Connecting the Personal with Professional: A Survey of Social Workers on Advance Care Planning

Background: Though practitioners overwhelmingly agree on the importance of advance care planning (ACP) and preparing for the end of life (EOL), the process is fraught with barriers. Many providers do not always talk to their patients about ACP, even when opportunities emerge in a clinical visit (Ahluwahlia et al., 2012). When communication does occur the quality and content of these conversations vary (Trice & Prigerson, 2009). Clinicians report difficulties such as language or medical interpretation issues, patients’ limited health literacy, patients’ mistrust of the health care system, and a lack of understanding about patients’ cultural or religious beliefs surrounding death, dying and decision making (Periyakoil, Neri & Kraemer, 2015). Other reported barriers include lack of knowledge about available services, insufficient training, and absence of standardized criteria for referrals (Schenker et al., 2014). Though no research examines completion rates of social workers themselves, research suggests that even physicians do not have formal conversations about their own ACP with providers and families (Gallo et al., 2003). A lack of personal experience with ACP may influence the lack of professional implementation in practice.

The goal of this research was to explore potential connections between social work providers’ own personal experiences and current professional practices in ACP and EOL care.

Methods: A cross-sectional survey design was used gathering anonymous responses between August and December 2016. The survey sought information from social work providers in three distinct areas: (1) personal experiences of loss; (2) personal ACP; and (3) professional practices related to ACP and EOL care. 72 social workers participated in the survey across a greater, Metropolitan area in the Midwest. Questions for professional practices were subscales from the End-of-Life Professional Caregiver Survey: Patient- and Family-Centered Communication (PFCC) and Effective Care Delivery (ECD). Questions developed by the research team were evaluated by judges chosen for clinical and/or research expertise. Bivariate comparisons for categorical variables were made using Fisher’s exact test. Mean PFCC and ECD scores were compared across groups using Wilcoxin Rank Sum and Kruskal-Wallis tests as appropriate. All analyses were conducted in SAS 9.4 (Cary, NC) using an alpha of 0.05.

Results: Multiple connections were found between social workers’ histories of loss, personal ACP, and professional practices. For example, social workers with personal experience caring for someone who is dying scored higher in both PFCC and ECD. Those who discussed their own wishes with family members and providers also demonstrated higher scores on both professional delivery scales and were more likely to refer patients to hospice and palliative care.

Implications: Results support educational interventions involving opportunities for reflection and personal communication about advance directives and ACP. Social workers who have given considerable thought to their own wishes and who have discussed their wishes with family and providers demonstrated more competency in EOL professional practices and were more likely to refer to crucial EOL services. Future research includes an educational intervention incorporating narrative medicine as a tool to assist healthcare social workers in considering how their personal experiences connect with their professional ACP practices.