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Results of a nationwide hospice and palliative care social work job analysis

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Abstract

The role of the hospice and palliative social worker is often ambiguous and misunderstood by colleagues and fellow team members. One reason for this is the lack of identified, clearly delineated roles, skills, and tasks employed by these specialty social workers in their daily work. This article summarizes the first nationwide job analysis of hospice and palliative social workers. A contextual, cross-sectional survey design was used to identify current and relevant job tasks from practicing hospice and palliative social workers. A sample of 482 social workers representing 46 states responded to a survey that included demographic questions and ranking of 152 tasks and importance to the position. Tasks were categorized into four broad categories: assessment and reevaluation; planning and intervention; death, grief, and bereavement; and professionalism; which includes subcategories consisting of multiple tasks and skills. Respondents identified performing a psychosocial assessment from a patient/family centered care perspective, assessment of the patient’s current and desired quality of life and of coping skills as the tasks most important to their role. This outline of the role of the hospice and palliative social worker was then used in the development of an evidence-based certification exam that may be required of those who want to receive specialty certification in the field.

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... From the inception of palliative care in the latter half of the 20th century, social workers have always been involved [5][6][7] and today they can even How can social workers be meaningfully involved in palliative care? A scoping review on the prerequisites and how they can be realised in practice be described as core members in this field of practice. ...
... 9,12 Furthermore, the empirical added value associated with these roles relates to better outcomes for care recipients and general cost-savings in end-of-life care spending for care institutions. 13 However, social workers often struggle when claiming their role 7 and their capacities often remain underutilised in professional palliative care delivery. 6 At the same time there is a call for optimising underused nonprofessional capacity in palliative care. ...
... 94,100 Concrete outlines of social work competencies have already been developed in Canada 91 but also a general outline for European countries already came into being. 101 In the United States, a first comprehensive outline of core competencies was established by Gwyther et al. 16 and further elaborated by Head et al. 7 in a nationwide hospice and palliative care social work job analysis. For other countries, there either are no peer-reviewed records describing such outlines or they may not be published in English. ...
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Palliative care is a holistic practice using a multidisciplinary approach in addressing multidimensional needs. Although the social aspects surrounding the end-of-life phase suggest a place for social work in it, the profession is often inadequately involved in daily practice. This contrasts strongly with the potential meaningful contributions of social workers in this field. To date, no comprehensive list of prerequisites for meaningful social work involvement in palliative care exists. This review aims to gain more insight on the prerequisites for meaningful social work involvement in palliative care and how to realise them in practice. It could therefore provide pathways for future intervention development in enhancing the involvement of social workers and maximising their contributions in palliative care. A scoping review methodology was used. A systematic selection of peer-reviewed articles ranged from 2000 to April 2021 – out of the electronic databases Web of Science, Scopus and Pubmed – was conducted. The 170 articles that met the eligibility criteria were analysed for relevant content using open and axial coding processes. The findings are reported according to the PRISMA-ScR checklist. The nine prerequisites listed in this review concern the level of individual social work capacities and the level of contextual factors structuring social work practices. A majority of articles have, however, focused on the level of individual social work capacities in a rather specialist view on palliative care. Future research should further address the contextual level of social work involvement in the broader practice of death, dying and bereavement.
... The majority of palliative care social workers identify themselves as performing in roles reflective of direct clinical social work practice and report that their jobs offer the chance to help other people (Head, Peters, Middleton, Friedman, & Guman, 2019;Marmo & Berkman, 2018). Palliative care organizations provide an environment for social workers to engage in professional altruistic behavior (Cabin, 2008). ...
... Overall, the findings of this study, particularly the qualitative responses that explored conceptualization of social justice, suggest an identification more with individual and direct social work practice and less with macro, mezzo, and political palliative care practice. Similar findings were also reported in a recent job analysis of palliative care social workers (Head et al., 2019). However, as also indicated by these findings, palliative care social workers find working in an environment that incorporates social justice norms improves their organizational commitment. ...
Article
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Job satisfaction and organizational commitment are critical factors in retention of qualified and experienced social workers. Palliative care organizations may struggle to retain social workers who question if the organization’s practices are in conflict with social work values of social justice and equity. Improving palliative care social workers’ job satisfaction and organizational commitment can be a pathway to keeping palliative care social workers in their jobs. Aims of this study were to explore how social justice influences palliative care social workers’ organizational commitment and intention to stay in their jobs, and if these associations were mediated by job satisfaction. A cross-sectional, survey design, administered online, with a sample of 127 palliative care social workers was used. Findings suggest that job satisfaction mediates the relationship between an organization that establishes a norm of social justice and organizational commitment, this in turn, makes palliative care social workers less likely to want to leave their jobs.
... This is also a set of basic roles and competencies referred to by many studies, namely: "Initial and continuous psychosocial assessment of the patient and the family; intervention in crises; individual and family counseling. Development of the care plan; making referrals to local resources and agencies; cooperation with other disciplines; facilitating Effective communication between family and team; patient/family education regarding palliative and end-patient/family case management; heritage work; ethical problem-solving; financial counseling; grief counseling; bereavement care; spiritual evaluation and interventions; and advanced care planning " (Head et al., 2019). ...
