Social Worker Perspectives: Providing High-Quality Palliative Care to Individuals Preferring Languages Other Than English

Background: As the United States becomes increasingly diverse, there is a growing need to provide culturally- and linguistically- appropriate care. Patients with a preferred language other than English (PLOE) and serious illness are at particularly high risk of receiving poorer quality care because of the central role of communication in understanding illness, making informed decisions, and being able to communicate values, goals, and preferences. Palliative care, which offers interdisciplinary support to help attend to the distress that patients with serious illness and their families experience, can address these barriers.

Social workers are key to supporting the palliative care needs of patients with PLOE and serious illness through connecting them to resources, facilitating goals-of-care communication, and addressing emotional distress. However, there is limited research about barriers that social workers face in addressing the needs of these populations.

Methodology: As part of a larger, multi-level intervention development study, we conducted semi-structured interviews with social workers who provide services to Chinese-, Spanish-, Vietnamese- and/or Somali- speaking patients with dementia or advanced cancer (n=7). Interviews were audio-recorded, transcribed and pair-coded. We utilized thematic analysis to understand the facilitators and challenges social workers face when supporting PLOE patients living with serious illness.

Results: Social workers' professional experience ranged from 5-28 years. Four participants currently work in a Palliative Care Clinic, while three work in a related clinic (e.g. gerontology). Interviews highlighted multiple barriers to supporting PLOE patients including: 1) often connecting with PLOE patients and their families during a time of crisis, leaving minimal bandwidth for planning for the future; 2) added complexity in assessing patient and family comprehension of care options, and understanding patient's symptoms (especially for patients with dementia); 3) establishing a therapeutic connection with patients and families when having to communicate through an interpreter; 4) difficulty in helping PLOE patients navigate technology to schedule follow up appointments, referrals, and to check-in with concerns; 5) language, cultural, and documentation-status related barriers to connecting patients with support programs and services (e.g. respite, Medicaid); and 6) lack of existing linguistically- and culturally-appropriate palliative care resources.

Interview participants also highlighted policy and practice adjustments that could aid in intervention development, including: 1) providing consistent in-person interpreters for seriously ill PLOE patients to help aid in continuity of care; 2) participating in pre-meeting and debrief sessions with the care team to make sure that everyone is clear about patient and family priorities; 3) enhancing hospital scheduling systems to support PLOE patients; and 4) developing linguistically- and culturally-appropriate resources.

Conclusion: Our findings identify distinct opportunities for intervention to better support social workers in providing linguistically- and culturally- appropriate palliative care for seriously ill PLOE patients and their families.