Social work competencies in palliative and end-of-life care

Social Work Competenciesin Palliative and End-of-Life Care

Lisa P Gwyther MSW LCSWTerry Altilio ACSWSusan Blacker MSWGrace Christ DSW

Ellen L Csikai BASW MSW PhDNancy Hooyman PhD

Betty Kramer PhDJulie M Linton BA

Mary Raymer MSW ACSWJudith Howe PhD

Lisa P Gwyther MSW LCSW is affiliated with the Duke University Institute onCare at the End of Life Durham NC

Terry Altilio ACSW is affiliated with the Beth Israel Medical Center New YorkNY

Susan Blacker MSW is affiliated with St Michaelrsquos Hospital Toronto CanadaGrace Christ DSW is affiliated with Columbia University School of Social Work

New York NYEllen L Csikai BASW MSW PhD is affiliated with The University of Alabama

School of Social Work Tuscaloosa ALNancy Hooyman PhD is affiliated with the University of Washington School of

Social Work Seattle WABetty Kramer PhD is affiliated with the University of Wisconsin School of Social

Work Madison WIJulie M Linton BA is affiliated with the Duke University Center for the Study of

Aging Durham NCMary Raymer MSW ACSW is affiliated with the National Hospice and Palliative

Care Organization Williamsburg MIJudith Howe PhD is affiliated with the Mt Sinai School of Medicine and GRECC

Program Bronx Veterans Affairs Medical Center New York NYAddress correspondence to Lisa P Gwyther MSW LCSW Associate Clinical

Professor Department of Psychiatry and Behavioral Sciences 3600 Duke UniversityMedical Center Durham NC 27710 (E-mail lpggeridukeedu)

The authors gratefully acknowledge the cosponsors of the Social Work LeadershipSummit on End of Life and Palliative Carendashthe Last Acts Provider Education Commit-tee the Duke Institute on Care at the End of Life and the Soros Foundationrsquos Project onDeath in America

Journal of Social Work in End-of-Life amp Palliative Care Vol 1(1) 2005httpwwwhaworthpresscomwebJSWEL

2005 by The Haworth Press Inc All rights reservedDigital Object Identifier 101300J457v01n01_06 87

ABSTRACT Social workers from clinical academic and research set-tings met in 2002 for a national Social Work Leadership Summit on Pal-liative and End-of-Life Care Participants placed the highest priority onthe development and broad dissemination of a summary document of thestate-of-the-art practice of social work in palliative and end-of-life careNine Summit participants reviewed the literature and constructed thisdetailed description of the knowledge skills and values that are requi-site for the unique essential and appropriate role of social work Thiscomprehensive statement delineates individual family group teamcommunity and organizational interventions that extend across set-tings cultures and populations and encompasses advocacy educationtraining clinical practice community organization administrationsupervision policy and research This document is intended to guidepreparation and credentialing of professional social workers to assist in-terdisciplinary colleagues in their collaboration with social workers andto provide the background for the testing of quality indicators and ldquobestpracticerdquo social work interventions [Article copies available for a fee fromThe Haworth Document Delivery Service 1-800-HAWORTH E-mail addressltdocdeliveryhaworthpresscomgt Website lthttpwwwHaworthPresscomgtcopy 2005 by The Haworth Press Inc All rights reserved]

KEYWORDS Social work practice social work competencies pallia-tive care end-of-life care bereavement

All social workers regardless of practice setting will inevitablywork with clients facing acute andor long-term situations involvingloss (Sheldon 1998) life-limiting illness dying death grief andor be-reavement (Kramer 1998 2003) Care providers in nursing and medi-cine confront end-of-life care primarily in health settings Howeversocial work by virtue of its scope of practice has the unique potential toextend the work around palliative and end-of-life care issues beyondhealth care settings to the larger community This opportunity creates amandate for educators to integrate core generalist knowledge of pallia-tive and end-of-life care issues as well as specialist skills into the formaleducation of professional social workers (Altilio 2001) and in continu-ing education programs

Within the social work scope of practice loss extends beyond illnessdeath and bereavement to a broader view of unanticipated and adverselife events Although not all those who experience loss require or seek

88 JOURNAL OF SOCIAL WORK IN END-OF-LIFE amp PALLIATIVE CARE

intervention social workers witness the grief responses of clients facedwith unemployment crime poverty divorce disability abuse neglectabandonment incest suicide chronic and acute physical or mental ill-ness (Kramer 1998) Working with populations from varying culturesages socioeconomic status and nontraditional families social workersassist families across the life span in varied settings assessing the im-pact of crises and intervening appropriately Those who practice inschools have a role in stress debriefing suicide prevention and supportof children and teens as they experience loss transitions the illness andor death of friends family members or teachers Child welfare workersaddress loss separation anxiety and bereavement in their work withchildren parents and caregivers Social workers are called upon to re-spond to the mental health needs caused by natural disasters includingtornados hurricanes and floods and other national disasters such as theOklahoma City bombing and the September 11 2001 terrorist attacks(Webb 2002) Additionally mental health and gerontological practitio-ners have important roles in working therapeutically with those experi-encing the multiple losses associated with aging stress reactions andother impacts of caregiving and adaptation to chronic life-threateningillness Loss and bereavement consequent to violence is disproportion-ately experienced by families in poverty-stricken rural and urban areaswhere social workers are the committed and primary providers of socialand mental health services (Van Epps Opie amp Goodwin 1997)

Practitioners in health care settings play essential roles in the care ofthe patients and families who are living with and dying from life limit-ing illness These settings include home health care (Chichin Ferster ampGordon 1994 Egan amp Kadushin 1999) hospice palliative care orfree-standing hospice units associated with hospitals and skilled nurs-ing facilities (Amar 1994) the emergency room (Lauria Whitaker ampColeman 2001) intensive care (Mosenthal Lee amp Huffman 2001)other acute care settings (Fauri Ettner amp Kovacs 2000) hospital ob-stetrical units (Pauw 1991) neonatal intensive care (Silverman 1992)pediatric settings (Jones amp Weisenfluh 2003) pediatric palliative andcritical care (Browning amp Solomon in press Dungen Junquay Reznikamp Sands 1995) pain clinics (Mendenhall 2003 Otis-Green ShermanPerez amp Baird 2002) community-based substance abuse and healthagencies agencies serving immigrants and refugees hospital bioethicscommittees (Csikai amp Sales 1998 Silverman 1992) and nursinghomes (Cleary amp Carbone 1997 Kruzich amp Powell 1995)

Consistent with the primary value base of the profession socialworkers are concerned with enhancing quality of life promoting justice