... Job analysis is the procedure through which we determine the duties of the positions and the characteristics of the people to hire for them (Anyakoha, 2019;Ashraf, 2017). Job analysis has been called the building block of everything that the personnel department does (Head et al., 2019). Job analysis is a primary tool to collect job-related data (Morgeson et al., 2016). ...
... One-half of the described needs are also reported to be unmet (Pattersson & Rangganadhan, 2010). Social workers in hospices and palliative care have an important role in assisting with coping, assessing needs, and delivering support to family members through end of life care and bereavement (Head, Peters, Middleton, Friedman, & Guman, 2019). ...
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The purpose of this study was to investigate variations in psychosocial well-being over time among young adults who participated in a support group after the death of a parent from cancer. Fifty-five young adults, aged 16-28 years, completed questionnaires that measured self-esteem, anxiety, depression, and life satisfaction at three time-points during the first year-and-one-half after the loss. Results indicated overall poor psychosocial well-being with few increases in psychological health over the study period, despite access to support and social networks. However, these resources may help to prevent major impairments in the participants' future lives.
... Findings can be used to enhance the live discharge process to not only support the unique psychosocial needs of patients and PCGs but also improve the service delivery from hospice clinicians. Social workers primary roles in hospice and palliative care include tasks related to assessing hospice eligibility and recertification, educating patients/caregivers about the hospice benefit, ensuring continuity of care across practice settings, and assisting with transfer, discharge, or other care transitions (Head et al., 2019). Colón and Wladkowski (2019) describe the role of social workers as an advocate for the patients and caregivers' goals of care while respecting the right to self-determination; function as problem solvers and guides to help prepare to support those goals. ...
Article
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Hospice social workers face many challenges in attempts to replicate or supplement the holistic support and unique services hospice provides for individuals discharged alive. This discontinuity in care can impact the types of supports needed by individuals and caregivers, which may or may not be accessible within their community. Patients and families who have access to community-based palliative care programs following a discharge generally tend to navigate the process with fewer challenges. This qualitative study (N = 24) explored both the challenges of the live discharge process and the opportunities within social work practice in the US. Results from this study emphasize the need for a framework to better approach a live discharge to ensure appropriate supports are accessible for all patients and caregivers. Specifically, results highlight both the concrete and psychosocial challenges in live discharges as a result of tension between current eligibility requirements and individual feelings and needs. Social workers also provided suggestions to improve the live discharge process, including attention to communication and preparation. This paper outlines specific challenges of live discharge from hospice, a framework for understanding presented challenges, and implications for policy and practice.
... Social work billing requires a licensed clinical social worker to provide services only upon diagnosis of a mental health illness, which may not apply to every cancer patient (Parman 2012(Parman , 2018. Low use of DSM criteria in palliative care social work practice, and thus billing for social work visits, is suggested by a national social work job analysis that surveyed 482 palliative care social workers (Head et al. 2019). "Utilizing DSM criteria to guide assessment and determination of needs" was reported to be the least important task out of 152 identified tasks that define the roles of palliative care social work (Head et al. 2019 p. 25). ...
Article
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PurposeThis policy analysis examines key aspects of two policies fundamental to work with terminal cancer patients: the Medicare Hospice Benefit and Medicare policy in palliative care. End-of-life care, affected by these policies, should address physical, emotional, and spiritual suffering for all vulnerable groups.Methods Using Gilbert and Terrell’s framework, social allocations, social provisions, service delivery, and financing are examined to better understand each policy’s effects on equality, equity, and adequacy for terminally ill cancer patients.ResultsIn practice, each has substantially socially unjust effects for cancer patients. Disproportionate advantages result for those who are white, have family caregiving support systems, those with higher socioeconomic status, and individuals with stable insurance coverage.Conclusion The Medicare Hospice Benefit and Medicare coverage for palliative care need to be better understood by policy practitioners and all practitioners in health care settings. Advocacy can contribute to improved equity in end-of-life cancer care.
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For palliative care social workers, utilizing clinical practice theories in an acute hospital setting can be challenging but important. This article describes a process improvement project designed to increase intentionality in the implementation and documentation of social work interventions. It details the process of identifying major social work domains, interventions deployed and how the interventions specifically connect back to clinical practice theory.
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Objective The objective of this training project is to develop and host Interprofessional Communication courses to improve interdisciplinary communication in oncology care. The initial national course was held in a virtual format and included pre- and post-course participant data. The curriculum was developed with support from the National Cancer Institute. Methods A virtual two-day course was held to equip nurses, social workers, and chaplains with vital communication skills in oncology practice, so that they could return to their home institutions and teach communication skills to other healthcare professionals, with the intention of making improved communication a quality improvement goal. Fifty-two participants were selected through an application process to attend the virtual course in two-person interprofessional teams (e.g., nurse and chaplain, or social worker and nurse). The Interprofessional Communication Curriculum was based on the National Consensus Project for Quality Palliative Care's eight domains of quality palliative care. The six online modules developed by the investigators were presented in lectures, supplemented by discussion groups, role plays, and other methods of experiential learning. Results Pre- and post-course results identified areas of communication, which are a priority for improvement by oncology clinicians. Participant goals identified specific strategies to be implemented by participants in their settings. Significance of results The need for communication training was clearly demonstrated across professions in this national training course. Participants were able to apply course content to their goals for quality improvement in cancer settings.
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Challenges and opportunities for social workers in hospice and palliative care
  • C Herman