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Verbal Cues in Palliative Care

Healthcare social workers are frequently called upon to support and counsel patients and family caregivers in distress and help them piece together a web of resources to address care needs and social determinants of health.

The National Association of Social Workers’ identifies the following as “core functions” of social work in healthcare:

  • Psychosocial Assessment—assessment, goal planning, evaluation, intervention
  • Resource Management—financial counseling, coordinating/developing/maintaining community resources
  • Continuity of Care Planning—admission diversion, discharge planning, transitions
  • Psychosocial Interventions—counseling, adaptation to illness/loss, support groups, end of life issues, advance directives
  • Crisis Intervention—life span violence, neglect, trauma, new life altering diseases
  • Health Education—patient/family, interdisciplinary training, community education
  • Interdisciplinary Collaboration—advocacy, teamwork, leadership, consultation/liaison/ institutional/community committees.[i]

Competency in these functions is critically important to ensure social workers are able to support those in their care. Palliative social workers integrate these skills within the context of advanced, serious or chronic illness.

Shirley Otis-Green, MSW, ACSW, LCSW, OSW-C, co-editor of the Oxford Textbook of Palliative Social Work, believes that quality palliative care education is needed to increase the awareness of health professionals to the individual needs of each patient and family. “To provide quality culturally-nuanced, person-centered and family-focused care professionals have to have a robust understanding of the impact of illness on each individual if we are to deliver interventions that are most likely be helpful. Palliative care education teaches professionals to be more attuned to the verbal and non-verbal clues that patients and family caregivers give regarding their values and concerns so that providers can better address the multidimensional ways that they are suffering.”

The Awareness Test Video

Shirley uses a simple YouTube video to demonstrate the impact that such a shift in awareness may have. The Awareness Test video shows a group of people passing a basketball and asks you to count the number of passes that one group of players makes. While watching and counting, viewers typically miss an obvious event that happens on the court. After the sequence, the narrator points out this event and then plays the scene again. Watching it again, you can’t not see it – it’s so very obvious.

As Shirley points out, “The video is a nice metaphor for demonstrating the importance of an interprofessional approach to care. Each provider in the room with the patient or family performs their function while with a patient – focused on technically doing their job, but in the midst of that interaction, may miss something that is really important. We each have “different eyes” and are trained to see different things. We need each other so that we won’t miss what’s most important to that particular patient and family at this particular moment in time.”

Ask The Right Questions

Palliative care teams — physicians, nurses, social workers, chaplains, aides, techs, physical therapists, pharmacists and volunteers – need specialized training to see those clues. Yet palliative care specialists will never see all of the patients with advanced illness. “That’s why educating all staff in generalist palliative care skills is so important. Once you’ve been trained to ask the right questions and listen for the clues your awareness changes,” Shirley states.

Learn more about Shirley Otis-Green at her website:

[i] Certified Social Worker in Health Care

The CSU Shiley Institute for Palliative Care offers a program that teaches many of these critical skills in it’s online course: Critical Palliative Care Skills. This course teaches the essential skills that every social worker needs to know. If your career involves even occasional involvement with palliative care, then you’ll find this engaging and interactive course an ideal way to build your confidence and keep your knowledge and skills up to date.

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