Gwyther et al 89

and access to care for clientspatients their biologic or created familiesandor other types of caregivers Social workers have a multidimen-sional role as clinicians educators researchers advocates communityleaders and policy analysts The content of this article represents a sum-mary statement that identifies competencies that are needed to providehigh-quality social work services across a variety of practice settingsand populations with particular attention to contexts that transcendhealth care settings and involve adaptation to life-threatening illnessThe competencies are described in terms of the knowledge skills andvalues that are at the core of social work practice in palliative and end-of-life care

BACKGROUND

The impetus for this document began with a national Social WorkLeadership Summit on End-of-Life and Palliative Care held in March2002 at Duke University in Durham North Carolina The meetingbrought together leaders from 30 organizations representing 160000social workers from national professional organizations schools of so-cial work hospices hospitals government agencies and advocacygroups Co-sponsored by the Last Acts Provider Education Committeethe Duke Institute on Care at the End of Life and the Soros Founda-tionrsquos Project on Death in America the summit was led by Grace ChristDSW and Susan Blacker MSW

Participants engaged in a facilitated process (by Benjamin JBroome PhD Hugh Downs School of Human Communication Ari-zona State University) that produced a prioritized social work agendahighlighting the need for standards of practice collaborative organizedleadership and increased preparation at all levels of education and re-search

The specific priority areas were

1 Develop a consensus statement for the social work role in pallia-tive care and end-of-life care for broad dissemination

2 Create a coalition of experts institutions and organizations topromote advocacy education research and networking

3 Produce a concise document that integrates and synthesizes theresearch and practice-based literature about psychosocial factorsand the unique role of social work across settings and stages ofthe life span in an interdisciplinary context


4 Identify the competencies needed to guide and develop standardsfor eventual inclusion in licensing and certification exams

5 Create an information clearinghouse to increase public and pro-fessional awareness and to conduct an educational campaign re-garding psychosocial dimensions and the social work role

6 Develop social work content for infusion into existing curricula7 Review federal and state authorizing legislation to identify fund-

ing opportunities for research training and education and de-velop an action plan for advocacy

8 Directly approach public and private sources of funding for so-cial work research awardsgrants

9 Establish academic and clinical partnerships to develop collabo-rative research on the efficacy of social work interventions in or-der to identify best practices

10 Identify create implement and disseminate models for post-graduate continuing education (Blacker amp Christ 2002)

This document is a direct product of this priority list Specifically itcombined the priorities numbered 1 3 and 4 After the Summit the au-thors (all Summit participants) collaborated on a literature review withthe assistance of Duke University Aging Center Intern Julie LintonEach author focused on their own areas of expertise within palliativeand end-of-life care to develop the comprehensive reference list that isprovided with this article It is important to note here that this referencelist is by no means an exhaustive list but rather reflects an attempt tocover the literature relevant to social work practice in palliative andend-of-life care The authors attempted whenever possible to locateworks authored by social workers some in collaboration with otherhealth care disciplines This literature review was then synthesized intoa comprehensive statement of the social work role (including knowl-edge skill and value competencies) in an interdisciplinary contextacross practice settings and stages of the life span

KNOWLEDGE COMPETENCIES

Effective practice in palliative and end-of-life care and bereavementis based on the assumption that the patient and family are the unit of carewho bring to their illness experience rich life narratives This underly-ing value is complemented by a working knowledge of the following

Gwyther et al 91

bull The multifaceted role of social workers as clinicians educatorsbrokers advocates researchers community and policy leaders(Bern-Klug Gessert amp Forbes 2001 Taylor-Brown BlackerWalsh-Burke Christ amp Altilio 2001)

bull Biological psychological social emotional spiritual practicalinformational and financial needs and challenges experienced bythe clientpatient family and caregiver (Contro Larson ScofieldSourkes amp Cohen 2002 Corless Germino amp Pittman 2003Taylor-Brown et al 2001)

bull Definitions goals strengths and limitations of various care op-tions including hospitals (Kaufman 2002) home care (Egan ampKadushin 1999 Soskis 1997) hospice care (Rusnack Schaefer ampMoxley 1990) long-term care (Amar 1994 Kruzich amp Powell1995) assisted living and continuing care retirement communities(Hays Galanos Palmer McQuoid amp Flint 2001) palliative careservices in health care institutions (Institute of Medicine 2001)and griefbereavement interventions (Birnbaum 1991 GenevroMarshall amp Miller 2003 Oliver Sturtevant Scheetz amp Fallat2001 Stoddart Burke amp Temple 2002)

bull Commonly experienced symptoms treatments and effects on pa-tients and families across illness trajectoriesbull Illness-specific issues related to cancer (Institute of Medicine

2001) chronic obstructive pulmonary disease (Fraser amp Chap-man 2000) congestive heart failure (Abdelhafiz 2002) HIVAIDS (Cochran amp Wilson 1999) Alzheimerrsquos disease andother dementias (Gwyther 2000) and neurological disorders(Cowan amp Kandel 2001)

bull Symptoms including weakness and fatigue (Abbey 2000)pain and dyspnea (Desbiens Mueller-Rizner ConnorsWenger amp Lynn 1999 Gallo-Silver amp Pollack 2000) pressuresores (Berlowitz Brandeis Anderson Du amp Brand 1997)nausea and vomiting (Rousseau 1996) nutritional problems(Blacker 2002) decreased appetite and weight loss (Desbienset al 1999) cognitive impairment and a knowledge of potentialpharmacological and integrative treatments (Rousseau 1996 Turk ampFeldman 2000)

bull Emotional psychosocial and cognitive responses to symptomssuch as pain (Altilio 2004 Otis-Green et al 2002) and delir-ium and to treatments and interventions (Steinhauser et al2000) such as tube feeding intravenous fluids opioid medica-tion including recognition of the potential for symbolic mean-


ing to be attached to both symptoms and treatment eg pain assacrifice or punishment hydration and nutrition as symbols ofcaring and life

bull Psychological physical economic and spiritual impacts of thecaregiving role and responsibility (Glajchen 2004)

bull Knowledge of the symptoms treatment and impact of variousDSM IV diagnoses and psychiatric symptoms for clientspatientsfamilies and caregivers including major depression and anxietydisorders (Block 2001) Post Traumatic Stress Disorder (PTSD)(Sprang 2001) delirium (Block 2001) degenerative dementias(Gwyther 2000) mental health issues resulting from a stroke(Sandberg Franklin Bucht amp Gustafson 2001) Korsakoff syn-drome (Langlais 1995) and substance abuse (Passik amp Portenoy1998)

bull Pain and symptom management includingbull Definitions and assessment of pain and suffering from a multi-

