Exploring social work practice patterns of advance care planning conversations across Ontario: a pilot study

Advance care planning (ACP) is a communication process whereby capable individuals can express, discuss, and document their thoughts, values, and wishes as they relate to their future health care. ACP conversations are now widely recognized as a critical part of providing person centered, holistic care to patients at all points in their health-care journey. Social workers (SW) are uniquely situated to lead these important conversations. A cross-sectional online survey was made available to all registered wocial workers in Ontario, Canada, through the Ontario College of Social Workers and Social Service Workers (OCSWSSW) to explore practice characteristics as they relate to ACP conversations (n = 159). The research team sought to identify similarities and differences in ACP conversations with social workers practicing within Ontario and to answer what social workers' practice patterns are when engaging in ACP conversations in hospital and community settings. We aimed to examine contextual and respondent characteristics (practice setting, years of experience) and ACP training with view to apply results to make training, onboarding, and practice recommendations for ACP conversations for clinicians and trainees. Eligible social workers had access to the survey via the OCSWSSW website. Participants were also contacted via e-mail through professional associations, including the Ontario Association of Social Workers and invited to participate. The survey instrument, created by the research team, included three stages of design and testing. Results of the survey indicated that hospital social workers were significantly more likely to report participation in ACP conversations compared to those working in a non-hospital setting (56.5% versus 20.8%, respectively, p < 0.001, two-sided Fisher's exact test). There was also a significant association between having received ACP training and reporting participation in ACP conversations in practice setting (p < 0.001, two-sided Fisher's exact test). Specifically, 48.8% of those who received ACP training reported engaging in ACP conversations in comparison to 27.9% who did not receive any ACP training. Thematic analysis of responses also indicated the importance of patient and family readiness as a critical factor in practicing ACP. Future research should look to examine types of ACP training and its impact on ACP practice, the role of ACP for community social workers, and specific approaches for supporting patients and families at different stages of readiness for these important conversations.