I started my oncology career as an inpatient social worker working with hematology patients and their families. During those initial years, I worked with individuals throughout the continuum of care, from initial diagnosis to relapsed disease to end of life. Mainly, the patients had low to moderate psychosocial risk. I would see very few end-of-life cases. 

Then a shift occurred that had a significant impact on my practice. Many chemotherapy regimens that were initially provided inpatient were now switched to outpatient regimens. This meant my main population was now comprised of individuals who had moderately high or high-risk disease with acute needs. 

This was significant because the change in protocol forced my focus from providing clinical interventions primarily at initial diagnosis or maintenance to acute symptom management and end-of-life. What became very apparent to me was that I was not comfortable addressing these types of psychosocial needs due to a lack of knowledge, and the organization’s structural approach to palliative care was not efficient for my service. 

To address these concerns, I did two things: First, I focused on my training by attending webinars and shadowing the Palliative Care team to gain more knowledge and awareness of end-of-life concerns. Secondly, I started reading evidence-based research. As a result of these two interventions, I developed the understanding and knowledge to conduct a program evaluation, complete a comprehensive literature review, and develop relationships with key stakeholders who supported a proposal for structural change, including advocacy efforts at the executive leadership level.   

Palliative Medicine and Supportive Care (PMSC) is a specialized service that focuses on improving the quality of life for patients with serious illnesses by alleviating symptoms associated with their disease. Research has shown that palliative care improves quality of life for patients and caregivers, enhances patient satisfaction, increases survival rates, and reduces symptom burden. The objectives of palliative care are to improve effective communication, support informed decision-making, engage in goal-setting discussions, explore patients’ values and treatment goals, support interventions that reflect those values, and facilitate care transitions. 

There is a growing emphasis on interprofessional team-based care as it has been linked to lower healthcare costs, improved patient and provider satisfaction rates, and an increase in the recruitment and retention of staff (Blacker et al., 2016). Social workers are uniquely positioned to serve as leaders in interprofessional teams. We are trained to provide services utilizing concepts such as person-centered care, self-determination, a holistic perspective, and communication through multi-level systems. 

It is important for us as social workers to be equally knowledgeable of the disease patterns and the culture of our clinics. This understanding will help inform your practice and facilitate the application of interventions. Studies conducted by multiple research teams have described the impact of early palliative care compared to late palliative care (Kim et al., 2015; Finn et al., 2017). When patients receive a late PMSC referral, their family members are more likely to struggle with negative emotions and denial regarding the patient’s prognosis, unlike when there is early involvement.  

The term “palliative” is met with a negative stigma. You may notice that, depending on the speaker or organization, the palliative care service/department may have a different name. I’ve seen variations that include palliative care, supportive care, and the quality-of-life team. Why is that? Why have so many name variations for one service? Because of the lack of education on palliative care combined with our societal fear and negative view about dying, palliative care is still linked to only hospice care or the “H” word. Hospice care is palliative care, but palliative care is not always hospice care. 

To improve the quality of care, medical providers and social workers must have a comprehensive understanding of the patient’s perspective on treating their cancer through the continuum of care, including end-of-life (Nortjé & Stephan, 2021). An intervention to accomplish that task is through advanced care planning.  

Remember, you are never out of school! Some trainings I have found beneficial are the following:   

• Educating Social Workers in Palliative and End-of-Life Care (ESPEC) Geriatric Oncology: Cognition and Communication | Memorial Sloan Kettering Cancer Center  
• NCI Training for Cancer Health Care Professionals in Biopsychosocial Pain Management and Quality Improvement | City of Hope  
• VA Advance Care Planning – Group (ACP-G) Facilitator Training 

As social workers, we are masters at navigating complex systems and advocating for change. We need to occupy more leadership positions at the mezzo and macro levels. Our ability to understand complex systems and work effectively with diverse groups of individuals makes us a valuable asset to organizations. Leadership is often viewed as a position of power and authority; however, authentic leadership is not just a noun, but an adjective and verb. Leadership is a concept that is embodied through qualities and skill sets. Don’t wait to lead until you hold a formal title or position. 

Organizational change can be slow but consider the interventions you can implement in your service and how you interact with your providers. For instance, a simple shift in mindset. At the beginning of my career, if you were to ask me if I identified as a palliative social worker, I would have said ‘No, I’m an oncology or hematology social worker.’ I was initially focused on the literal job title, but I realized it was more than that and, in fact, all oncology social workers are palliative care social workers. Our focus is on improving the quality of life for patients with serious illnesses by enhancing effective communication and supporting informed decision-making that reflects patients’ values and treatment goals. 

If not you, then who? 

References

Blacker, S., Head, B.A., Jones, B.L., Remke, S.S., & Supiano, K. (2016). Advancing hospice and palliative care social work leadership in interprofessional education and practice. Journal of Social Work in End-of-Life & PalliativeCare,12(4),316–330. https://doi.org.10.1080/15524256.2016.1247771

Finn, L., Alva, R. G., & Malhotra, S. (2017). Oncology and palliative medicine: Providing comprehensive care for patients with cancer. The Ochsner Journal, 17(4), 393-397.  https://pmc.ncbi.nlm.nih.gov/articles/PMC5718452/ 

Kim, S. H., Hwang, I. C., Ko, K. D., Kwon, Y. E., Ahn, H. Y., Cho, N. Y., & Kim, S. J. (2015). Association between the emotional status of family caregivers and length of stay in a palliative care unit: A retrospective study. Palliative & Supportive Care, 13(6), 1695- 1700. https://doi.org/10.1017/S1478951515000619.  

Nortjé, N., & Stepan, K. (2021). Advance care planning conversations in the oncology setting: Tips from the experts. Journal of Cancer Education: The Official Journal of the American Association for Cancer Education, 36(2), 325-329. https://doi.org/10.1007/s13187-019-01631-1.