dimensional and systemic perspective that includes physicalpsychological socioeconomic cultural emotional cognitiveand spiritual dimensions (Altilio 2004 Mendenhall 2003Paice amp Fine 2001 Otis-Green et al 2002 Sieppert 1996Wolfe et al 2000)

bull Barriers to pain relief related to patientfamily health care pro-fessionals health care systems public policy and societalper-sonal beliefs and fears (Glajchen Blum amp Calder 1995)

bull Awareness of the potential discrepancy in the assessments ofpain and quality of life between clientpatient family andhealth care providers (Brunelli et al 1998 Lobchuk amp Degner2002)

bull Basic pharmacological and medical management of pain sideeffects (Portenoy 2000) and related emotional responses

bull Integrative and social work interventions indications for theiruse across the life span to enhance management of distresssymptoms and suffering to maximize quality of life (Abbey2000 Altilio 2004 Breitbart amp Payne 2000 Cherny 2000Gallo-Silver amp Pollack 2002 Lesko 2000 Osterlund ampBeirne 2001 Turk amp Feldman 2000)

bull The impact of untreated pain and symptoms on the quality oflife of the patient family and staff bereavement and integrationof the quality of the death into the family legacy (Altilio 2004Otis-Green et al 2002)

Gwyther et al 93

bull Principles of addiction tolerance and dependence (OrsquoNeill ampFallon 1997)

bull Specific cognitive behavioral psychodynamic crisis and envi-ronmental interventions and therapeutic techniques that can ame-liorate the distress of the patient family and caregivers

bull Signs and symptoms of imminent death including anxiety andrestlessness death rattle symbolic communication vs confusionand altered mental status including potential interventions such aspharmacologic and integrative modalities therapeutic silence andpresence (Berry amp Griffie 2001)

bull Clinically and culturally informed preparation of patientfamilyfor death including physical changes after-death care funeral andritual culturally relevant body disposition wishes decisions aboutautopsy and organ or body donation and facilitating needs and de-sires of family and the grieving process as per religious and cul-tural beliefs (Bern-Klug Ekerdt amp Wilkinson 1999 Berry ampGriffie 2001 Koenig amp Gates-Williams 1997)

bull Religious spiritual and cultural values and expectations associatedwith illness and end-of-life care including specific ritualscustomsbeliefs and taboos (DelRio 2002 Battaglia 1998 Braun Tanji ampHeck 2000 Crawley et al 2000 Johnson amp McGee 1998 Kagawa-Singer amp Blackhall 2001 Koenig amp Gates-Williams 1997 KoenigGeorge amp Peterson 1998 Koenig McCullough amp Larson 2001Lloyd 1997 Miller amp Thoresen 2003 Rosenblatt 2001)

bull Ethical and legal principles underlying and informing palliativeand end-of-life care the patientclientfamilystaff interface deci-sion making and social work participation on ethics committees(Csikai 1997 Csikai amp Sales 1998 Silverman 1992) includingbull Confidentiality (Csikai amp Bass 2000)bull Autonomy self-determination (Galambos 1998 Reinardy

1999) and informed consent (Kastenbaum 2001)bull Dignity conserving care (Chochinov 2002) and medicalization

of dying (Stanley amp Zoloth-Dorfman 2001)bull Advance directives (Baker 2000 Galambos 1998 Kass-

Bartelmes amp Hughes 2003 Landau 2000) and DNR (Do NotResuscitate) AND (Allow Natural Death) orders (wwwhospicepatientsorgandhtml) durable powers of attorney(POA) (Hoffman 1994) health care proxies will and livingwills (Silveira DiPiero Gerrity amp Feudtner 2000)

bull Issues of guardianship competency capacity and surrogate de-cision-making (Gessert Forbes amp Bern-Klug 2001) medical


futility (Atkinson et al 1994) withdrawing or withholding oftreatment (Pellegrino 2000) artificial nutrition and hydration(Sieger Arnold amp Ahronheim 2002) pain and symptom man-agement (Altilio 2004) palliative sedation (Cherny ampPortenoy 1994 Faisinger De Moissac Mancini amp Oneschuk2000) the principle of double effect (Lo 2000) physician-as-sisted suicide and euthanasia (Altilio Hedlund amp Smolinski1999 Csikai 1999 Miller Hedlund amp Murphy 1998)

bull Perspectives values and beliefs that affect end-of-life decisionsamong diverse religious and cultural groups (Blackhall et al1999 Braun et al 2001 Vincent 2001 DelRio 2002) and amonggay lesbian bisexual or transgender persons (Bowman 2000Stein amp Bonuck 2001 Tesar amp Rovi 1998)

bull Death specific issues such as organ donation (Geva amp Weinman1995) autopsy (Mittleman Davis Kasztl amp Graves 1992) cre-mation (Banks 1998) and transporting the body (Harvey 2001)

bull The experience of loss grief and bereavement includingbull The development of human emotional attachments (Bretherton

1992) and the experience of loss (Shaver amp Tancredy 2001Sheldon 1998 Weiss 2001) across the life course

bull Definitions relevance manifestations (signs and symptoms)and effects of loss grief bereavement and mourning (Corlesset al 2003 Kastenbaum 2001 Tomita amp Kitamura 2002Wortman amp Silver 2001) across multiple practice settings cul-tures among diverse populations and across the life span(Catlin 1993 Irish Lundquist amp Nelson 1993 Lauria et al2001 Lloyd 1997 Olsson 1997 Rosenblatt 2001)

bull Risk factors for complicated grief reactions (Christ 2002Prigerson amp Jacobs 2001 Parkes amp Weiss 1983 Rando1993)

bull Types of grief including anticipatory grief (Christ 2000Walker amp Pomeroy 1996) unresolved grief (Kastenbaum2001) disenfranchised grief (Doka 1989 Kastenbaum 2001)traumatic grief (Jacobs amp Prigerson 2000) professional grief(Kramer 1998) compassion fatigue (Keidel 2002) and self-care strategies (Gamble 2002 Vachon 2000)

bull Strengths and limitations of current theories of grief mourningand bereavement (Genevro et al 2003) including grief work(Lindestrom 2002) stage theories (Corr 1993 Kubler-Ross1969 Neimeyer amp Hogan 2001) process and phase theories(Horowitz Fridhandler amp Stinson 1991 Murray 2001 Peter-

