Palliative Care Social Work Interventions and Co-occurring Outcomes: A Six-Year Descriptive Cohort

Area of Science:

• Palliative Care
• Social Work
• Health Informatics

Background:

• Palliative care social workers (PCSWs) provide essential patient, family, and team support.
• Routine, structured documentation of PCSW interventions and outcomes is currently lacking.

Purpose of the Study:

• To categorize documented PCSW interventions and outcomes using a structured electronic health record (EHR) flowsheet.
• To analyze variations in documentation across teams and between initial and aggregated visits.
• To identify cases involving staff or team de-escalation.

Main Methods:

• Retrospective analysis of 4,993 adult palliative care consultations (November 2019 - December 2025).
• Development of intervention and outcome categories by consensus among six PCSWs.
• Statistical analysis of patient-level co-occurrences using odds ratios (ORs) and false discovery rate (FDR) correction, with sensitivity analyses for team stratification and first-visit data.

Main Results:

• Over 18,560 interventions and 8,877 outcomes were documented for 3,287 patients.
• Significant co-occurrences included team discussions leading to care focus changes (OR 10.66) and avoidance of invasive interventions (OR 10.35), and family counseling associated with improved coping (OR 7.55).
• Staff de-escalation was documented in 21.8% of patients but varied significantly across teams.

Conclusions:

• Structured EHR flowsheet documentation effectively captures reproducible intervention-outcome patterns at scale.
• Consistent patterns across teams and initial encounters suggest potential as quality indicators or staffing benchmarks.
• Further multisite psychometric and prospective research is needed due to limitations in current data collection methods.