Medical Social Workers' Contributions to Cultivating Prognostic Awareness: Supporting Cognitive Understanding, Emotional Coping and Value-Based Decision Making

Background and Purpose: Prognostic awareness is central to informed, value-concordant decision-making in serious illness, yet most research has focused on physician disclosure of prognosis rather than on how patients and families come to understand, emotionally process, and respond to prognostic information over time. This leaves an important gap in the social work literature, particularly given palliative social workers’ expertise in psychosocial assessment, family systems, therapeutic communication, and trauma-informed care. This study adds to the social work knowledge base by identifying the specific skills and strategies hospital-based palliative social workers use to cultivate prognostic awareness. Guided by the Prognostic Awareness Impact Scale (PAIS), the study asked: How do palliative social workers support cognitive understanding, emotional coping, and adaptive response to serious illness prognosis?

Methods: This qualitative study used interpretive description. Semi-structured Zoom interviews were conducted with 17 Advanced Palliative and Hospice Social Work-Certified social workers practicing on hospital-based interprofessional palliative care teams across the United States. Participants were purposively recruited from the national APHSW-C registry to capture perspectives of specialist practitioners with advanced palliative care expertise. Interviews explored participants’ clinical roles, communication practices, and approaches to supporting prognostic awareness among patients and families facing life-limiting illness. Interviews were audio-recorded, transcribed verbatim, and analyzed in NVivo using a two-stage analytic process: inductive line-by-line coding followed by focused thematic analysis using the PAIS domains of cognitive understanding, emotional coping, and adaptive response as a sensitizing framework. Rigor was strengthened through team coding, iterative analytic discussion, reflexive memoing, and member checking.

Findings: Findings showed that palliative social workers contribute in distinct ways across all three PAIS domains. In cognitive understanding, participants described conducting holistic psychosocial assessments, identifying gaps and disconnects in illness understanding, translating medical language into more accessible terms, and reinforcing information about illness trajectory over time. In emotional coping, participants described assessing emotional readiness, modulating the pace and intensity of difficult conversations, recognizing trauma and psychological defenses, and creating space for patients and families to process fear, grief, and uncertainty. In adaptive response, participants described providing anticipatory guidance, supporting values-based planning, facilitating legacy work, and helping patients and families hold both hope and preparation at the same time. Across interviews, prognostic awareness was described not as a single conversation or disclosure event, but as an ongoing, relational, and emotionally mediated process. Emotional coping and adaptive response emerged as especially salient areas of social work contribution.

Conclusions and Implications: Findings suggest that prognostic awareness is best understood as interprofessional, relational work rather than physician disclosure alone. Palliative social workers play a distinct role in creating the psychosocial conditions under which prognostic information can be understood, emotionally tolerated, and integrated into coping and planning. By making these contributions more visible, this study offers actionable guidance for hospital palliative care practice, social work education, and interprofessional training, including clearer role integration of palliative social workers in serious illness communication. These changes may support more equitable, trauma-informed, and value-concordant care, particularly for patients and families navigating distress, communication barriers, and power differences in medical settings.