Welcome to the twentieth volume of the journal! It is our twentieth year of devotion to the work of palliative social work researchers, practitioners, and our interdisciplinary collaborators around the world. With the next volume (21), we will usher in a new decade of advances in social work practice and research in all areas of the field, diverse settings where needs are seen that are palliative in nature related to serious illness and conditions that are near to end of life particularly with populations (diverse in racial, cultural, socio-economic, geographic and personal identity factors) that may be facing limited health inequities and limited access to adequate care. Aspects of providing care for these individuals and of family caregivers, who provide the majority of care in the home across the globe, especially remains of importance as does issues of loss, grief and bereavement, across the lifespan. We look forward to the future with anticipation for opportunities to support practice and research that continues to add to the knowledge and skill base of social work in end-of-life and palliative care.
In this twentieth volume, we continue on our path to providing an outlet for diverse topics from authors internationally. The first issue contains first two poignant reflections worth a read. The following research articles span various types of research topics and methods.
In the first, Rattner and Cait, described an important role for hospice and palliative care social workers that they have identified as “under-resourced.” They examined social work and other disciplines in Canada in their work with nonphysical suffering inclusive of psychological, emotional, social, spiritual and existential. Although, it is often seen that medical concerns are most often considered foremost, some of the medical problems could be resolved by a focus on the patients’ multidimensional suffering. The authors identified a lack of specialist social workers (and time) to attend to the holistic nature of suffering in palliative care settings and the stress that social workers doing the work to address suffering because of the pressure of the meaning of their professional values.
Another qualitative study takes us to a rural environment for social work practice. Curd and Hong explored how rural hospice social workers, in the U.S., help patients and families to navigate a system they described as “cracked.” Rural areas are essential synonymous with an inadequately resourced environment for health care, particularly specialty care such as hospice and palliative care. In their interviews with rural hospice social workers, they were able to identify systems barriers as well as resource and geographic. They wanted to reveal the challenges of these social workers and highlight the need for advocacy and macro-level practice by these social workers with first-hand experience, in addressing barriers that exist to care that could maximize individuals’ and families’ quality of life.
Next, we go from the rural environment to and an urban one in Bangkok, Thailand although the issues may be similar regarding continuity of care. Continuity of care is of utmost importance in addressed quality of life near the end of life. This qualitative study, using multiple data collection strategies, by Wongchan and colleagues, examined a sample of health care providers at one specialized hospital inpatient unit in community and continuity of care, including social workers. Important barriers to continuity were identified such as lack of understanding of palliative care, lack of adequate information about the patient and family, and work overload. The authors suggest further educational training in palliative care and how to maintain continuity in services provided.
Murahashi and colleagues next discuss an all-important factor in care at the end of life. Trust, particularly in the primary physicians and in the health system overall or lack of trust can dramatically alter patients’ and families’ experiences. In this Japanese study, the authors specifically focus on bereaved family caregivers’ perceptions of patients’ relationships with their physicians. These caregivers identified several factors related to trust, such as a caring attitude and thorough explanations, and referral by a trusted physician. They discuss the implications for design of interventions that may promote trust with individual physicians and other members of the health care team.
Finally, around the world, dementia is becoming and increasing studied topic within health care and palliative care settings. Much research has also been conducted since an emphasis on completing advance care directives among nursing home residents with dementia emerged within the past twenty years; particularly renewed effort seen with the advent of COVID-19 worldwide. Hormazábal- Salgadoa and colleagues conducted a scoping review to examine the research specifically related to advance care directives and, they believed surprisingly, the search turned up only 28 studies. They make recommendations about how advance directives could be better addressed with the assistance of the health care team, particularly social workers.