Social Work Assessment and Outcomes Measurement in Hospice and Palliative Care.

While psychosocial assessment is required in hospice, no requirement exists for documentation of psychosocial outcomes. Social work research has identified the psychosocial and spiritual domains most often and appropriate for social workers to address, and standardized assessment tools have been developed by social workers based on this research. The aims of this study were to document the current use of standardized assessment measures for assessment and documenting outcomes and specifically the use of the Social Work Assessment Tool. A national sample of 203 hospice and palliative care social workers was recruited for this mixed methods study. Results indicated that most social workers used a form developed by a nonsocial worker in the agency for the initial assessment, and many palliative care social workers were not responsible for the assessment. Fewer conducted a follow-up assessment or documented outcomes. No common standardized measure was used. This study confirmed anecdotal evidence about lack of standardized social work assessment and outcomes measurement occurring in hospice and palliative care. As the Centers for Medicare and Medicaid Services is likely to select a standardized tool to measure psychosocial outcomes, social workers have an opportunity to contribute a quantitatively driven outcomes measure, developed by social workers, that will demonstrate effectiveness of social work intervention and lead to a better understanding of the social work role in hospice and palliative care.

University-Community-Hospice Partnership to Address Organizational Barriers to Cultural Competence.

Research documents a lack of access to, utilization of, and satisfaction with hospice care for African Americans. Models for culturally competent hospice services have been developed but are not in general use. Major organizational barriers include (1) lack of funding/budgeting for additional staff for community outreach, (2) lack of applications from culturally diverse professionals, (3) lack of funding/budgeting for additional staff for development of culturally competent services, (4) lack of knowledge about diverse cultures, and (5) lack of awareness of which cultural groups are not being served. A participatory action research project addressed these organizational barriers through a multicultural social work student field placement in 1 rural hospice. The effectiveness of the student interventions was evaluated, including addressing organizational barriers, cultural competence training of staff, and community outreach. Results indicated that students can provide a valuable service in addressing organizational barriers through a hospice field placement.

Organizational Barriers to Cultural Competence in Hospice.

This national mixed method study with directors of 207 hospices identified major barriers to cultural competence, including (1) lack of funding for additional staff for community outreach or development of culturally competent programs, (2) lack of applications from diverse professionals, and (3) lack of knowledge about diverse cultures and what cultural groups in the community are not being served. Qualitative results indicated that elements of an organizational culture, which create barriers to access included (1) failure to prioritize cultural competence, (2) failure to budget for culturally competent services, and (3) a staff that does not value awareness of cultural differences, is uncomfortable with diversity, and stereotypes diverse individuals. In phase 2, an interactive session with a 100-symposium audience provided strategies to address the barriers.

African American client satisfaction with hospice: a comparison of primary caregiver experiences within and outside of hospice.

This study, conducted within a larger participatory action research project, explored satisfaction with end-of-life care among African Americans in a rural southeastern community. Researchers collaborated with practitioners and the African American community, conducting qualitative interviews with 1 African American hospice patient, 9 primary caregivers of terminally ill patients within hospice, and 10 family caregivers outside of hospice. Results indicated a more positive experience for hospice patients, and that most nonhospice participants preferred hospice after learning about it through the study. Participants made recommendations for public information efforts, the referral and intake process, and developing a relationship with the African American community. Implications for practice are to include the reasons found for African American preference for hospice in public information sessions with the African American community.

Interdisciplinary perceptions of the social work role in hospice: building upon the classic Kulys and Davis study.

This national survey found that hospice directors (n = 43) considered social workers most qualified, and most involved, in 12 of 24 interventions considered by social workers to define their role. This is a change from Kulys and Davis' ( 1986 , 1987 ) findings of a more limited social work role in hospice. The results of the current study provide new information about director attitudes, social work involvement, and the impact of efforts to develop the hospice social work field. Social work education should incorporate more end-of-life care content to continue this progress, and hospice social workers should continue to document their effectiveness on the hospice team.

Proposal for a university-community-hospice partnership to address organizational barriers to cultural competence.

