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Role of the Hospice and Palliative Care Social Worker #390

Alyssa Middleton, MSW1; Barbara Head, PhD, RN, CHPN, FPCN, ACSW1; Stacy Remke, MSW,
Background Social workers provide unique knowledge and psychosocial skills for seriously ill patients
and their family (1). Clinicians often collaborate with social workers when caring for seriously ill patients.
In fact, the Medicare Hospice Benefit and the National Consensus Project for Quality Palliative Care state
that social workers are a core member of a hospice or palliative care (PC) interdisciplinary team (IDT) (2).
This Fast Fact will discuss the role of the hospice and palliative social worker.
Training and Certification Although social work practice requires a Bachelor of Social Work (BSW)
degree at minimum, most hospice and palliative social workers have a Master of Social Work (MSW) or
Master of Science in Social Work (MSSW) degree, awarded upon completion of a 2-year post-graduate
program accredited by the Council on Social Work Education in the United States that includes
supervised practicum experience. Licensure, certification, or registration is available in all states, and
regulations vary (3). Currently, many palliative programs prefer clinical licensure at the Licensed
Independent Clinical Social Worker (LICSW) / Licensed Clinical Social Worker (LCSW) level or similar,
which reflects 2 years post master’s degree supervised work experience and denotes qualifications for
mental health diagnosis and treatment as well as individual and/or family therapy. Advanced certification
in hospice and palliative social work is available and requires experience, licensure, commitment to
ethical practice, and passing of an evidence-based exam (3). Most social workers report learning their
specialty through interprofessional practice and post graduate continuing education (4).
Scope of Practice Major social work roles for the seriously ill include providing evidence-based
interventions that empower the patient in the context of their health care and family situation and
facilitating a dignified death as defined by the patient. According to the NCP Guidelines, “social workers
attend to family dynamics, assess and support coping mechanisms and social determinants of health,
identify and facilitate access to resources, and mediate conflicts” (2). A national job analysis further
delineated the social work role (6). From this work, a range of direct and indirect patient care services
driven by individualized assessments and care planning needs have been described (2,5-10):
Direct Patient Care Services Indirect Patient Care Services
Utilizing a biopsychosocial assessment of the
patient and family as the basis for care planning
Facilitating or co-facilitating family meetings
Facilitating effective communication between
patient/family and the IDT
Advocating for effective team dynamics, including
conflict management, wellness and self-care
Assisting patients with advanced care directives Debriefing difficult cases or deaths within the IDT
Patient/family psychoeducation regarding coping
with illness, normalization of stress, and palliative
care options such as hospice services
Identifying and reporting abuse and neglect as
mandated by law
Resource identification and referrals; practical
assistance; insurance coverage; system
navigation; funeral planning.
Documenting assessments, progress, and
response to treatment as required by
organizational and professional standards.
Financial counseling related to the cost of care Improving care delivery for persons with life-
threatening illness
Individual and family counseling specific to the
disease process, coping, and planning
Educating IDTs about mental health issues, family
dynamics, or psychosocial factors impacting care
Assessing and addressing caregiving resources
and needs
Advising IDT members of the maintenance of
appropriate and therapeutic boundaries
Crisis intervention including suicide assessment
and prevention
Facilitating and participating in research and
quality improvement activities
Collaborating on discharge planning Cultivating community relationships and
developing community resources
Legacy work including dignity therapy and
Acceptance and Commitment Therapy (ACT)
Influencing and improving social policy and ethical
practice related to hospice and palliative care
Bereavement care and grief counseling, including
anticipatory responses to and processing of grief
Awareness of state laws and regulations
regarding end of life care
Like other members of the PC IDT, social workers develop expertise relative to the patient situation. PC
social workers are often engaged with adjustment to illness, decision making, and family coping along the
illness trajectory. Hospice social workers are focused more specifically on end of life, though the job
descriptions and tasks carried out are much the same as those in PC social work. Typically, there are two
main models for utilizing social workers to address palliative care needs: 1) utilizing the unit or clinic
generalist social worker or 2) utilizing the IDT social worker with specialized training and experience. A
specialized palliative social worker is preferred and offers greater expertise relative to the serious illness
context of the IDT, patient and family.
Summary Hospice and palliative social workers have unique education, skills, and training essential to
the interdisciplinary provision of holistic patient-centered care. Their psychosocial expertise and attention
to the social determinants of health enables IDTs to better appreciate the complexity of issues patients
and families face and thereby develop more effective, feasible, and patient-directed interventions.
1. National Association of Social Workers. NASW Standards for Social Work Practice in Palliative
and End of Life Care. Washington, DC: Author; 2004.
2. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative
Care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018.
3. Chai E, Meier D, Morris J, Goldhirsch S (Eds). Geriatric Palliative Care: A Practical Guide for
Clinicians. New York: Oxford University Press; 2014.
4. Social Work Hospice and Palliative Network. APHSW-C Certification.
certification. Accessed January 4, 2019.
5. Sumner B, Remke S, Leimena, M, Altilio T, Otis-Green S. The serendipitous survey: A look at the
primary and specialist palliative social work practice, preparation and competence. Journal of Palliative
Medicine. 2015;18(10): 881-883.
6. Head B, Peters B, Middleton AA, Friedman C, Guman N. Results of a nationwide hospice and
palliative care social work job analysis. Journal of Social Work in End-of-Life & Palliative Care, 2019;
7. Gwyther LP, Altilio T, Blacker S, Christ G, Csikai EL, Hooyman, N, …Howe, J. Social work
competencies in palliative and end-of-life care. Journal of Social Work in End-of-Life & Palliative Care.
