Unpacking Pathways to Success in Hospice Social Work: A Qualitative Comparative Analysis of Assessment, Intervention, and Case Duration Configurations

Background/Purpose: Social work in hospice settings in China is thriving, in tandem with the rapid expansion of the end-of-life care sector, driven largely by the country’s aging population and the growing recognition of hospice and palliative care needs. Hospice social workers play a crucial role in improving the overall quality of life for terminally ill patients and their caregivers by addressing emotional, social, spiritual, and practical concerns. However, the impact of hospice social work in China remains under-documented and difficult to evaluate, primarily because of the diversity in intervention types and the complex, individualized nature of end-of-life care. Traditional outcome evaluations that rely solely on qualitative or quantitative approaches often fall short in capturing the nuanced interplay between social work activities and patient outcomes. To address this methodological gap, this study applies Qualitative Comparative Analysis (QCA), a case-based, set-theory approach that allows for the examination of complex causal relationships and multiple conjunctural causation. Guided by the Logic Model (McLaughlin & Jordan, 1999), this study applies QCA to explore how various components of social work - assessments, interventions, and case duration - interact to result in successful or unsuccessful achievement of social work goals in hospice settings.

Methods: A cross-sectional study included 254 Chinese hospice patients (mean age = 74.7). Physical condition was categorized by diagnosis (cancer vs. non-cancer). Psychosocial-spiritual conditions were assessed via the Social Work Assessment Tool. Interventions included five services: funeral support, grief support, end-of-life counseling and family guidance, religion-informed preparation, and existential support. Case duration was calculated from intake to closure. Goal achievement was measured as “achieved” or “not achieved.” Fuzzy-set QCA was used, with data calibration, necessity analysis, and sufficiency analysis conducted in R and fsQCA software.

Results: Necessity analysis revealed that providing funeral support (consistency = 0.939), providing grief support (0.908), and not providing religion-informed preparation (0.902) were necessary for goal achievement. Conversely, not providing grief support (0.923) and not offering counseling and family guidance (0.923) were necessary for failure of social work goal. A total of eight configurations were found to lead to goal achievement (solution coverage = 0.414; consistency = 0.819), all of which involved funeral support. Five configurations were associated with failure to achieve goals (solution coverage = 0.214; consistency = 0.824), each involving a cancer diagnosis.

Conclusions and Implications: This study demonstrates the value of QCA in evaluating hospice social work, offering a nuanced understanding of how multiple service components interact to influence outcomes. Findings highlight funeral support as a pivotal service, while cancer patients appear more likely to experience unmet goals due to complex psychosocial needs. Competent grief support and tailored end-of-life counseling may enhance outcomes, while religion-informed services are needed to be adapted case by case to improve goal achievement. Different combinations of social work assessments, activities, and case duration influence the hospice social work outcome. Social workers can apply these insights to adjust service emphasis and better address the complexities of end-of-life care, especially for cancer patients.