Social workers’ involvement in advance care planning: a systematic narrative review

Abstract

BackgroundAdvance care planning is a process of discussion that enables competent adults to express their wishes about end-of-life care through periods of decisional incapacity. Although a number of studies have documented social workers’ attitudes toward, knowledge about, and involvement in advance care planning, the information is fragmented. The purpose of this review was to provide a narrative synthesis of evidence on social workers’ perspectives and experiences regarding implementation of advance care planning.MethodsSix databases were searched for peer-reviewed research papers from their respective inception through December 2016. All of the resulting studies relevant to both advance care planning and social worker were examined. The findings of relevant studies were synthesized thematically.ResultsThirty-one articles met the eligibility criteria. Six research themes were identified: social workers’ attitudes toward advance care planning; social workers’ knowledge, education and training regarding advance care planning; social workers’ involvement in advance care planning; social workers’ perceptions of their roles; ethical issues relevant to advance care planning; and the effect of social work intervention on advance care planning engagement. The findings suggest that there is a consensus among social workers that advance care planning is their duty and responsibility and that social workers play an important role in promoting and implementing advance care planning through an array of activities.ConclusionsThis study provides useful knowledge for implementing advance care planning through illustrating social workers’ perspectives and experiences. Further studies are warranted to understand the complexity inherent in social workers’ involvement in advance care planning for different life-limiting illnesses or within different socio-cultural contexts.

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“…Hospice social workers and community-based PSWs were found to increase advance directive (AD) documentation rates more than hospital-based HSW in part due to strong interdisciplinary dynamics within hospice and palliative settings. 5 Additionally, HSW introduce ACP more frequently and spend 30-60 minutes per day on the topic, 3 as compared with physicians and nurses who spend, on average, <30 minutes in these discussions. 3,6 Despite this discrepancy, HSW still feel this time is inadequate given the nuances of these conversations.…”

“…5 Additionally, HSW introduce ACP more frequently and spend 30-60 minutes per day on the topic, 3 as compared with physicians and nurses who spend, on average, <30 minutes in these discussions. 3,6 Despite this discrepancy, HSW still feel this time is inadequate given the nuances of these conversations. 7 It is important to note that many of the preferences being outlined in ACP documents elicit specific treatment choices and may warrant the input of a medical provider for detailed explanation of complex medical options.…”