Discussion 1: Hospice Social Work

Hospice is a concept of care that does not accelerate death or prolong life. It provides support and comfort to patients and caregivers in the face of a terminal illness that is no longer responding to standard medical treatment. Hospice services are delivered by a specialized team of health care professionals to provide comfort and dignity to patients in their last days of life. Social workers are an integral part of any hospice team. The burden of working with individuals at the end of life can be significant for members of a hospice team who are confronted with death on a daily basis. Hospice social workers in particular must be mindful of issues of secondary trauma and self-care.

To prepare for this Discussion:

Review this week’s resources. Consider hospice care at the end of life and the different programs providing hospice service. Examine the quality of each program. Think about the emotional burden experienced by a hospice social worker.

Post an explanation of the importance of an interdisciplinary team in end-of-life care. 
Briefly describe different programs providing hospice care with regard to team structure and scope of services. 
Compare the roles of a social worker on a hospice team in a hospital-based program and in a home hospice program. 
Explain your feelings about the emotionally intense work of hospice care. 
Finally, explain the strategies you might consider to cope with your emotions.

Be sure to support your postings and responses with specific references to the resources and the current literature using appropriate APA format and style.


Palliative &
End of Life


Palliative &
End of Life


National Association of Social Workers

Gary Bailey, MSW

NASW President (2003–2004)

Palliative and End of Life Care

Expert Steering Committee

Susan Blacker, BSW, MSW, RSW,

Volunteer Leader

Iraida V. Carrion, LCSW

Yvette Colón, ACSW, BCD

Pamela M. Jackson, MEd

Stuart Kaufer, CSW, ACSW

Patricia O’Donnell, DSW, LICSW, CCM

Mary Raymer, ACSW

Sherri Roff, CSW, PhD Candidate

Elizabeth Smart, MA

Sharon Hines Smith, PhD, QCSW, MSW

Mila Ruiz Tecala, ACSW, DCSW, LICSW

Katherine Walsh-Burke, DSW

NASW Staff

Elizabeth J. Clark, PhD, ACSW, MPH

Executive Director

Toby Weismiller, ACSW

Tracy Whitaker, ACSW

Karyn Walsh, ACSW, LCSW

©2004 National Association of Social Workers.
All Rights Reserved.


7 Introduction

9 Definitions

13 Background

14 Guiding Principles

15 Standards for Professional Practice

26 Standards for Professional Preparation and Development

29 References

31 Resources

31 Acknowledgements

f o r P a l l i a t i v e a n d

E n d o f L i f e C a r e

Standard 1. Ethics and Values
The values, ethics, and standards of both the
profession and contemporary bioethics shall
guide social workers practicing in palliative and
end of life care. The NASW Code of Ethics
(NASW, 2000) is one of several essential guides
to ethical decision making and practice.

Standard 2. Knowledge
Social workers in palliative and end of life care
shall demonstrate a working knowledge of the
theoretical and biopsychosocial factors essential
to effectively practice with clients and

Standard 3. Assessment
Social workers shall assess clients and include
comprehensive information to develop
interventions and treatment planning.

Standard 4. Intervention/Treatment Planning
Social workers shall incorporate assessments in
developing and implementing intervention plans
that enhance the clients’ abilities and decisions
in palliative and end of life care.

Standard 5. Attitude/Self-Awareness
Social workers in palliative and end of life care
shall demonstrate an attitude of compassion and
sensitivity to clients, respecting clients’ rights to
self-determination and dignity. Social workers
shall be aware of their own beliefs, values, and
feelings and how their personal self may
influence their practice.


Original Article

Creating social work competencies for
practice in hospice palliative care

Palliative Medicine

24(1) 79–87

! The Author(s), 2010.

Reprints and permissions:


DOI: 10.1177/0269216309346596


Harvey Bosma School of Social Work, University of British Columbia, Vancouver, BC, Canada
Meaghen Johnston School of Social Work, University of British Columbia, Vancouver, BC, Canada
Susan Cadell Lyle S Hallman Faculty of Social Work, Wilfrid Laurier University, Kitchener, ON, Canada
Wendy Wainwright Victoria Hospice, Victoria, BC, Canada
Ngaire Abernethy Mental Health Services for the Elderly, Brandon Regional Health Authority, Brandon, MB, Canada
Andrew Feron Parkwood Hospital, St Joseph’s Health Care, London, ON, Canada
Mary Lou Kelley School of Social Work & Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada
Fred Nelson Palliative Care Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada


Social workers play an important role in the delivery of Hospice Palliative Care in many diverse settings. The profession

brings a unique perspective to end-of-life care that reflects and supports the holistic philosophy of Hospice Palliative

Care. Despite the prominent and longstanding position of social work in this area, the role and functions of social

workers had not been clearly defined. A Canadian task group of social work practitioners and educators utilized a

modified Delphi process to consult front line clinicians nationally, and thereby achieved consensus regarding the identi-

fication and description of eleven core competencies in Hospice Palliative Care. These competencies are relevant for

social workers at different experience levels across care settings. They can be used to inform social work practice, as

well as professional development and educational curricula in this area.