Gwyther et al 95

son amp Rafuls 1998 Stroebe et al 2000 Worden 2002) andtask theories and models (Rando 1992-1993 1993)

bull Interventions and practice guidelines for work with diverse in-dividuals in grief and bereavement (Chazin Kaplan amp Terio2000 Ellis 1998)

bull Equity in palliative and end-of-life care including vigilance to is-sues such as access to care justice ethnic and racial disparities(Bonham 2001 Edwards Fillingim amp Keefe 2001 MacDonald1991 Otis-Green amp Rutland 2004 Owen Goode amp Haley2001)

bull Insurance entitlement and financial issues during the course ofillness and at the end of life including Family Medical Leave Act(Hudson amp Gonyea 2000 Wisensale 2001) payment and reim-bursement issues with Medicare and Medicaid (Birnbaum 1999Hoffman Klees amp Curtis 2000 Tilly amp Wiener 2003)

bull Changes in population demographics and service delivery systemsthat necessitate adaptation of professional education and practiceto integrate the impact of these factors across the life span (Bern-Klug et al 2001 Last Acts 2002 Taylor-Brown et al 2001) anddisability (Stein amp Esralew 2004)

bull The status of local state and federal policies that impact healthcare issues such as access regulation and insurance coverage ana-lyzed from multidimensional perspectives including ethical fi-nancial and quality of care (Christopher 2003 Soskis 1997)

bull Practical and community resources (Taylor-Brown et al 2001)bull Standards of care established by social work hospice palliative

care professional organizations and governmental bodies includ-ing the National Association of Social Work Association of On-cology Social Work National Consensus Project for QualityPalliative Care Joint Commission on Accreditation of HealthcareOrganizations the National Hospice and Palliative Care Organiza-tion American Geriatrics Society Society of Critical Care Medi-cine and the Institute of Medicine

SKILLS COMPETENCIES

Assessment

Assessment is the foundation of social work practice Often assess-ment is a beginning intervention as it implies an expertise and a willing-ness to listen understand provide support and treatment all of which


have the potential to lessen the isolation confusion and helplessnessthat often accompanies illness death and trauma (Altilio 2004) In ad-dition to interviews assessment is complemented by the use of genderage and culturally appropriate tools and practice guidelines The focusand method of assessment will be determined by the setting presentingproblem and needs associated with each encounter whether on an indi-vidual family community or systems level For example when work-ing with persons with advanced disease an understanding of symptomssuffering caregiver needs prognosis goals of care and perception ofdisease may be essential Assessment of bereaved or critically ill chil-dren suicidal adolescents or elders will involve other considerationsCulturally respectful practice involves individualized assessments ofthe clientpatient family (as defined by the clientpatient) caregiversand supports (Bowman 2000)

The following factors are important aspects of assessment

bull Physical functional financial social emotional spiritual andpsychological resources and supports and unmet needs (Monroe1993 Zabora amp Loscalzo 1998)

bull Strengths competencies and coping resources (Monroe 1993)bull History and needs in relation to the patientfamily developmental

stage and life course (Monroe 1993)bull Structure roles boundaries and dynamics of the family network

(Monroe 1993 Taylor-Brown et al 2001)bull Cultural expectations preferences and health beliefs and values

related to issues such as truth telling advance care planning per-ception of illness and prognosis (Blackhall et al 1995 Bowman2000 Powaski amp Walsh 1999 Vincent 2001)

bull Spiritual andor religious beliefs rituals values and existentialconcerns related to end-of-life care symptom managementcaregiving death and dying (Johnson amp McKee 1998 Koenig ampGates-Williams 1997 Lloyd 1997 Otis-Green et al 2002Parker-Oliver 2002)

bull Quality of past and present symptom management (Altilio 2004Otis-Green et al 2002)

bull Educational practical health care advance care planning dis-charge planning support needs and preferences (Altilio 2004Powazki Palcisco Richardson amp Stagno 2000)

bull Emotional issues including cognitive and emotional integration ofdiagnosis or trauma (Miller et al 1998 Powazki amp Walsh 1999)death anxiety (Parker-Oliver 2002) emotional coping (Souza amp

Gwyther et al 97

Siegler 2001) adaptive and maladaptive denial (Faulkner 1998)grief-related issues including unresolved ongoing or anticipatorygrief (Kastenbaum 2001)

bull Impact of illness on the patientrsquos body integrity and functioningand concerns about dependency (Teno Casey Welch amp Edgman-Levitan 2001) sexuality and intimacy (Monroe 1993 Zabora ampLoscalzo 1998)

bull Potential barriers and risk factors that may impede success of thetreatment plan (Rusnack et al 1990)

bull Functional issues and environmental circumstances including nec-essary equipment accessibility pets ability of the patient care-giver and family support system to manage illness-relateddisabilities (Powazki amp Walsh 1999) and exploration of emo-tional aspects of integrating medical equipment health care clini-cians into a home setting (Altilio amp Rigoglioso 2004)

bull Legal and ethical principles confusions andor concerns (Baker2000)

bull Safety issues including abuseneglect environmental safety haz-ards thoughts of and plans for suicide and desires to hasten death(Csikai amp Manetta 2002 Miller et al 1998)

Treatment Planning and Interventions

Multidimensional assessment enables the social worker to plan biopsychosocial spiritual interventions with the patientclientfamilycare-giver and support network in collaboration with care providers andorthe interdisciplinary team Treatment plans are developed and revised inorder to address identified and evolving needs respond to changinggoals of care and enhance quality of life Fundamental to treatmentplanning is the ability to adapt techniques to individuals from differentage groups ethnicities cultures religions socioeconomic and educa-tional backgrounds lifestyles and varying states of mental health anddisability and in diverse medical and non-medical settings Interven-tions may include

bull Enhancing communication to maximize effective and compas-sionate care

bull Individual supportive counseling and integrative therapies such asGestalt techniques (Clarkson 1989) brief solution-focused thera-pies (Webster Vaugh Webb amp Playter 1995) reminiscence andlife review (Byock 1996) Jungian approaches (Bogart 1991)


therapeutic dream work (Goelitz 2001) stress management(Tolman amp Rose 1985) and problem-solving techniques (Loscalzo ampBecher 1999)

bull Family counseling and therapy (Monroe 1993 Powazki et al2000)

bull Effective organization leadership andor participation in familymeetings or familyteam meetings (Powazki et al 2000) grouppsychotherapy counseling (Monroe 1993) and psychoeduca-tional interventions (Taylor-Brown et al 2001)

bull Liaison skills linking clientpatient caregivers family profes-sional communities and resources (Glajchen et al 1995)

bull Cognitive-behavioral and integrative interventions to facilitate ad-aptation enhance coping and management of distress pain andsymptoms including relaxation techniques diariesjournalingcognitive restructuring coping statements distraction (Altilio2004 Loscalzo 1996 Loscalzo amp Jacobsen 1990) hypnosis (Turk ampFeldman 2000) healing touch guided imagery (Osterlund ampBeirne 2001) eye movement desensitization and reprocessing(EMDR) (Shapiro 2002 Sprang 2001) humor massage(McCaffrey amp Pasero 1999) music therapy (Beck 1991) art ther-apy (Mayo 1996) play therapy (LaBauve Watts amp Kottman2001) animal companions (McCaffrey amp Pasero 1999)

