Social workers in palliative care: assessing activities and barriers in the intensive care unit

Social workers are playing an increasingly important role in providing palliative care to dying patients and their families in the intensive care unit (ICU). The purpose of this study was to determine which activities social workers provided to families of patients who die in the ICU, what barriers to care social workers identified, and whether these activities and barriers were associated with the social workers' satisfaction with the care provided to family members. The study took place at a 350-bed hospital with 65 ICU beds. We examined hospital records and identified 253 consecutive eligible patients who had died in an ICU between August 2003 and March 2004. Of these, 157 (62%) received social work services from one or more social workers. One hundred and seventy-eight questionnaires were sent to 27 social workers; 20 social workers completed 150 questionnaires for 136 patients giving a response rate of 84% for questionnaires sent to social workers (150/178). A multiple regression model with clustering under social workers was used to analyze the data. Talking about the family's feelings and providing support for decisions made by the family were the most frequent activities provided by social workers; both were positively associated with the social workers' satisfaction with meeting families' needs. A heavy patient caseload was one of the most common barriers to care identified by social workers. In conclusion, we identified specific activities and barriers that, if targeted, might improve social workers' abilities to meet a family's needs and we also provided some preliminary evidence for the reliability and validity of questionnaires designed to assess these constructs.