Social Workers' Collaborative Roles in Increasing Illness and Prognostic Understanding for Seriously Ill Patients: Insights from Hospital-Based Palliative Care Physicians and Social Workers

Background and Purpose: For patients experiencing serious or life-limiting illnesses, informed decision-making depends on developing an understanding of their illness trajectory and disease prognosis, commonly referred to as cultivating prognostic awareness (CPA). Although physicians (MDs) are viewed as the appropriate profession to share medical information around prognosis, there is growing recognition that other interprofessional palliative clinicians can contribute to holistic aspects of these discussions. Rising demand for palliative services, coupled with recent clinical trials of nonphysician-led goals of care interventions, are contributing the expansion of SWs CPA role expansion. Yet, little research exists on how teams understand and negotiate models of shared CPA. Using role theory, this study therefore seeks to explore MDs’ and SWs’ perceptions of SWs’ CPA roles as members of hospital-based interprofessional palliative care teams, with a particular interest is in understanding the degree to which the two professions have aligned or disparate views in the construction of role boundaries, role sharing, and role conflict.

Methods: A two-step recruitment process was used to gain a matched sample of 17 SWs and 17 MDs. As a study focus on experienced palliative SWs, participation eligibility was based on two criteria, having Advanced Palliative and Hospice Social Work Certification (APHSW-C) and employment on a hospital-based adult palliative care team in the prior six months. An email outreach was sent to the approximate 250 APHSW-C social workers nationally with a request to participate in a 45-60-minute zoom interview on the study theme. Each of the 17 interviewed SWs were asked to share the name and contact information for two team members they thought would be willing to participate a zoom interview, of which one (if possible) should be a physician). A total of 17 physicians agreed to participate in a 20-30 minute zoom interview. With permission, all interviews were recorded and transcribed. An interpretive description approach was used for the data analysis, this method is increasingly being adopted by qualitative health researchers for understanding clinical phenomena that yield practice implications.

Results: Thematic analysis revealed key insights into SWs’ comfort levels and roles in CPA. Areas of convergence between the two professions affirm SWs’ role in a) assessing readiness for prognostic discussions b) identifying gaps in understanding c) translating medical conditions into lived reality and d) supporting emotional processing of patients and their families. Both groups spoke of the benefit of CPA role sharing in advancing goal concurrent care; yet also acknowledged the potential for role conflicts particularly around the delivery of medically complex information. Findings emphasized the importance of role clarity, mutual respect, trust, and communication among interprofessional team members.

Conclusions and Implications: Findings underscore that both professions perceive that SWs have unique psychosocial expertise and skills that are valuable to CPA. Yet, for SWs to assume greater leadership roles in the psychological and emotional aspects of palliative care, we need to both grow the pipeline of APHSW-C social workers as well as better define and demonstrate the impact of SW interventions in supporting the CPA and patients’ wellbeing.