2005;1(1):87-120. doi: 10.1300/J457v01n01_06
8. Altilio T, Otis-Green S, Dahlin CM. Applying the national quality forum preferred practices for palliative
and hospice care: A social work perspective. Journal of Social Work in End-of-Life & Palliative Care.
2008;4(1):3 – 16.
9. Weisenfluh SM, Csikai EL. Professional and educational needs of hospice and palliative care social
workers. Journal of Social Work in End-of-Life & Palliative Care. 2013;9(1): 58-73.
10. Friedman C, Guman, N. A job analysis study of the advanced hospice and palliative care social
worker. Kansas City: PSI; 2017.
Conflicts of Interest: None to report.
Authors’ Affiliations: 1University of Louisville, Louisville, KY; 2University of Minnesota, Minneapolis, MN
Version History: originally edited by Sean Marks MD; first electronically published December 2019.
Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate
editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a
volunteer peer-review editorial board, and are made available online by the Palliative Care Network of
Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s
content. The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact
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... Despite the burden of mental health comorbidity in palliative care, palliative care clinicians often lack the time, training, or systematic support to provide mental health services (Patterson et al., 2014). Few palliative care teams have dedicated mental health clinicians; palliative care social workers are frequently assigned as designated mental health clinicians on palliative care teams but often have compound roles with competing tasks (Middleton et al., 2020). The lack of integrated mental health clinicians on palliative care teams is particularly noteworthy given the diagnostic challenges of detecting and managing psychopathology in the setting of serious medical illness (Ng et al., 2015). ...
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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Health professionals have begun to identify competencies needed for primary and specialist levels of palliative care practice, but little attention has been given to how these skills are acquired. The authors electronically surveyed a wide range of health social workers and educators to investigate their reported levels of preparation, training, and self-assessed competence to provide palliative and end-of-life care. Two health social work surveys were developed: one for educators and one for practitioners and students. The study used an electronic snowball sampling method with eight national social work listservs to capture a wide range of settings where health social workers may teach or practice. The survey was completed by 1149 self-identified health care social workers, 35% of whom identified as a specialist in palliative care. Health social work clinicians report competence in many skills related to palliative care and the psychosocial determinants of health, having developed these skills primarily through interprofessional and peer collaboration. A representative sample of social workers practicing in health care identify high competence in essential aspects of palliative care. This speaks to an existing pool of clinicians who, if practicing to the top of their licenses, have the potential to provide primary palliative care and contribute to the person-family centered care called for in the Institute of Medicine (IOM) report. Few programs exist to prepare social workers to work as specialists in palliative or end-of-life settings, and respondents identified key areas of practice that need to be integrated into graduate education to ensure that students, practitioners, and educators are better prepared to maximize the impact of health social work. Further research is needed to better understand how to prepare and train specialist-level palliative care social workers.
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Social workers from clinical, academic, and research settings met in 2002 for a national Social Work Leadership Summit on Palliative and End-of-Life Care. Participants placed the highest priority on the development and broad dissemination of a summary document of the state-of-the-art practice of social work in palliative and end-of-life care. Nine Summit participants reviewed the literature and constructed this detailed description of the knowledge, skills, and values that are requisite for the unique, essential, and appropriate role of social work. This comprehensive statement delineates individual, family, group, team, community, and organizational interventions that extend across settings, cultures, and populations and encompasses advocacy, education, training, clinical practice, community organization, administration, supervision, policy, and research. This document is intended to guide preparation and credentialing of professional social workers, to assist interdisciplinary colleagues in their collaboration with social workers, and to provide the background for the testing of quality indicators and "best practice" social work interventions.
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.
In the past decade much growth has occurred in the numbers of patients and families served by hospices and palliative care services. Thus, not surprisingly, these services have also been subject to increasing regulation by governmental and accrediting entities. In order to stay up-to-date in this ever-changing environment and to continue to provide effective interventions, social workers must stay engaged in the professional community and continuing education. In this quantitative study, 1,169 practicing hospice and palliative care social workers provided information about their practice activities and agency characteristics, professional affiliations and certification, and ongoing educational needs. About one-half of respondents carried a caseload of 21-50 and were most engaged in communicating the psychosocial needs of the patient and family to other members of the team and assessing for grief and bereavement issues. The most important educational needs pertained to the psychological and social needs of patients and families and psychosocial interventions. Most were members of professional organizations and three-quarters were members of NASW. Although many were aware of the joint NASW-NHPCO social work hospice specialty certification, few held this certification yet. The results of this survey can be utilized in the design of continuing education programs and advocacy for programmatic and policy change within agencies and the industry.
The National Consensus Project's (NCP) Clinical Practice Guidelines for Quality Palliative Care, published in 2004, defined eight domains of care essential to palliative care clinical practice. The National Quality Forum's (NQF) 2006 document, A National Framework and Preferred Practices for Palliative and Hospice Care Quality: A Consensus Report, based on the NCP's Guidelines, identified 38 evidence-based preferred practices for palliative care. This article demonstrates how the Guidelines and Preferred Practices may be operationalized in practice, focusing specifically on Domain 4 of the Guidelines, "Social Aspects of Care". Domain 4 incorporates many pertinent aspects of hospice and palliative care related to communication and care planning. In particular, emphasized is the inclusion of the patient and family in discussions about ongoing care and creation of care plans that respect the social community of patient and family.