bull Spiritual interventions including assessment exploration clarifi-cation referrals and reframing of hope (Ai 2000 Canda ampFurman 1999 Reese 2001 Smith 1995)

bull Educational interventions including information related to illnesspain and symptom management insurance and financial issues(Reese amp Sontag 2001)

bull Environmental interventions such as arranging for equipment al-tering or personalizing the physical environment advocating forprivate or shared hospital room

bull Risk management (Reamer 2000)bull Crisis intervention (Chung 1993) essential in emergency room

trauma response (Lauria et al 2001) and sometimes necessary insettings where evolving symptoms or new diagnostic informationsignals change in disease progression and prognosis or when thepatient is near death

bull Conflict resolution including communication barriers (Sheldon2000) intergenerational conflict (Parker 1991) and moderatingthe impact of family dysfunction (Zabora amp Smith 1991)

Gwyther et al 99

bull Advocacy for the needs desires and goals of the client caregiverand family members (Taylor-Brown et al 2001)

bull Case management interventions including referrals (Kennedy1996) navigating medical social and community systems such ashome care entitlements courts (Sheldon 1998) discharge plan-ning (Abramson Donnelly King amp Mailick 1993) and facilita-tion of the continuity of care across care settings with particularattention to family systems needs and the emotional symbolicand practical significance of caring for a family member at home(Altilio amp Rigoglioso 2004)

bull Clinical interventions related to grief and bereavement includingbull Expressive techniques such as art (Goodman 2002 Salmon

1993) story-telling (Glazer amp Marcum 2001) metaphor (Schwartz-Borden 1992 Witzum amp Roman 2000) and ritual (Kagawa-Singer 1998) life review and legacy building (Otis-Green2003) and reminiscence with older adults (Beaver 1991)

bull Counseling for children and teens (Stanko amp Taub 2002)school-based crisis bereavement intervention and prevention inschools (Hawkins 2002 Lowton Higginson amp Shipman 2001Morgan 1995) trauma and grief focused interventions for teensexposed to violence and death (Saltzman Pynoos LayneSteinberg amp Aisenberg 2001) group work for children in fostercare (Williams Fanolis amp Schamess 2001) and parental guid-ance interventions (Christ 2002 Sandler et al 2002)

bull Interventions for specific populations including counseling andgroup interventions for children and adult survivors bereavedby suicide (Pfeffer Jiang Kakuma Hwang amp Metsch 2002Barlow amp Morrison 2002 Constantino Sekula amp Rubinstein2001) emotional expression interventions with bereaved elders(Shear et al 2001) ethnocultural counseling and psychother-apy (Peltzer 2001 Wilby 1995) hospital bereavement inter-ventions (Oliver et al 2001) and counseling later life families(Nadeau 2002)

bull Varied modalitiesndashbereavement groups (Stoddart et al 2002Picton Cooper Close amp Tobin 2001) psychoeducational groupinterventions (Pomeroy Green amp VanLaningham 2002Poijula Dyregrov Wahlberg amp Jokelainen 2001 Wahlberg ampDyregrov 2001 Yule 2001) grief counseling and therapy (Ca-nine 1996 Murray Terry Vance Battistutta amp Connolly2001 Walsh-Burke 2000 Zisook amp Shuchter 2001) cognitivebehavioral group therapy (Malkinson 2001 Stubenbart Donnel-


ly amp Cohen 2001) traumatic grief treatment protocols (Shear etal 2001) family systems grief interventions (McBride ampSimms 2001) Critical Incident Stress Debriefing followingtrauma (Irving amp Long 2001) community work followingsudden traumatic death (Underwood amp Maxim 2000) tech-niques for complicated grief (Goldman 1996 Witzum amp Ro-man 2000) on-line telephone and Web-based interventions(Kramer 2002)

Interdisciplinary Teamwork

Social workers participate on interdisciplinary teams in palliativecare units hospices outpatient clinics and on consultation teams inhospital home health hospice and nursing home facilities In manysettings social workers are essential members of interdisciplinary andtransdisciplinary teams and in some this role is built in by actual regu-lation For example hospice Medicare regulations require that a socialworker as well as nurse medical director and volunteer be available toall patients Social workers have skills to assist and enhance team func-tioning in a number of ways including

bull Fostering effective communication among members of the inter-disciplinary team (Leipzig et al 2002)

bull Promoting collaborative cross-disciplinary education (HoweMellor amp Cassel 1999 Howe Hyer Mellor Lindeman ampLuptak 2001)

bull Integrating and documenting information observations and sug-gestions for the team to prioritize address and resolve (Raymer etal 2002 Reese amp Raymer 2001)

bull Negotiating the tension between confidentiality of the client andsharing information with the team (Sheldon 2000)

bull Addressing ways in which the patient and family members are in-formed about probable prognosis and the course of events that mayevolve as death nears (Lord amp Pockett 1998)

bull Providing input consultation and advocating on behalf of the cli-ent regarding the bio-psychosocial (Davidson amp Foster 1995)economic (Reese amp Sontag 2001) and religiousspiritual(Daaleman amp VandeCreek 2000) needs and values of the client(Hart amp Matorin 1997)

bull Promoting discussion of ethical and legal issues during the courseof illness and at the end of life (Csikai 1999 Portenoy et al 1997)

Gwyther et al 101

including such constructs as justice access to care power imbal-ance inequities in health care

bull Supporting the members of the team by demonstrating ways tohandle conflict and crisis situations (Hart amp Matorin 1997 Quig1989) such as abuseneglect substance abuse and suicidal ideationmanaging onersquos own anxiety (Sheldon 2000) educating team mem-bers about compassion fatigue and burnout (Keidel 2002) offeringinterdisciplinary palliative care education (Fineberg Wenger ampForrow 2004) helping professional caregivers with religiousspiritual issues (Catlin et al 2001) using humor to mitigate burn-out (van Wormer amp Boes 1997) and modeling appropriate pro-fessional self-care and self-awareness (Sheldon 2000)

