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Table 1 Summary of descriptive studies that included a sample of only social workers

From: Social workers’ involvement in advance care planning: a systematic narrative review

Study (country) Objective Design Participants N Major findings
Han, 2016 [20] (South Korea) To examine social workers’ understanding of a patient’s right to EoL care decisions in long-term care facilities A cross-sectional survey A non-probability sample of social workers in long-term care facilities. 297 1. 55.3% of the respondents had experience aiding elderly patients and/or family members by providing information about ADs.
2. Social workers’ understanding of a patient’s right to EoL care decisions was associated with their general and medical knowledge of ADs, experience in EOL care, and relevant training.
Kwon & Kolomer, 2016 [19] (South Korea) To examine social workers’ awareness & attitudes toward EoL care planning A cross-sectional survey A non-probability sample of gerontological or geriatric social workers 246 1. 73% of the social workers reported no knowledge of ADs.
2. 22% had education or training in EOL issues.
3. 83.3% reported that they did not have any experience working with terminally ill patients.
4. 41.1% felt comfortable with death discussion in general, and 26.8% felt comfortable in having a discussion about death with older clients.
5. Social workers who emphasized self-determination, professed a preference for hospice care, and were comfortable discussing death were more likely to have a positive attitude to ACP.
Stein et al., 2016 [44] (USA) To explore social worker involvement and leadership in ACP conversations with patients and families A cross-sectional, web-based survey Social workers employed in hospice, palliative care, and related settings 641 1. 96% of the respondents reported that social workers in their department conducted ACP discussions with patients/families.
2. 80% of the respondents reported that social workers were responsible for educating patients and/or families about ACP options.
3. 68% of the respondents reported that social workers were responsible for documenting ACP.
4. Compared with those at other care settings, oncology and inpatient palliative care social workers were less likely to be responsible for ensuring that patients/families are informed of ACP options and documenting ACP preferences.
Kwon et al., 2014 [11] (USA) To examine the attitudes of social work students toward EoL care planning, A cross-sectional survey A cluster sample of social work students at a school 102 1. 72% of the participants indicated that they felt comfortable discussing the topic of death.
2. 97% indicated that self-determination is a very important principle in social work practice.
3. 75% answered that they would be troubled if problems of self-determination resulted in conflicts.
4. Positive attitudes toward ACP were associated with higher levels of comfort when discussing death, more emphasis on self-determination, and apprehension of conflicts of self-determination.
Sherwood, 2012 [24] (USA) To explorer the knowledge and attitudes of social service workers’ in nursing homes regarding the preparation of ADs. Qualitative interviews A purposive sample of 15 social work assistants came from 11 facilities. 15 1. 60% of the respondents said that they receive no training regarding ADs, although 53% said they have recently received training on the POLST.
2. One third of the respondents stated that social workers initiate the AD conversation, 33% said that nurses initiate the AD conversation, and others said that AD conversation is done at admission or during care planning meeting with family members.
3. 73% stated that they have conversations about AD during care meetings.
4. 40% indicated that they provide a facility-specific form to residents regarding ADs, and additional 40% noted that no AD forms are provided at all.
5. All respondents indicated a situation they had once dealt with where the family requests something different from what is written on the patient’s ADs.
Gutheil & Heyman, 2011 [35] (USA) To examine social workers’ attitudes toward EoL planning A cross-sectional survey Randomly selected social workers (response rate: 42%) 844 1. Social workers in health and aging had significantly higher positive attitude scores than those not in health and aging.
2. For social workers in health and aging, 72.3% had completed a HCP, compared with 48.8% in other than health and aging.
3. For social workers in health and aging, 88.8% had training in EoL care issues, compared with 53.2% in other than health and aging.
4. For social workers in health and aging, 78.3% indicated that they received EoL care training in continuing education programs.
Peck, 2009 [38] (USA) To examine the extent to which the death anxiety of oncology social workers impacts the completion of personal ADs, and their communication about ADs with patients. A cross-sectional survey A random sample of oncology social workers (response rate: 25%) 114 1. 68% of the respondents reported having completed a personal AD.
2. Motivating factors for personal AD completion included professional experience, peace of mind, control over decisions, and the desire to not have family members make decisions.
3. As death anxiety scores increased, the communication scores decreased related to disclosure of information about ADs (to patients) and values in living.
4. There was no significant difference in death anxiety scores between social workers who had completed and those who had not completed an AD.
Heyman & Gutheil, 2006 [39] (USA) To examine the factors associated with social workers’ involvement in EoL planning. A cross-sectional survey A random sample of NASW members in health and aging (response rate: 63%) 390 1. 62% of the respondents stated they had a role in EoL planning.
2. 72.5% rated education as an important role and 31.5% said that facilitating decision making was an important role for them in EoL planning.
3. 75% felt that physicians saw social workers as having a role in work with EoL planning.
4. 44% stated they are very often involved in discussing the HCP with clients, and 37.3% stated they are very often involved in counseling clients regarding HCPs.
5. Almost 25% stated that they were very often involved in receiving requests from other professionals to explain HCP, and 23.8% stated they were very often involved in completing HCPs.
