Multilevel Barriers and Facilitators of Social Work Practice in Palliative Cancer Care

BackgroundPalliative care is an essential component of high-quality cancer care; however, limited research has examined the multilevel barriers to and facilitators of social workers' ability to deliver palliative care for patients with cancer. Guided by ecological systems theory, this qualitative study identifies such barriers and facilitators perceived by social workers providing palliative cancer care in the United States.MethodsUsing an exploratory qualitative design, we conducted semi-structured Zoom interviews with 10 social workers practicing in palliative cancer care settings. We identified themes in participant responses using reflective thematic analysis and interpreted those themes within an ecological systems framework.ResultsParticipants identified barriers and facilitators across societal, organizational, interpersonal, and individual levels. Societal barriers included stigma, misunderstandings about palliative care, and financial constraints, whereas integration into care teams and continuity across care settings facilitated coordinated care. Organizational barriers included excessive workload demands and delayed referrals; social workers' community connections facilitated enhanced resource access and care coordination. Interpersonal barriers centered on unclear role delineation, while interprofessional collaboration, proactive role education, and positive patient experiences strengthened social work practice in palliative care settings. At the individual level, insufficient role preparation and administrative burden constrained patient-centered care; however, a strong sense of professional meaning and clinical competence supported social workers' practice in these settings.ConclusionEnhancing role clarity, palliative care education, interprofessional collaboration, and organizational support may strengthen social workers' integration within palliative care settings and advance person- and family-centered cancer care.