Essential Elements: Social Workers In End-of-Life Care

Background and Purpose: Research has shown that in Euro-American culture, death is rarely a part of routine conversations (Coombs, 2017; Silverman, 2000; Talwar et al., 2011). Thus, when a loved one reaches end-of-life stages, families struggle to communicate with the dying person and with each other about important topics. Social workers, who are trained to facilitate emotion-laden conversations across diverse situations and populations, play a critical role as members of end-of-life care teams. Guided by symbolic interactionism, this study asked end-of-life care workers about the content and meaning of their role in supporting families experiencing the death of a loved one, specifically facilitating conversations about death. The value of social work training in end-of-life care work was recognized as an important component of what families and teams need at this critical time.

Methods: I conducted in-depth, semi-structured interviews via Zoom with nine end-of-life care workers, all seasoned professionals with 5 to 30 years of experience in the field. Participants, recruited via snowball sampling, had varied backgrounds, including nursing, death midwifery, volunteering, child-life, medicine, death education, and social work.

I used thematic analysis (Braun & Clarke, 2021) to identify key themes that reflected end-of-life care workers’ experiences, and the meanings they attached to those experiences. First, I read each participant’s narrative and highlighted statements that reflected their experiences and related meanings. Then I identified similar statements across transcripts and transferred them to a separate document. Finally, I read the clustered statements, seeking to understand and describe the essence of the theme, their identification of what was important about their role, and the meaning they attached to their experiences. To establish trustworthiness in my analysis, my co-investigator reviewed the clustered statements for their alignment with participant narratives. We discussed and resolved discrepancies. I also shared preliminary findings with participants to confirm their accuracy.

Results: One overarching theme emerged: Social workers are vital team members in holding space for emotional release during end-of-life care. Three subthemes surfaced: (1) social worker processes for holding space, (2) recognition of other interdisciplinary team members about the importance of social workers in holding space, and (3) the role of social workers within diverse community settings, including prisons, to assist with the holding space process.

Conclusions/Implications: This research elucidates the importance of social workers as skilled “space-holders” for dying individuals and their families who invariably grapple with emotional processes, relationship dynamics, difficult conversations, and practical challenges. Beyond medical staff training to care for the physical needs of the dying person, the emotional/relational needs of dying people and their families are also critically important. It is important for medical and insurance systems to include and pay for the services of social workers as members of end-of-life care teams.

Findings reveal ways that these professionals provide support and guidance for families at this sensitive time. This informs educational programming for families to prepare for inevitable end-of-life situations. Moreover, it inspires advocacy for hospice-related services that are available and affordable for all families to access supportive end-of-life care.