Supervision Leadership and Training

Social workers with specialized expertise in palliative and end-of-lifecare serve as role models leaders consultants researchers and educa-tors for students and generalist health care professionals They canshare information from the unique multidimensional perspective that isthe basis of both palliative care and social work practice Such responsi-bilities may include

bull Program planning and design administration and supervision ofsocial work staff volunteers advocacy organizations and otherswho care for clients (Rusnack McNulty Schaefer amp Moxley1988)

bull Consultation with and education of clinical social workers whodonrsquot confront life-threatening illnesses death or trauma on a day-to-day basis (Christ amp Sormanti 1999)

bull Teaching and precepting social work students (Howe et al 1999)and health professional trainees (Browning amp Soloman in pressHowe et al 2001) to prepare them for interdisciplinary teamwork

bull Systems work to produce needed changes in organizations andprograms (Christ amp Sormanti 1999) policies and legislation atlocal state and federal levels to improve the quality of care(Kramer 2002 Roff 2001)

bull Community educationoutreach to promote or mobilize commu-nity support and develop resources on behalf of individuals andfamilies (MacDonald 1991)

bull Psychosocial research to identify needs within the communityaddress relevant practice questions examine ethical issues (Jansson amp


Dodd 1998) evaluate effective interventions and document so-cial work outcomes

bull Continuing education (Kovacs amp Bronstein 1999) and collabora-tive work with social work organizations (Christ amp Sormanti1999) to further the social work practice base and advocate for ex-panded social work fellowships in palliative and end-of-life care

bull Advocacy on behalf of humane and dignified care public healthneeds and social change with particular attention to domestichealth disparities as they relate to age gender (Hooyman ampGonyea 1999 Cleeland et al 1994) ethnicity race (Bonham2001 Crawley et al 2000) socioeconomic status level of educa-tion

PRACTICE VALUES AND ATTITUDES

Social workers have the responsibility to provide client-centered carethat is compassionate sensitive and respectful of multiple and fre-quently disparate desires values and views within the clientfamilynetwork as they interface with the equally disparate desires values andviews within the staff health care system and society at large In orderto reconcile differing views and perspectives social workers are oftenhelped by turning to the core values of the profession Many underlyingpractice values essential to palliative and end-of-life care reflect the ba-sic values of the social work profession and include

bull Recognition and examination of onersquos own attitudes feelingsand expectations about illness death and related issues

bull Demonstration of respect for the clientrsquosfamilyrsquos narrativeviews strengths and wishes about care

bull Sensitivity and compassion in interacting with clientspatientsand their family members

bull Willingness to work with other members of the community andinterdisciplinary team to provide care comfort and professionalexpertise throughout the continuum of illness death and be-reavement

bull Philosophy and beliefs congruent with the goals of teamwork(Taylor-Brown et al 2001) including comfort in managing theassociated challenges and conflicts (Leipzig et al 2002)

bull Respect for and understanding of cultural (Blackhall et al1999) linguistic (McGrath Vun amp McLeod 2001) religious

Gwyther et al 103

(Johnson amp McGee 1998) spiritual (Lloyd 1997) and genderdiversity (Tesar amp Rovi 1998)

bull Respect for dignity (Chochinov 2002) confidentiality patientautonomy values and ethical decision-making within the cli-entfamily unit (Csikai amp Bass 2000)

bull Ability to create an environment of ldquohopeful supportrdquo and comfortin helping the patientfamily to express fears goals and desires(Parker-Oliver 2002) with particular attention to responding tothe concerns fears needs and hopes of people who are dying(Gallup 1996-1997 Steinhauser et al 2000)

bull Commitment to further professional development (Christ ampSormanti 1999)

bull Commitment to advancing psychosocial research to expand theevidence base for practice (Christ Siegel amp Weinstein 1995)

bull Confidence in and clarity about social work roles and functions(Reese amp Sontag 2001)

FUTURE DIRECTIONS

Social workers are uniquely qualified and positioned to work in thefields of palliative and end-of-life care and bereavement Historically acore professional value has been the need for a multidimensional ap-proach to problem solving whether on an individual family or societallevel This is a frame of reference replicated in the provision of qualitypalliative and end-of-life care Professional education and experience ina range of community and institutional practice settings with diverseclient populations enable social work clinicians to help with major lifetransitions loss and trauma both within and beyond the health carearena A consistent bio-psychosocial-spiritual perspective and a broadscope of practical and clinical skills combine to equip social work prac-titioners to provide a variety of individual family group and commu-nity and organizational interventions Beyond the direct clinical carethe profession is focused in the additional and essential areas of advo-cacy education training community organization administration su-pervision and policy development However rigorous and well-conceptualized studies are needed to enhance social work practice andto address gaps in end-of-life care research These areas of needed re-search include psychological mental health and spiritual issues indi-vidual and collective fear of death (Roff 2001) end-of-life care forchildren provider and caregiver impacts health system variables sup-


portive services outside medical care (George 2002) multidimensionalcomponents of pain (Glajchen et al 1995) and interventions with olderpeople and their families (Hooyman 1998) Sustaining relevant re-search in clinical practice settings is imperative for the field and thepractice of social work within it (Turnbull Saltz amp Gwyther 1988)

This document outlines the essential knowledge skills values andattitudes that are reflective of quality social work practice in palliativeand end-of-life care These competencies are relevant for social workersacross a range of practice settings populations and community con-texts It is hoped that this document will be used to inform interdisci-plinary colleagues of the scope of practice unique perspective andskills that social workers bring to this important work The developmentand evaluation of optimal education and training opportunities continu-ing education quality assurance indicators and a cohesive researchagenda that fully incorporate social work values ethics knowledgeskills and attitudes will ensure the highest quality of palliative and end-of-life care

Received 061204Revised 070204

Accepted 070804

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Altilio T (2000) Project on Death in America Social Work Leadership retreat LakeTahoe CA

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Gwyther et al 105

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Bern-Klug M Ekerdt D J Wilkinson D S (1999) What families know about fu-neral-related costs Implication for social work practice Health amp Social Work24(2) 128-137

Bern-Klug M Gessert C and Forbes S (2001) The need to revise assumptionsabout the end of life Implications for social work practice Health and Social Work26 38-43

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Black K (In press) Advance directive communication with hospitalized elderly pa-tients Social workersrsquo roles and functions Journal of Geronotological SocialWork

Blacker S amp Christ G (2002) Social Work Leadership Summit on End-of-Life andPalliative Care Retrieved on 61104 from wwwswldaorg

Blacker S (2002) Nutritional Problems and the Cancer Patient Psychosocial Con-siderations Oncology Issues MarchApril 41-44

Blackhall L J Frank G Murphy S T Michel V Palmer J M amp Azen S P(1999) Ethnicity and attitudes towards life sustaining technology Social Science ampMedicine 48(12) 1779-1789


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Byock I R (1996) The nature of suffering and the nature of opportunity at the end-of-life Clinic of Geriatric Medicine 12 237-251

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Christ G H Siegel K amp Weinstein L (1995) Developing a research unit within ahospital social work department Health and Social Work 20(1) 60-69

