The Impact of Personal and Professional Loss on Advance Care Planning and Effective Care Delivery for Healthcare Social Workers

2018 ◽  
Vol 99 (4) ◽  
pp. 358-368
Author(s):  
Cara L. Wallace ◽  
Yit Mui Khoo ◽  
Leslie Hinyard ◽  
Jennifer E. Ohs ◽  
Dulce M. Cruz-Oliver
Keyword(s):  
Social Workers ◽  
Advance Care Planning ◽  
Care Delivery ◽  
Death And Dying ◽  
Care Planning ◽  
Professional Experiences ◽  
Effective Care ◽  
Advance Care ◽  
Past Experiences ◽  
The Impact

Personal experiences can influence the practice of social work. However, the connection between past experiences with death and social workers’ practice has been underexplored. As such, this study surveyed social workers ( N = 74) about their personal and professional experiences of loss, personal advance care planning, and professional practices. Results demonstrated that social workers that experienced prior loss were more likely to complete an advance directive and communicate their end-of-life wishes. Additionally, those who had experienced personal and professional loss showed greater effectiveness on measures of patient- and family-centered communication and care delivery. Findings suggest positive outcomes for encouraging social workers to connect their personal and professional experiences surrounding death and dying to effectively serve in their professional capacity.

scholarly journals Thoughts about Dying in America: Enhancing the impact of one’s life journey and legacy by also planning for the end of life

2016 ◽  
Vol 113 (46) ◽  
pp. 12908-12912 ◽  
Author(s):  
Philip A. Pizzo
Keyword(s):  
End Of Life ◽  
Social Services ◽  
Advance Care Planning ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
The United States ◽  
Care Planning ◽  
Public And Private ◽  
Advance Care ◽  
The Impact

This Perspective offers a summary of the recommendations in the Institute of Medicine report Dying in America. How we die is a deeply personal issue that each of us will face. However, the approach to end-of-life (EOL) care in the United States needs improvement. Too frequently, healthcare delivery is uncoordinated and has many providers who are not adequately prepared to have meaningful conversations about EOL planning. This is amplified by payment systems and policies that create impediments, misunderstanding, and sometimes misinformation. Dying in America made five recommendations to improve quality and honor individual preferences near the EOL beginning with making conversations with providers and families something that occurs during various phases of the life cycle and not just when one is facing serious illness or possible EOL. It was recommended (i) that public and private payers and care delivery organizations cover the provision of comprehensive care that is accessible and available to individuals on a 24/7 schedule; (ii) that professional societies and other entities establish standards for clinician patient communication and advance care planning and that payers and care delivery organizations adopt them; (iii) that educational institutions, credentialing bodies, accrediting boards, state regulatory agencies, and care delivery organizations establish palliative care training, certification, and/or licensure requirements; (iv) that public and private payers and care delivery organizations integrate the financing of health and social services; and (v) that public and private organizations should engage their constituents and provide fact-based information to encourage advance care planning and informed choice.

scholarly journals Multi-Site Study of Provider Self-Efficacy and Beliefs in Explaining Judgments About Need and Responsibility for Advance Care Planning

2020 ◽  
pp. 104990912097997
Author(s):  
Kristin R. Baughman ◽  
Ruth Ludwick ◽  
David Jarjoura ◽  
Mia Yeager ◽  
Denise Kropp
Keyword(s):  
Social Workers ◽  
Advance Care Planning ◽  
Self Efficacy ◽  
Skilled Nursing Facility ◽  
Care Planning ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Negative Beliefs ◽  
Advance Care ◽  
The Impact

Background and Objectives: We examined the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgments about resident need and provider responsibility for initiating ACP conversations. Research Design and Methods: This observational multi-site study of 348 registered nurses, licensed practical nurses, and social workers within 29 SNFs used an anonymous survey in which providers judged vignettes with assigned situational features of a typical SNF resident. Mixed modeling was used to analyze the vignette responses. Results: Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring ACP took place. Self-efficacy did not have a significant impact on judgments of need, but did significantly increase judgments of responsibility for ensuring ACP conversations. Providers with the highest levels of ACP self-efficacy were most likely to feel responsible for ensuring ACP conversations. In an exploratory analysis, these relationships remained the same whether responding to high or low risk residents (i.e., based on risk of hospitalization, type of diagnosis, functional status, and rate of declining health). Discussion and Implications: Both negative beliefs about ACP and self-efficacy in one’s ability to conduct ACP discussions were associated with professional judgments regarding ACP. The findings illustrate the importance of addressing negative beliefs about ACP and increasing provider ACP self-efficacy through education and policies that empower nurses and social workers.

