Knowledge
Of communication and mediation theories
Of advocacy techniques
Of local health and social care structures, processes and systems
Of the particular barriers to health and social care faced by people from marginalised groups
and those that underuse palliative care services(10)
5.3 Skills
Advanced communication and negotiation skills
Ability to work collaboratively with individuals, carers and service providers at all levels of the
health and social care system
Ability to challenge others at individual and agency level on behalf of clients in ways that
facilitate better client outcomes but maintain good working relationships
Ability to identify gaps in services in order to advocate for appropriate responses
Ability to plan for anticipated need in relation to specific disease trajectories
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 7
6. Information sharing
Communication and information sharing with clients, their families and the wider interdisciplinary
team are core elements of the social work role. Skilled palliative care social workers can provide a
safe listening space for people to reflect and process sensitive or difficult information. The effective
provision of information is a two way street; social workers are required to listen effectively and
check that their response has been fully understood by the recipient. Attending to issues of pace and
sensitivity, so as not to overload people, is critical. The issue of confidentiality is heightened when
the expectation within teams is that most information is shared. Checking out with individuals and
families what can be shared and in what form requires skill and diplomacy.
6.1 Values and attitudes
Clients have a right to clear, truthful and understandable information about all aspects of
their condition and service options
A recognition that clients should be enabled to negotiate the pace and levels at which
information is shared with them
A nuanced approach to information sharing is required when working with children or those
with cognitive or intellectual challenges
Clients have a right to confidentiality, with exceptions
6.2 Knowledge
Of communication tools that assist in gathering and imparting information – particularly that
of a sensitive or difficult nature
Of age appropriate communication techniques with children and young people
Of the communication needs and appropriate techniques for those with sensory or cognitive
impairment and those with learning disability or mental health needs
Of translation services
6.3 Skills
Advanced communication skills
Ability to provide information in a sensitive, timely and clear way, having first established the
clients’ requirements and limitations
Ability to impart difficult information and communicate this, where required, in an honest
and clear manner
Ability to assess a person’s response to information shared, to check understanding and
respond appropriately
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 8
Ability to take account of cultural and language barriers to the sharing of information and
take appropriate measures to counter these
7. Evaluation
Social workers are expected to evaluate the services they provide and to implement changes to
practice and provision, where necessary.(8) The use of medically orientated assessment tools such as
the Distress Thermometer(11) to help individuals crystallise their current feelings and needs and to
measure distress is considered an appropriate tool to use by social workers and it provides a base
line from which to evaluate interventions and monitor distress over time. Another example,
developed by a social worker, is the Adult Attitude to Grief scale which helps to assess the level of
need in bereaved people and can also be used as a post intervention outcome measure.(12) Palliative
care social workers should be aware of validated tools to objectively measure outcomes and apply
these where possible.
7.1 Values and attitudes
A vision of evaluation at the micro and macro levels as a central social work task
Actively seeks feedback on interventions and practice
A willingness to incorporate feedback in the review of care plans and service provision
A readiness to empowers and enable clients to engage in giving feedback
7.2 Knowledge
Of evaluation research and theory
Of appropriate assessment and evaluation tools and measures in the palliative and end of life
care arena
Of the impact of diversity on expectations, utilisation and engagement by clients from
different backgrounds with palliative and end of life care services
Of resources available to augment or alter care packages and interventions appropriate to
the stage of illness
7.3 Skills
Ability to assess and re-assess the impact of interventions on clients, carers and their families
and to modify these accordingly
Ability to respond to criticism of services by clients in a collaborative and constructive
manner
Ability to negotiate changes in service provision that better meet client needs in collaboration
with relevant professionals and provider agencies
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 9
Ability for self-reflexive practice
Readiness to access appropriate line management and clinical supervision
8. Interdisciplinary team working
As noted above, interdisciplinary team working is a central aspect of palliative and end of life care
practice. Many palliative care social workers work within interdisciplinary teams which bring
multiple perspectives, opinion and knowledge to provide holistic care for people and their families. A
social work presence should ensure that psychosocial care is at the core of that provision. Issues of
role overlap and blurring are common and within the team there are likely to be different
personalities, opinions and goals. It should also be noted that unpaid workers or volunteers may
make a significant contribution to the care offered by the wider team. In the UK for example, many
bereavement services are partly or wholly staffed by volunteer counsellors and support workers who
are involved in direct service provision.(13) Social workers have much to offer from their professional
perspective, however, and should seek to contribute this to the team effort in a spirit of
collaboration and with confidence in their professional standpoint
8.1 Values and attitudes
Respect for the range of perspectives within the interdisciplinary team
Confidence in the value and expertise of the social work perspective
Trustfulness and honesty with colleagues
Prepared to take leadership roles
Committed to teamwork
Commitment to client confidentiality within an interdisciplinary team context
8.2 Knowledge
Of interdisciplinary teamwork theory; how teams form, how they develop, how a teamwork
approach may be facilitated
Of the strengths and challenges of a teamwork approach
Of role boundaries and overlap with that of other professionals within the team
Of the synergistic potential of the teamwork approach
Of techniques and strategies for managing conflict within teams
8.3 Skills
Ability to foster communication within the team and to contribute to effective team
management and team building
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 10
Ability to provide input on the psychosocial aspects of palliative and end of life care
Ability to facilitate communication with the between individuals, their carers, their family
members and the wider interdisciplinary team
Ability to protect the confidentiality of client information whilst enabling the interdisciplinary
team process
Ability to self-care and to support other members of the team in dealing with dying, death
and bereavement
9. Education and research
Social workers should be able to bring a psychosocial perspective to interdisciplinary education and
research. Palliative care social workers are expected to teach and supervise colleagues from health
and social care and to participate in the training of students, both from social work and the wider
interdisciplinary team. There is a particular need to help in the on-going professional development
of qualified social workers with a generalist role in order to enhance their knowledge and practice
around palliative and end of life care and service provision. Although social workers – like many
other professionals – have a clinical or direct work focus, they should use an evidence base in their
professional development and contribute to research endeavour.
