Enhancing Oncology Social Work in Palliative Care: A Role Delineation Study

Background and Purpose: Palliative care provides robust benefits to the growing population of patients with cancer and their family caregivers. Although palliative care emphasizes interdisciplinary teamwork to address the multifaceted problems patients face, many palliative care teams are currently exclusively physicians and nurses. Social workers serve an important role in the provision of quality psychosocial services in cancer care. However, the role (i.e., a set of related functions or tasks that require both knowledge and skill) of an oncology social worker (OSW) in palliative care is not clearly delineated. Defining the role of OSWs in palliative care is crucial for clarifying their responsibilities, functions, and contributions to the healthcare team, as well as providing a guide for academic programs preparing social workers for this specialty practice. This study aimed to distinguish and delineate the role of OSWs in palliative care.

Methods: Data for the secondary analyses was derived from a nationwide survey of workforce conditions for OSWs. OSWs involved in direct practice with patients with cancer were eligible (N = 892). Through an online survey, respondents indicated the relevance of 91 tasks related to their practice. Responses were rated on a six-point scale ranging from 0 (“not applicable to my job”) to 5 (“extremely significant”). Individual demographic and work-related characteristics were included. Exploratory Factor Analysis and Independent-samples T tests were used to compare the role of OSWs in palliative care with those who do not practice in that domain.

Results: Responses from 243 OSWs who indicated involvement in palliative care derived a 6-factor solution consisting of 34 tasks. The six factors included: Therapeutic Interventions for Individual, Couples, and Families; Facilitate Treatment Decision-making; Care Coordination; Assessment and Emotional Support; Organization and Community Service; and Equity and Justice. Reliability of the factors was ensured with the Cronbach’s alpha, with all six factors having a score above 0.70, suggesting a good internal reliability.

Compared to 649 OSWs whose position does not include palliative care, OSWs whose position includes palliative care (n = 243) were significantly more likely to perform the following tasks: assist patients and families with planning for long-term or end-of-life care and medical treatment needs; help the medical team understand social determinants of health; assess patient understanding of treatment options; promote communication between patient and spouse/partner/caregivers; help patients talk to their children about cancer; facilitate goals of care discussion; as well as grief and bereavement support and counseling (p < .05).

Conclusions and Implications: This study extends previous efforts to define the role of palliative social work and provides more depth into the role in cancer settings. The study findings illustrate the unique roles and tasks of OSWs in palliative care where they are engaged as part of an interdisciplinary care team. The findings can be used to more accurately identify skills needed in job descriptions for OSWs employed in palliative care and also identify content for MSW programs, ongoing education, and the evaluation of social workers in this specialty practice.