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1335-1347Cleel and C S Gonin R Hatfield A K Edmonson J H Blum R H Stewart

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Czech E L (2004) Social workersrsquo participation in the resolution of ethical dilem-mas in hospice care Health amp Social Work 29(1) 67-76


Czech E L amp Bass K (2000) Health care social workersrsquo view of ethical issuespractice and policy in end-of-life care Social Work in Health Care 32(2) 1-22

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Edwards C L Fillingim R B Keefe F (2001) Race ethnicity and pain Pain 94133-137

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Ellis R R (1998) Multicultural grief counseling In K J Doka amp J D Davidson(Eds) Living with grief Who we are how we grieve (pp 248-260) WashingtonDC Hospice Foundation of America

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Francoeur R (In press) The relationship of cancer symptom clusters to depressive af-fect in the initial phase of palliative radiation Journal of Pain and Symptom Man-agement Including supportive and palliative care

Francoeur R (2001) Reformulating financial outcomes in cancer interventions to im-proved psychosocial and functional outcomes in cancer patients and their familiesJournal of Psychosocial Oncology 19(1) 1-20

Gwyther et al 109

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Gallo-Silver L amp Pollack B (2000) Behavioral interventions for lung cancer-relatedbreathlessness Cancer Practice 8(6) 268-273

George H Gallup International Institute (1997) Spiritual Beliefs and the Dying Reportof a National Survey Conducted for the Nathan Cummings Foundation and FetzerInstitute Princeton NJ

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Galambos C M (1998) Preserving end-of-life autonomy The Patient Self-Determi-nation Act and the Uniform Health Care Decisions Act Health amp Social Work23(4) 275-281

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Kass-Bartelmes B amp Hughes R (2003) Advance care planning Preferences for careat the end of life Research in action Washington DC Agency for Healthcare Re-search and Quality

Gwyther et al 111

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day Washington DC AuthorLauria M M amp Whitaker T amp Coleman M (2001) Bereavement practice guide-

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Lesko L M (2000) Psychiatric management of eating disorders in palliative-caremanagement of cancer patients In H M Chochinov amp W Breitbart (Eds) Hand-


book of Psychiatry in Palliative Care (pp 161-173) New York Oxford UniversityPress

Linderstrom T (2002) It ainrsquot necessarily sohellip Challenging mainstream thinkingabout bereavement Family amp Community Health 25(1) 11-21

Lloyd M (1997) Dying and bereavement spirituality and social work in a marketeconomy of welfare British Journal of Social Work 27(2) 175-190

Lo B (2000) Resolving ethical dilemmas A guide for clinicians PhiladelphiaLippincott Williams amp Wilkins

Lobchuk M amp Degner L (2002) Symptom experiences Perceptual accuracy be-tween advanced-stage cancer patients and family caregivers in the home care set-ting Journal of Clinical Oncology 20(16) 3495-3507

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Loscalzo M amp Belcher J (1999) The COPE model Its usefulness in solving pain-related problems Journal of Psychosocial Oncology 16(34) 93-117

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Mayo S (1996) Symbol metaphor and story The function of group art therapy in pal-liative care Palliative Medicine 10(3) 209-216

McBride J amp Simms S (2001) Death in the family Adapting a family systemsframework to the grief process American Journal of Family Therapy 29(1) 59-73

McCaffery M amp Pasero C (1999) Pain Clinical Manual (2nd ed) New YorkMosby

McGrath P Vun M amp McLeod L (2001) Needs and experiences of non-English-speaking hospice patients and families in an English-speaking country AmericanJournal of Hospice amp Palliative Care 18(5) 305-312

Mendenhall M (2003) Psychosocial aspects of pain management A conceptualframework for social workers on pain management teams Social Work in HealthCare 36(4) 35-51

Miller W R amp Thoresen C E (2003) Spirituality religion and health An emergingresearch field American Psychologist 58(1) 3-66X

Miller P J Hedlund S C amp Murphy K A (1998) Social work assessment at end oflife practice guidelines for suicide and the terminally ill Social Work in HealthCare 26(4) 23-36

Gwyther et al 113

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Mosenthal A C Lee K F amp Huffman J (2002) Palliative care in the surgical inten-sive care unit Journal of the American College of Surgeons 194(1) 75-83

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Oliver R C Sturtevant J P Scheetz J P amp Fallat M E (2001) Beneficial effectsof a hospital bereavement intervention program after traumatic childhood death including commentary by Jurkovich GJ Cooper A Mullins RJ Rivera FA andHammond JS with author response Journal of Trauma Injury Infection amp CriticalCare 50(3) 440-448

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OrsquoNeill B amp Fallon M (1997) Principles of palliative care and pain control BritishMedical Journal 315 801-804

Osterlund H amp Beirne P (2001) Complementary therapies In B R Ferrell amp NCoyle (Eds) Textbook of Palliative Nursing (pp 374-381) New York OxfordUniversity Press

Otis-Green S (2003) Legacy building Smith Studies in Social Work 73(3) 395-404Otis-Green S amp Rutland C (2004) Marginalization at the end of life In J Berzoff amp

P Silverman (Eds) Living with dying A comprehensive resource for healthcarepractitioners New York Columbia University Press


Otis-Green S Sherman R Perez M amp Baird R P (2002) An integrated psychosocial-spiritual model for cancer pain management Cancer Practice 10(1) S58-S65

Owen J E Goode K T amp Haley W E (2001) End-of-life care and reactions todeath in African American and white family caregivers of relatives with Alzhei-merrsquos disease Omega 43(4) 349-361

Paice J A amp Fine P G (2001) Pain at the end of life In B R Ferrell and N Coyle(Eds) Textbook of palliative nursing (76-90) New York Oxford University Press

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Parker-Oliver D (2002) Redefining hope for the terminally ill American Journal ofHospice amp Palliative Care 19(2) 115-120

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Pauw M (1991) The social workerrsquos role with a fetal demise and stillbirth Health ampSocial Work 16(4) 291-297

Pellegrino E D (2000) Decisions to withdraw life-sustaining treatment A moral al-gorithm JAMA 283(8) 1065-1067

Peltzer K (2001) An integrative model for ethnocultural counseling and psychother-apy of victims of organized violence Journal of Psychotherapy Integration 11(2)241-262

Petersen S amp Rafuls S E (1998) Receiving the scepter The generational transitionand impact of parent death on adults Death Studies 22(6) 493-524

Pfeffer C R Jiang H Kakuma T Hwang J amp Metsch M (2002) Group interven-tion for children bereaved by the suicide of a relative Journal of the AmericanAcademy of Child amp Adolescent Psychiatry 41(5) 505-513