social work competencies, social work practice, palliative care, end-of-life care, Delphi technique


Social workers play an important role in the delivery of
Hospice Palliative Care (HPC). In time, most social
work practitioners will encounter adults, children, and
families who are facing progressive life limiting illness,
dying, death, or bereavement. Such social work inter-
actions occur not only in health care settings, but in all
locations where social workers practice. These include
hospitals, hospices, nursing homes, adult daycare, and
senior centers as well as non-health-care sites such as
child and family services agencies, income assistance
programs, schools, courts, and employee assistance


The profession of social work brings a unique per-
spective to end-of-life care that reflects and suppo

Progress in Palliative Care 2010 Vol 18 No 4 205

An overview of contemporary social work
practice in palliative care

Susan Cadell1, Meagan Johnston2, Harvey Bosma3, Wendy Wainright4

1Manulife Centre for Healthy Living, and Lyle S. Hallman Faculty of Social Work, Wilfrid Laurier
University, Kitchener-Waterloo, Ontario, Canada
2Alberta Children’s Hospital, Calgary, Alberta, Canada
3School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada
4Psychosocial Counselling Services, Victoria Hospice, Victoria, British Columbia, Canada

It is widely acknowledged that social workers play a pivotal role in the delivery of palliative care. A
group undertook a process to define and validate social work competencies in palliative and end-
of-life care delivery. The aim of this article is to provide an overview of the palliative care social work
practice competencies developed in the Canadian context and to illustrate them with case
examples. The competencies involve a complex interaction of values, knowledge and skills. The
next phase in the development of these competencies is to embed them in the system of social
work education at all levels. The case examples illustrate the importance of social work practice in
palliative care. They also demonstrate that the competencies are interconnected as certain aspects
of social work practice and client and family experience arise in various areas and guises.
Ultimately, the goal is excellent palliative care to clients and their families throughout the trajectory
of a serious illness and social workers have an important role to play in that.

Keywords: social work competencies, paediatric palliative care, palliative care, hospice care


It is widely acknowledged that social workers play a
pivotal role in the delivery of palliative care.1 In the
Canadian context, social workers have been involved
in healthcare and hospital work for many years and
have been implicated in palliative care since its earliest
history. More recently, various professions involved in
palliative care in Canada have moved to formalise the
competencies required in palliative care. A pan-
Canadian group undertook a process to define and

validate social work competencies in palliative and
end-of-life care delivery.2 The present article will focus
on describing the competencies and providing
examples of social work practice for each one. It is our
aim to demonstrate the breadth of practice in palli-
ative care across the ages of clients from child to adult
and throughout a variety of settings, family com-
positions, and cultural influences.

The work of establishing the social work
competencies was supported by Health Canada, our
national health body, and its Secretariat of Palliative
and End of Life Care. The group included social
workers from across the country and various practice
areas, from hos

266 © 2016 Indian Journal of Palliative Care | Published by Wolters Kluwer – Medknow


The 2015 Indian population‑based cancer registry
reported that the age‑adjusted cancer incidence rates
of childhood cancers in India are in the range of
18.6/million ‑ 159.6/million in the male pediatric
population and 11.3–112.4/million in the female
pediatric population. The highest incidence of cancer
is observed in the Southern region of India with an
incidence of 159.6/million in male pediatric population.

The lowest incidence of cancer is observed in the
Northeast region of India with an incidence of 18.6 and
11.3/million in male and female pediatric population
respectively. Leukemia, lymphomas, and brain tumors
are the most common malignancies seen in Indian
pediatric population. There is a rising trend of childhood
cancers in India,[1] and cancer is the ninth common cause

Original Article

Specialist Pediatric Palliative Care Referral Practices in
Pediatric Oncology: A Large 5-year Retrospective Audit

Arunangshu Ghoshal, Naveen Salins, Anuja Damani, Jayita Deodhar,
MaryAnn Muckaden

Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India

Address for correspondence: Dr. Naveen Salins; E‑mail: [email protected]


Purpose: To audit referral practices of pediatric oncologists referred to specialist pediatric palliative care services.
Patients and Methods: Retrospective review of medical case records of pediatric palliative care
patients over a period of 5 years from January 1, 2010 to December 31, 2014. Descriptive summaries of
demographic, clinical variables, and patient circumstances at the time of referral and during end-of-life
care were examined.
Results: A total of 1135 patients were referred from pediatric oncology with a gradual increasing trend over 5
years. About 84.6% consultations took place in the outpatient setting. In 97.9% of the cases, parents were the
primary caregivers. Availability of specialist pediatric health-care services at local places was available in 21.2%
cases and 48% families earned <5000 INR (approximately 73 USD) in a month. Around 28.3% of the referrals
were from leukemia clinic and maximum references were late with 72.4% patients having advanced disease
at presentation. 30.3% of the referrals were made for counseling and communication and 54.2% had high
symptom burden during referral. After referral, 21.2% patients continued with oral metronomic chemotherapy and
10.5% were referred back to oncology services for palliative radiotherapy. Only 4.9% patients had more than 2
follow-ups. 90.8% of the patients were cared for at home in the last days of illness by local general practitioners.
70.6% of

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