Provider perceptions of the social work role in oncologic pain management.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 214-214
Author(s):  
Claire Ralli ◽  
Michelle Bailiff ◽  
Crystal Fields-Burdick ◽  
Kali Gajewski ◽  
Tara Garza ◽  
...  
Keyword(s):  
Social Work ◽  
Pain Management ◽  
Social Workers ◽  
Advance Care Planning ◽  
Care Delivery ◽  
Social Work Practice ◽  
Care Planning ◽  
Interdisciplinary Approaches ◽  
The Social ◽  
Advance Care

214 Background: Best practices of cancer care delivery have shifted from medical models to interdisciplinary approaches aimed at holistic care. The social work profession has advanced itself by gaining competence in psycho-oncology, advance care planning, biopsychosocial assessment and intervention, and pain management. While Masters prepared Social Workers (MSW) are widely recognized as experts in most of these areas, it appears that they are underutilized in pain management. This study will examine provider and nursing perceptions about social work expertise and whether those perceptions may limit utilization of social work in multidisciplinary management of cancer pain. Methods: While review of psycho-oncology literature supports the role of social work in pain management, this was not clearly indicated within the medical oncology domain. A survey was created to ascertain the perception of the MSW role in pain management as a supplement to pharmacologic and medically-based care when identifying and treating multidimensional pain. The survey was completed by Physicians, Advanced Practice Providers, and Nurses in outpatient oncology practices in The US Oncology Network. Results: 139 medical professionals responded. As hypothesized, 88% reported they were comfortable with MSWs conducting Advance Care Planning, while 61% reported being comfortable with MSWs educating patients and families about pain management during palliative/end of life care. 95% believed unmet emotional, social, spiritual and existential needs can present as physiological pain, however only 55% indicated they would include Licensed Clinical Social Workers to provide therapeutic interventions as part of pain management. Conclusions: Under half of survey participants reported an understanding of the scope of social work practice, which aligns with the lack of awareness and under-utilization of social work as a vital contributor in oncologic pain management. MSWs have training in evidence-based interventions such as CBT, guided imagery, mindfulness and biofeedback techniques which may diminish the experience of pain. Further research is recommended to identify strategies to promote and integrate social work into multidisciplinary pain management.

scholarly journals Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 903-903
Author(s):  
Yifan Lou ◽  
Deborah Carr
Keyword(s):  
Life Expectancy ◽  
Racial Differences ◽  
Advance Care Planning ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Risk Of Death ◽  
Advance Care ◽  
Survival Expectations ◽  
The Impact

Abstract The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.

Cultural Differences in Advance Care Planning and Implications for Practice

2021 ◽  
pp. 003022282110295
Author(s):  
Jung-Hwa Ha ◽  
Changsook Lee ◽  
Jennifer Yoo
Keyword(s):  
Social Workers ◽  
Cultural Differences ◽  
Advance Care Planning ◽  
Qualitative Interviews ◽  
Relationship Building ◽  
Cultural Norms ◽  
Care Planning ◽  
The Us ◽  
Health Related ◽  
Advance Care

This study examined cultural differences in advance care planning (ACP) and various strategies that social workers use to initiate conversations on ACP. We conducted qualitative interviews with 12 social workers in South Korea and the US and a thematic content analysis of the transcribed data. Our findings show that different cultural norms and generational viewpoints surrounding death and health-related decision-making influence how people prepare for end-of-life care (EOLC). Whereas principles of self-determination and autonomy guide ACP practices in the US, decisions regarding EOLC are more often made in consultation with family members in Korean and Korean-American communities. Nevertheless, social workers in both countries identified relationship-building, empowerment, and individualized approaches as common strategies in initiating discussions on ACP.

Discussion and documentation of future care: a before-and-after study examining the impact of an alternative approach to recording treatment decisions on advance care planning in an acute hospital

2017 ◽  
Vol 10 (2) ◽  
pp. e12-e12 ◽  
Author(s):  
Alexandra C Malyon ◽  
Julia R Forman ◽  
Jonathan P Fuld ◽  
Zoë Fritz
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Decisions ◽  
Care Planning ◽  
New Approach ◽  
Significance Level ◽  
Oncology Ward ◽  
Future Care ◽  
Advance Care ◽  
The Impact

ObjectiveTo determine whether discussion and documentation of decisions about future care was improved following the introduction of a new approach to recording treatment decisions: the Universal Form of Treatment Options (UFTO).MethodsRetrospective review of the medical records of patients who died within 90 days of admission to oncology or respiratory medicine wards over two 3-month periods, preimplementation and postimplementation of the UFTO. A sample size of 70 per group was required to provide 80% power to observe a change from 15% to 35% in discussion or documentation of advance care planning (ACP), using a two-sided test at the 5% significance level.ResultsOn the oncology ward, introduction of the UFTO was associated with a statistically significant increase in cardiopulmonary resuscitation decisions documented for patients (pre-UFTO 52% to post-UFTO 77%, p=0.01) and an increase in discussions regarding ACP (pre-UFTO 27%, post-UFTO 49%, p=0.03). There were no demonstrable changes in practice on the respiratory ward. Only one patient came into hospital with a formal ACP document.ConclusionsDespite patients’ proximity to the end-of-life, there was limited documentation of ACP and almost no evidence of formalised ACP. The introduction of the UFTO was associated with a change in practice on the oncology ward but this was not observed for respiratory patients. A new approach to recording treatment decisions may contribute to improving discussion and documentation about future care but further work is needed to ensure that all patients’ preferences for treatment and care at the end-of-life are known.

Involvement of Japanese Care Managers and Social Workers in Advance Care Planning

2018 ◽  
Vol 14 (4) ◽  
pp. 315-327 ◽  
Author(s):  
Yoshihisa Hirakawa ◽  
Chifa Chiang ◽  
Mayu Yasuda Uemura ◽  
Atsuko Aoyama
Keyword(s):  
Social Workers ◽  
Advance Care Planning ◽  
Care Planning ◽  
Care Managers ◽  
Advance Care
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