Establishing Core Competencies, Opportunities, Roles, and Expertise (CORE) for Oncology Social Work

Background and Purpose. Despite 40+ years of evidence demonstrating effectiveness of psychosocial interventions for cancer patients, short-comings and disparities still exist with regard to the delivery, targeting, and tailoring of psychosocial support services to those that need them. Especially troubling is the evidence suggesting that the patients most likely to benefit from psychosocial support services are also those least likely to access or receive them. As the primary providers of psychosocial support services for cancer patients and their families, Oncology Social Workers (OSWs) are uniquely trained to identify and respond to the supportive care needs of vulnerable cancer patients, yet they vary in what they do, how they work, and how they are deployed across different cancer care settings. The purpose of this study was to identify a range of activities that delineate and distinguish the Competencies, Opportunities, Roles and Expertise (CORE) for oncology social work.

Methods. The study employed Concept Mapping, a structured and prescribed approach to collecting, analyzing, and interpreting qualitative and quantitative data while engaging an expert panel of stakeholders in the research process. The process derives a “Concept Map” – a stakeholder-authored visual geography of ideas derived from an iterative process of brainstorming, card sorting and rating of item importance along a 0-4 point ordinal scale, multi-dimensional scaling and hierarchical cluster analysis, and group member interpretation of data analytic results. Individual item mean scores and cluster means are calculated to suggest the relative importance of clusters and items within clusters.

Results. An expert panel of oncology social work practitioners, academicians, and leaders in the field (n=35) generated 91 practice behaviors that were subject to card sorting and ratings of importance. A visual map consisting of six clusters best represented the statistical fit of the data (stress value = 0.18) while maintaining the most meaningful categorization of individual statements. These six domains were: Clinical Assessment and Intervention (38 items; mean importance=3.31); Professional Advocacy and Political Action (5 items; mean importance=3.03); Case Management and Care Coordination (16 items; mean importance=3.02); Patient Education and Advocacy (8 items; mean importance=2.82); Organizational Support and Service (12 items; mean importance=2.74); Professional Education (12 items; mean importance=2.45). Reflecting upon the data, stakeholders emphasized the “essential nature” of oncology social work and the critical role played by social workers to mitigate the effects of social determinants of health on patient and family outcomes, including adherence to therapy.

Conclusions and Implications. Results depicted the relative importance of six theoretical domains of OSW practice, along with the relative importance of specific practice behaviors within each domain for OSWs working in a variety of practice settings. Defining and delineating the OSW role is needed to achieve an efficient and value-based cancer care system in which social work is demonstrated as essential for optimizing biomedical treatment. These results will clarify the OSW role for organizations that employ OSWs, and also inform initiatives related to social work education and training, credentialing and certification, health policy, research and advocacy on behalf of patients, families, communities and the profession.