End-of-life care.

Abstract

End-of-life care is not a new arena for social workers who historically have provided care for dying individuals and their families in a variety of settings. What is new is that end-of-life care is finally receiving the attention that it deserves. This special issue is testimony to the growing recognition that the final phase of a person's life has enormous implications for the individual, his or her family, and the community and should be addressed and supported by established policies and programs. It also confirms the central role of social work to this specialized field's ongoing development. Social workers have professional contact with those who are dying in a number of contexts. A national survey found that 75 percent of supportive counseling for cancer patients at National Cancer Institute--designated cancer centers was provided by social workers (Coluzzi et al., 1995). Social workers have been described as the hub of the interdisciplinary team that provides comprehensive medical and support services to patients facing death (Blackman, 1995). Using their expertise in working with people of varying cultural backgrounds, ages, socioeconomic situations, and family constellations, social workers must be prepared to intervene appropriately with families facing trauma and death across the life span (NASW, 2003). As more care has shifted from institutional settings to homes and as survival with serious illness is extended, social workers have helped coordinate an increasingly broad range of services to individuals and families coping with complex medical regimens and periodic physical or emotional crises (Christ & Sormanti, 1999; Volland, 2000). During the past decade, social work practice in end-of-life care was enhanced by significant funding from the Open Society Institute's Project on Death in America (PDIA) and the Hartford Foundation. With this financial support, social work researchers, educators, and practitioners collaborated to advance knowledge and practice in end-of-life care. A number of significant products emerged from these initiatives. For example, in 2001 five of the PDIA social work leaders wrote Care at the End of Life as part of the best practices series for the Society for Social Work Leadership in Health Care (Taylor-Brown, Blacker, Walsh-Burke, Altilio, & Christ, 2001). In 2002 PDIA convened a group of social work experts in end-of-life care who developed an agenda to improve care for dying individuals and their families and to elevate social work's role and contributions in this arena (PDIA, 2002). Building on this foundation, the National Association of Social Workers (NASW, 2003) developed Standards for Social Workers in Palliative and End-of-Life Care as a tool for social workers. The standards reflect core elements of social work practice in palliative and end-of-life care and have utility for social workers in a variety of settings. For many social workers in palliative and end-of-life care these standards reinforce current practices. For others they provide objectives to achieve and guidelines to improve practice. Social work interventions can enhance the end of life in significant ways. Social workers help individuals and their loved ones examine the myriad changes associated with the illness or condition that has resulted in the individual's dying and find or create meaning in the dying process. Changes often reverberate throughout all aspects of a person's life. Social workers partner with individuals and families to navigate these changes, empowering them to build on pre-existing strengths and resources and to develop new strategies for adaptation. Social workers also intervene outside the individual and family context. For example, social workers advocate for the needs of individuals and families within specific health care teams and provider systems and, on a macro level, advocate for broader policy changes that support a more caring approach to end-of-life care for both patients and their loved ones. …