March 16, 2022

World Social Work Day, observed on 15^th March 2022, aims to bring attention to the importance of social workers and their efforts to support vulnerable families and communities. It celebrates their achievements and raises awareness of the contributions of the social services sector.

In ‘Social Work in Palliative and Hospice Care’ (Medical Social Work in Singapore, 2020), Assistant Professor Lee Geok Ling (NUS Social Work) and Miss Tan Ching Yee (HCA Hospice Care) examine the various elements of medical social work in palliative and hospice care and investigate the competencies required of Singapore’s medical social workers to provide dignified and quality end-of-life care in our hospices and hospitals.

Palliative care refers to a concept of care that adopts a holistic model that addresses the physical, psychological, social, and spiritual needs of terminally ill patients. At this stage, the focus of interventions shifts from treating the illness and postponing death to ensuring that the patient is treated with compassion, respect, and dignity. In addition, palliative care differentiates itself as a form of care by also focusing on the needs of the patient’s family. Palliative care’s holistic approach highlights the importance of the work medical social workers do when providing end-of-life care.

The palliative care movement in Singapore started in 1985. Over the years, the movement has gained traction on our shores. From its humble beginnings at St. Joseph’s Home in 1985, the country has strengthened its palliative care capabilities with the construction of several hospices and community hospitals and dedicated palliative care teams and consultants.

Patients under palliative care suffer from a range of problems that extend beyond the physical domain. In addition to fears of physical suffering and diminished independence, patients are confronted with anxieties of an unpredictable future, and a search for meaning and transcendence. While support from the patient’s family is encouraged, family members often do not have the capabilities to attend to the varied nature of the problems palliative care patients are confronted with.

Medical social workers in palliative care are required to address the different aspects of a patient’s care. These social workers focus on providing patients with a sense of control, autonomy, and identity, and ensuring that the patients and their families experience a good death.

Interestingly, the authors point out that patients and family members differ in their expectations of a ‘good death’. Patients preferred a quick death with little suffering while families preferred to have the chance to say their final goodbyes. This highlights the expectations of medical social workers in palliative care. These social workers are expected to navigate the relationships between patient and family, facilitate communication between medical staff and family members, and exercise ethical decision-making while providing end-of-life care.

These challenges are made more complex with the ongoing COVID-19 pandemic with patients delaying their decision to seek hospital admission for fear of having less time to spend with family members and their significant others because of movement restrictions and tightened visitor policies.

The authors highlight the complexity of the role of medical social workers in palliative care. Although these professionals often consider it a privilege to be able to journey with their patients, being a caretaker presents a myriad of physical, psychological, and emotional challenges. The authors advocate for a stronger support system to care for the well-being of these social workers.

Read the chapter here!