Things to Consider When Completing an Advance Directive.

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In response to a question about advance directives for a patient experiencing chronic pain, the authors discuss the importance of having legal documents in place.

Barriers to accessing quality health care for cancer patients: a survey of members of the association of oncology social work.

The present article reports data from a cross-sectional survey of members of the Association of Oncology Social Work (AOSW) completed in May 2006. The purpose of the survey was to gather information on AOSW members' practice roles, the clients they serve, and their views on barriers cancer patients face in obtaining quality cancer care. The survey instrument was a self-administered 18-page survey disseminated online and by U.S. mail to members who did not provide e-mail addresses. The response rate to the survey was 62.3% (622/999). Reported barriers to quality cancer care are presented here in three categories: health system, social/environmental, and individual-level barriers. The majority of respondents reported health system barriers, specifically inadequate health insurance, as the major barrier to accessing quality health care for cancer patients. Among social/environmental barriers, inability to pay for treatment-related expenses was the major barrier. Among individual-level barriers, patients' fears and distress were the major barriers. The conclusions from this survey point to the critical role of oncology social workers in assisting cancer patients in overcoming the barriers to quality care and achieving optimum quality of life.

Silent voices and invisible walls: exploring end of life care with lesbians and gay men.

The needs and desires of lesbians and gay men with cancer at the end of their lives are not fundamentally different from any other dying individual's needs. There are, however, significant legal restrictions and societal attitudes that can negatively affect the dying experiences of lesbians and gay men. Lesbians and gay men face many challenges at the end of their lives, including issues of disclosure in the healthcare setting, discrimination, misconceptions, legal and financial barriers and the disenfranchised grief of surviving same-sex partners. Oncology social workers can play a prominent role in advocating for these individuals to allow for dignity and support in spite of these barriers and provide effective interventions to help in assisting lesbians and gaymen with healthcare decision-making and end-of-life care planning.