6. Factors that predicted social workers’ involvement with the HCP included age, attitudes, perceptions of barriers, and perceived physician support.
Lacey, 2006 [42] (USA) To describe nursing home social services staff roles and perceptions related to EoL medical decision making for nursing home residents in end-stage dementia. A cross-sectional survey A convenient sample of nursing home social workers. 138 1. 97% identified themselves as being responsible for discussing ADs on admission.
2. 90% said that they often or always provided written information to newly admitted residents and family members (a PSDA requirement).
3. 72% said that they helped families clarify their thoughts about LST choices.
4. 45% agreed or strongly agreed that social work discipline is best suited to discussing ADs with residents and family members.
5. A substantial proportion of respondents (1–75%) did not correctly answered relevant “true/false” questions about LST.
Black, 2005a [40] (USA) To examine social workers’ personal death attitudes and experiences in relation to their ADs communication practice behavior. A cross-sectional survey A cluster sample of social workers employed at 6 hospitals (response rate: 94%) 29 1. 38% of the respondents reported recent experience with terminal illness; 48% reported recent death of a close friend or a family member.
2. Social workers with either fearful or avoidant death attitudes collaborated less frequently with other professionals about ADs, compared to practitioners with neutral death attitudes.
3. Social workers reporting recent personal experiences with terminal illness differed from practitioners without personal experiences by less frequent collaboration with others, initiation of the topic of AD, and disclosure of information regarding AD.
Lacey, 2005 [43] (USA) To discuss the responses of nursing home social workers regarding their perceived use of skills related to ACP for nursing home residents. A cross-sectional survey A convenient sample of nursing home social workers. 138 1. 93% of the respondents said they often or always educate families about ADs.
2. 93% said they are often or always involved in care planning for residents with dementia.
3. 77% said they often or always were involved in conflict resolution with families.
4. 58% reported often or always educate staff about ADs.
5. 55% reported they often or always engaged in developing a more professional role for social workers in their respective facilities.
Black, 2004 [41] (USA) To describe social workers’ AD communication practices with hospitalized elderly patients A cross-sectional survey A cluster sample of social workers employed at 6 hospitals (response rate: 94%) 29 1. Social workers frequently and comprehensively address the phases of the AD communication process in their practices with hospitalized elderly patients.
2. 52% of the social workers reported spending between 0.5 h and one hour daily in their AD communication practices with hospitalized elderly patients.
3. While 19% of the social workers believed that they were spending a sufficient amount of time discussing ADs, 82% reported that the time they spent in AD communications was inadequate.
Csikai et al., 2004 [25] (USA) To identify ethical problems in EoL care decision making faced by oncology social workers Qualitative interviews Hospital social workers 12 1. Common ethical issues identified through thematic analysis included preservation of patients’ autonomy/self-determination, beneficence of health care providers, and medical futility of end-of-life treatments.
2. Continued communication with all parties involved was key in resolving ethical problems. Referrals to ethics committees or ethics consultation teams occurred for more complex cases.
3. Although they viewed the development of relevant guidelines as desirable, many indicated there would be numerous barriers to their implementation.
Heyman & Gutheil, 2003 [36] (USA) To examine the attitudes of entry-level MSW students toward end-of-life planning and the factors associated with these attitudes. A cross-sectional survey A cluster sample of MSW students (response rate: 64%) 267 1. 57% of the respondents were knowledgeable about living wills.
2. Attitudes toward end-of-life planning was significantly correlated with age, knowledge, personal comfort with end-of-life discussions, and personal desire for treatment.
Werner & Carmel, 2001 [22] (Israel) to examine the involvement, beliefs, and knowledge of social workers in health care settings in the process of making decisions regarding LSTs. A cross-sectional survey A convenience sample of social workers 68 1. 31.2% of the social workers (in Israel) reported never or almost never being involved in asking patients about their wishes.
2. Social workers’ involvement in decision making regarding LST were negatively associated with their perceptions regarding physicians’ involvement and positively associated with higher exposure to terminal patients.
3. Most participants (52 to 71%) agreed with different statements regarding social workers’ responsibility for talking with patients and participating in the process of decision making regarding LSTs.
4. The area in which social workers reported being more involved were activities related to family members. The extent of social workers’ involvement was related to their beliefs regarding their role and their knowledge about LSTs.
Baker, 2000 [37] (USA) To describe the knowledge and attitudes of health care social workers regarding ADs. A cross-sectional survey A systematic random sample of social workers (response rate: 65%) 324 1. 98% of the respondents had positive attitudes regarding the use of ADs.
2. 82% had a high to moderate level of knowledge about ADs.
3. Those with more experience working with the elderly had higher levels of knowledge.
4. Those employed in nursing homes and hospice settings had more positive attitudes than did those working in other health care facilities.
  1. ACP advance care planning, AD advance directive, EoL end-of-life, HCP health care proxy, NASW National Association of Social Workers, POLST Physician’s Order for Life Sustaining Treatment, PSDA Patient Self-Determination Act, SD standard deviation