DISCUSSION OVERVIEW
Hospice services were created out of a need to provide ongoing care for the terminally ill who are no longer responding to traditional medical treatment for their illness. The focus is on having quality of life for the time they have left to live. Hospice services provide physical, emotional, and spiritual support to both the patient and their family/caregivers wherever they are living. Services are delivered by a specialized team of health care professionals to provide comfort and dignity to patients in their last days of life. Medical social workers are an integral part of any hospice team. The burden of working with individuals at the end-of-life can be significant for members of a hospice team who are confronted with death on a daily basis. Hospice social workers, in particular, must be mindful of issues of secondary trauma and should continually practice self-care.
Palliative care refers to specialized medical care that focuses on providing relief from physical symptoms and improving the quality of life of patients and caregivers. Palliative care can be provided to patients with any medical condition at any stage of illness to relieve symptoms. It can be a patients primary treatment (which is often the case with end-of-life care), or it can be provided in combination with standard medical treatments. Palliative care team members work alongside a patients medical team and can include professionals from multiple disciplines including doctors, nurses, social workers, and chaplains.
First sanctioned in 1976, advance directives (ADs) were designed to provide patients the opportunity to control treatment decisions when they may not be able to articulate their wishes. An advance directive (AD) also helps to ease the burden of decisions for family members during time of crisis or loss. All 50 states and the District of Columbia have legislation that authorizes the use of instructional ADs (such as living wills), the appointment of a health care surrogate, or both; however, there remain some contentions about advance directives.
Medical social workers play an integral role as support for patients and their families at the end of a patients life. Many physicians are not trained on how to handle the emotional responses of patients and their families at the end-of-life. More often than not, medical social workers are the principal health care professionals involved in educating, mediating, and coordinating end-of-life plans. In this capacity, medical social workers are charged with informing patients and their families about end-of-life decisions and providing counseling around these issues. Medical social workers must understand the terminology, technology, and legal issues that can dictate end-of-life care.
To prepare for this discussion, review the resources from this week and respond to the case.
Case Study:
Roger is a 53-year-old, homosexual male who has been undergoing treatment for lung cancer. He was admitted to the hospital for severe pain following a radiation treatment yesterday. The oncologist informs Roger and his life partner that his recent CT scan shows the cancer has metastasized to his bones and lymph nodes, and there is no chance that his condition will improve with further treatment. The physician recommends hospice services and writes an order for a hospice consult. Roger sensed this was coming, but his life partner is distraught and not accepting of his prognosis. The medical social worker is asked to visit the patient and his partner to discuss hospice services and to provide emotional support.
Please use all the resources provided
1) Post to Discussion Board your response to the following:
a) Discuss your feelings and thoughts about the emotionally intense work of managing patients during end-of-life care. Is this an area you see yourself working during your career?
b) Discuss the fundamental roles of social workers in helping patients facing end-of-life. What are two of the roles they would serve?
c) Provide an explanation of how you as a medical social worker would handle the case you selected and the services/information you might offer to the family within the applicable laws of your scope of practice.
