Amy Colver, LCSW
Melody Griffith, MSW, LMSW, OSW-C
AOSW Communications Director
Jeanice Hansen, LCSW, OSW-C
To submit a story or information for inclusion in a future issue of AOSW Newsletter, contact Amy Colver or Melody Griffith on the list above.
Pain, Palliative Care and End-of-Life Care SIG: To Be an Oncology Social Worker Is To Be a Pain Management Advocate
Good oncology social workers know a little something about cancer. Great oncology social workers know a lot about psychosocial stress and coping. Exceptional oncology social workers never forget to learn about pain.
An estimated 64 percent of all cancer patients experience pain; up to 33 percent of all cancer patients continue to have pain after curative therapies (van den Beuken-van Everdingen et al., 2007). Approximately 43 percent of cancer patients receive inappropriate, inadequate pain care. Deandrea, Montanari, Moja and Apolone (2008) believe that despite the existence of cancer pain management guidelines, undertreatment still is a major problem for people with cancer. All of this suffering presents many challenges to the healthcare team. Social workers are no exception. However, to be exceptional, they must seek out knowledge and build skills in cancer pain assessment and traditional and integrative treatment options. We have an ethical mandate to do something. And that something is to take actions that provide effective pain and symptom management with the ultimate goal to relieve suffering.
Dame Cicely Saunders, the founder of the modern hospice movement, developed the concept of “total pain” through her work with persons who were dying. The concept refers to complex reactions to pain and suffering with psychological, social, emotional and spiritual components, influenced by cultural background and subjective interpretation of the experience. Because of these complex reactions, quality pain and symptom management need to take into account the multidimensional ways in which a person with cancer pain and their loved ones may be suffering. It becomes abundantly clear why a team approach including social workers is the most effective. An integrated approach to pain management will seek to address not only the medical/physical impact on a person with pain, but also the social, psychological, spiritual, sexual, economic and existential dimensions of the patient’s life. If these dimensions do not perfectly describe the purview of oncology social work, then I do not know what could.
Oncology social workers not only provide important services to people with pain but we are the major mental health professionals in hospice and palliative care. As stated by Altilio, Otis-Green, Hedlund and Fineberg (2012), “Principles and values underlying pain management have much in common with those of social work. In both, comprehensive quality assessment is individualized, patient and family-centered, and multidimensional” (pg. 592). For patients with pain, social workers function as advocates, care managers, clinicians, educators and/or coordinators of their treatment plan. We play an important role in ensuring access to appropriate medications and other pain treatments. Some of our best work is when we can support patients who have pain, their families and caregivers, especially dispelling fears about addiction and other barriers to adequate pain management. We can advocate for insurance coverage or transportation to and from appointments to be sure that pain is seen and heard as loud as the very cancer itself.
Oncology social workers teach strategies to enhance pain relief, such as relaxation, breathing exercises and goal setting. We help cancer pain patients and their families more effectively communicate with other members of the medical team. Oncology social workers are sometimes the first provider with whom a patient will disclose their fear of opioids or of a painful death and their angst over the cost of a prescription. Oncology social workers specialize in helping people navigate the health care system to more easily access appropriate pain care that they absolutely have a right to and should not be denied.
Unfortunately, most health care professionals, including social workers, routinely do not receive training in pain assessment and management during their academic programs. Many entities, however, recognize the importance of social work involvement in pain management. The International Association for the Study of Pain has published a Curriculum Outline for Pain in Social Work that provides guidance for establishing content for courses on acute, chronic and cancer pain at both undergraduate and graduate levels. The suggested content organizes around four major areas: Multidimensional Nature of Pain, Pain Assessment and Measurement, Management of Pain and Clinical Conditions. Longtime AOSW member Terry Altilio was co-chair of the curriculum committee. For many years, the State Pain Policy Advocacy Network has been advocating for an increase in the number of pain CMEs/CEUs for all licensed health care professionals. Michigan, to my knowledge the only state that requires pain CEUs for social work license renewal, will be increasing their requirement by the end of 2016.
But AOSW members are fortunate. There are pain, palliative and end-of-life care paper sessions and posters at the AOSW annual conference. We have esteemed colleagues who are willing to share their expertise, skill and passion for excellent pain management and optimal end-of-life care. I know. I have had the honor and privilege to learn from the best. So, I encourage you to do the same—attend the presentations on pain, ask questions on SWON and welcome Jackie Ogg, MSW, LGSW, and Renee Katz, PhD, MSW, as your new Pain, Palliative Care, and End-of-Life SIG Co-Coordinators. I look forward to their leadership of this important SIG as I respectfully pass the baton to them!