Picton C Cooper B K Close D amp Tobin J (2001) Bereavement support groupsTiming of participation and reasons for joining Omega Journal of Death and Dy-ing 43(3) 247-258

Poijula S Dyregrov A Wahlberg K E amp Jokelainen J (2001) Reactions to ado-lescent suicide and crisis intervention in three secondary schools InternationalJournal of Emergency Mental Health 3(2) 97-106

Pomeroy E C Green D L amp Van Laningham L (2002) Couples who care The ef-fectiveness of a psychoeducational group intervention for HIV serodiscordant cou-ples Research on Social Work Practice 12(2) 238-252

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Portenoy R K Coyle N Kash K M Brescia R Scanlon C OrsquoHare D MisbinR I Holland J amp Foley K M (1997) Determinants of the willingness to endorseassisted suicidendasha survey of physicians nurses and social workers Psychosomatics38(3) 277-287

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Raymer M Huber R Reese D Orloff S Gerbino S Age A Dawson SValade R (2002) (Unpublished) The social work assessment tool (SWAT) SocialWork Outcomes Task Force of the Social Work Section National Hospice and Pal-liative Care Organization National Council of Hospice and Palliative Profession-als

Reamer F G (2000) The social work ethics audit A risk-management strategy So-cial Work 45(4) 355-366

Reese D (2001) Addressing spirituality in hospice Current practices and a proposedrole for transpersonal social work Social Thought Journal of Religion in the SocialServices 20(1-2) 135-161

Reese D J amp Raymer M (2001) Relationships between social work involvementand hospice outcomes Results of the National Hospice Social Work Survey SocialWork

Reese D amp Sontag M A (2001) Barriers and solutions for successful inter-profes-sional collaboration on the hospice team Health and Social Work 26(3) 167-175

Reinardy J R (1999) Autonomy choice and decision making how nursing home so-cial workers view their role Social Work in Health Care 29(3) 59-77

Roff S (2001) Analyzing end-of-life care legislation a social work perspective So-cial Work in health Care 33(1) 51-68

Rosenblatt P (2001) A social constructionist perspective on cultural differences ingrief In M S Stroebe R O Hansson W Stroebe amp H Schut (Eds) Handbook ofBereavement research Consequences Coping and Care (pp 285-300) Washing-ton DC American Psychological Association

Rousseau P (1996) Non-pain symptom management in terminal care Clinic Geriat-ric Medicine 12 313-327

Rusnack B Schaefer S M amp Moxley D (1990) Hospice social workrsquos response toa new form of social caring Social Work in Health Care 15(2) 95-119

Rusnack B McNulty Schaefer S amp Moxley D (1988) ldquoSafe passagerdquo Socialwork roles and functions in hospice care Social Work in Health Care 13(3) 3-19

Salmon P (1993) Healing images viewing the clientrsquos world through drawingsJournal of Holistic Nursing 11(1) 21-41


Saltzman W R Pynoos R S Layne C M Steinberg A M amp Aisenberg E(2001)Trauma- and grief-focused intervention for adolescents exposed to commu-nity violence Results of a school-based screening and group treatment protocolGroup Dynamics 5(4) 291-303

Sandberg O Franklin K A Bucht G amp Gustafson Y (2001) Sleep apnea delir-ium depressed mood cognition and ADL ability after stroke Journal of the Ameri-can Geriatrics Society 49(4) 391-397

Sandler I Ayers T S Wolchik S A Tein J Kwok O Haine R A Twohey-Jacobs J Suter J Lin K Padgett-Jones S Weyer J L Cole E Kriege G ampGriffin W A (2003) The Family Bereavement Program Efficacy evaluation of atheory-based prevention program for parentally bereaved children and adolescentsJournal of Consulting amp Clinical Psychology 71(3) 587-600

Schwartz-Borden G (1992) Metaphor Visual aid in grief work OMEGA 25(3) 239-248

Shapiro F (2002) EMDR 12 years after its introduction Past and future researchJournal of Clinical Psychology 58(1) 1-22

Shaver P R and Tancredy C M (2001) Emotion attachment and bereavement Aconceptual commentary In M S Stroebe M R O Hansson W Stroebe H SchutH (Ed) Handbook of Bereavement Research Consequences Coping and Care(pp 63-88)Washington DC American Psychological Association

Shear M K Frank E Foa E Cherry C Reynolds C F III Vander Bilt J ampMasters S (2001) Traumatic grief treatment A pilot study American Journal ofPsychiatry 158(9)1506-1508

Sheldon F M (2000) Dimensions of the role of the social worker in palliative carePalliative Medicine 14(6) 491-498

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ABSTRACT Social workers from clinical academic and research set-tings met in 2002 for a national Social Work Leadership Summit on Pal-liative and End-of-Life Care Participants placed the highest priority onthe development and broad dissemination of a summary document of thestate-of-the-art practice of social work in palliative and end-of-life careNine Summit participants reviewed the literature and constructed thisdetailed description of the knowledge skills and values that are requi-site for the unique essential and appropriate role of social work Thiscomprehensive statement delineates individual family group teamcommunity and organizational interventions that extend across set-tings cultures and populations and encompasses advocacy educationtraining clinical practice community organization administrationsupervision policy and research This document is intended to guidepreparation and credentialing of professional social workers to assist in-terdisciplinary colleagues in their collaboration with social workers andto provide the background for the testing of quality indicators and ldquobestpracticerdquo social work interventions [Article copies available for a fee fromThe Haworth Document Delivery Service 1-800-HAWORTH E-mail addressltdocdeliveryhaworthpresscomgt Website lthttpwwwHaworthPresscomgtcopy 2005 by The Haworth Press Inc All rights reserved]

KEYWORDS Social work practice social work competencies pallia-tive care end-of-life care bereavement

All social workers regardless of practice setting will inevitablywork with clients facing acute andor long-term situations involvingloss (Sheldon 1998) life-limiting illness dying death grief andor be-reavement (Kramer 1998 2003) Care providers in nursing and medi-cine confront end-of-life care primarily in health settings Howeversocial work by virtue of its scope of practice has the unique potential toextend the work around palliative and end-of-life care issues beyondhealth care settings to the larger community This opportunity creates amandate for educators to integrate core generalist knowledge of pallia-tive and end-of-life care issues as well as specialist skills into the formaleducation of professional social workers (Altilio 2001) and in continu-ing education programs

Within the social work scope of practice loss extends beyond illnessdeath and bereavement to a broader view of unanticipated and adverselife events Although not all those who experience loss require or seek





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Social work competencies in palliative and end-of-life care

Documents

Transcript of Social work competencies in palliative and end-of-life care