9.1 Values and attitudes
Confidence in the expertise of social work and the psychosocial perspective
Willingness to share experience and expertise through education and research activity
Commitment to continuing education and professional development
Commitment to enhancing the evidence base for palliative and end of life care through a
contribution to robust research
Commitment to advancing social work research in order to enhance practice
9.2 Knowledge
Of social work theory
Of the underlying principles of best practice palliative care
Of the social work role and psychosocial perspective in palliative and end of life care
Of illness trajectories of dying people
Of death, dying and bereavement processes and associated theories
Of the impact of diversity on death dying and bereavement
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 11
Of appropriate helping strategies
Of communication skills
Of research methodologies appropriate to palliative care
Of ethical guidelines in research
Of current issues in palliative and end of life research
9.3 Skills
Ability to model professional social work role
Teaching and mentoring skills
Ability to supervise staff in training or undergoing professional development
Ability to critically appraise research outcomes
Ability to integrate research results into practice
10. Reflective practice
The goal of self-reflection in a work context is to improve practice. The need to stay in touch with
difficult feelings and situations requires the support of managers and clinical supervisors.
Supervision provides checks and balances about the task and guidance for the worker.(14) All workers
in palliative and end of life care need to recognise and manage their own emotional responses to
death and dying. Palliative care social workers should be able to develop and demonstrate that level
of self-awareness.
10.1 Values and attitudes
Recognition that reflective practice is integral to self-care
Acknowledgement that reflecting on practice is a tool for enhancing care provision
Recognition of the impact on self of working with dying and bereaved people
Commitment to developing a culture of reflective practice in the wider team
Recognition of the importance of supervision and mentorship
10.2 Knowledge
Of the purpose of reflective practice
Of tools for considering self in relation to work
Of when and how to access support or mentorship
© Sean Hughes, Pam Firth, David Oliviere. pre-print FINAL 2014 Page 12
Of self: strengths, limitations, vulnerabilities, potential
10.3 Skills
Ability to recognise the impact of work on self
Ability to seek and act on feedback from clients, colleagues, mentors and managers
Ability to provide constructive feedback to others
Ability to model a reflective approach to work
Ability to integrate self-reflection into practice
Ability to maintain boundaries
Ability to recognise self-limitations
Ability to consult with and refer to others when necessary
Summary and next steps
The aim of this White Paper has been to provide an outline of the core competencies expected of
social workers in palliative and end of life care. We sought to situate these within the historical,
economic, socio-cultural and international contexts of palliative and end of life care, and to underpin
them with the value base of social work as a professional discipline. Inevitably, our competencies
framework needs to fit within a wide range of national contexts, cultures and a multiplicity of health
and social care systems in which palliative and end of life care may be at an early developmental
stage. This competencies framework may, therefore, need adapting to local need. But we would
argue that, in essence, it embodies that to which palliative care social work should aspire. The next
task of the EAPC Task Force will be to develop core curricula for the education of social workers in
palliative care that reflect and build on the competencies outlines above. Oliviere and Monroe have
argued that the challenge for all palliative care professionals is to produce more for less;(15) the need
for a confident, collaborative and competent palliative care social work contribution has never been
greater.
Acknowledgement:
The authors would like to acknowledge the comments and support of the EAPC task force on Social
Work in Palliative Care in the development of this paper.
References
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