Models of culturally competent hospice services have been developed, but they are not generally being used. This article describes a participatory action research project which is addressing organizational barriers to cultural competence through a university-community-hospice partnership. The intervention plan is to develop a connection with the African American community, increasing community knowledge, and hospice staff cultural competence through a social work student field placement. It is hoped that, if successful, this model will be replicated to address the problem of African American utilization and access to hospice.

A cross-national comparison of Hong Kong and U.S. student beliefs and preferences in end-of-life care: implications for social work education and hospice practice.

In this mixed methods study, the authors explored differences and similarities in beliefs about death and dying as well as end-of-life care preferences among social work students in Hong Kong and the United States. A convenience sample of 176 social work students from Hong Kong and 58 from the United States was recruited to complete a quantitative questionnaire with three open-ended questions. Findings revealed differences as well as similarities in beliefs about death and dying and that a larger proportion of Hong Kong students as compared to U.S. students preferred curative rather than palliative care. Implications for social work education and hospice practice in both countries include the need for social work student and practitioner self-awareness in order to prepare for culturally competent practice and policies that are relevant across cultures.

The Social Work Assessment Tool (SWAT).

This paper reports on the last of three National Hospice and Palliative Care Organization initiatives to move hospice and palliative care social workers into the patient/family outcomes arena: the development of the Social Work Assessment Tool. The experience of a team of practitioners and researchers is described, including results of two pilot studies and subsequent SWAT revisions. The major focus is on the current model performance improvement project, in which 19 social workers from 14 hospice and palliative care programs used the SWAT with 101 patients and 81 primary caregivers for a median of 44 days. Quantitative analysis indicated significant improvement in SWAT scores for patients from the first to the second social work visit (t = -2.60, df = 47, p .01). Qualitative interviewing of the social workers indicated some lack of readiness in the field to conduct quantitative outcomes measurement. Additional measures are needed in addition to the SWAT, including qualitative measures, and measures of mezzo and macro practice. Participants indicated that the SWAT was appropriate for use with economically and culturally diverse clients.

Beliefs, death, anxiety, denial, and treatment preferences in end-of-life care: a comparison of social work students, community residents, and medical students.

This study examined cultural and religious beliefs, death anxiety, denial, and medical treatment preferences in end-of-life care in a sample of social work students, community residents, and medical students in a mid-western city of 49,000. Results indicated that most social work students, community residents, and medical students preferred palliative as opposed to life-prolonging care during terminal illness. The three groups differed in cultural and religious beliefs and all three reported a moderate amount of death anxiety. Students reported less denial of terminality than community residents. Implications for personal and professional preparation to provide end-of-life care are discussed.

Programmatic barriers to providing culturally competent end-of-life care.

Despite many efforts to increase access to end-of-life care, culturally diverse groups are still not being served. Interviews of 22 hospice and palliative care program directors in one southeastern state indicated that directors overestimated how well programs are doing in meeting the needs of diverse groups but were very interested in implementing cultural diversity training for their staff Those who were more concerned about such issues had recruited more diverse volunteers into their programs. The presence of diverse staff or volunteers predicted a more diverse patient population. A number of efforts were underway to develop cultural competence and provide culturally competent care. Several directors reported no efforts in this direction, however Directors described programmatic barriers and resources needed. The authors concluded that directors should provide leadership in their agencies in welcoming diversity. Implications for further research and work within the larger end-of-life care field are discussed.

Relationships between social work involvement and hospice outcomes: results of the National Hospice Social Work Survey.

In a struggle to balance fiscal realities with hospice philosophy, some hospices have attempted to cut costs by reducing social work involvement. This cross-sectional survey of 66 hospices found, however, increased social work involvement was significantly associated with lower hospice costs. Additional benefits included better team functioning, more issues addressed by the social worker on the team, reduced medical services, and fewer visits by other team members, along with increased client satisfaction and lower severity of case. The authors concluded that higher salaries should be paid to a sufficient number of highly educated and experienced social workers. These social workers should be dedicated solely to the hospice social worker position, should participate in intake interviews, and should be supervised by a social worker.