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Table 4 Summary of research themes in the included studies

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

Themes Major findings
Attitudes toward the use of ACP • 98% of social workers had positive attitudes regarding the use of ADs [37].
• 97% of social workers identified themselves as being responsible for discussing ADs on admission [42].
• 62% of social workers stated they had a role in EoL planning [39].
• 45% of social workers agreed that social work discipline is best suited to discussing ADs with residents and family members [42].
• 52–71% of social workers agreed that they are responsible for talking with patients and participating in the process of decision making regarding LSTs [22].
• 72% of social work students in the US indicated that they felt comfortable discussing the topic of death [11].
• 41% of social workers in South Korea felt comfortable with death discussion [19].
• Social workers and nurses had generally positive attitudes toward the HCP, but social workers had higher attitude scores than nurses [45].
• Social workers in health and aging had significantly higher positive attitude scores than those not in health and aging [35].
• Those employed in nursing homes and hospice settings had more positive attitudes than did those working in other health care facilities [37].
Knowledge, education & training regarding ACP • 82% of social workers had a high to moderate level of knowledge about ADs; those with more experience working with the elderly had higher levels of knowledge [37].
• 57% of social work students were knowledgeable about living wills [36].
• For health care social workers, 88.8% had training in EoL care issues, compared with 53.2% in other social workers, and 78.3% indicated that they received EoL care training in continuing education programs [35].
• 60% of social worker assistants said that they receive no training regarding ADs, although 53% said they have recently received training on the POLST [24].
• A substantial proportion of respondents (1–75%) did not correctly answered relevant “true/false” questions about LST [42].
• Social workers as a group reported lower levels of satisfaction with AD laws and systems than nurses and other professionals [47].
• 73% of social workers in South Korea reported no knowledge of ADs [19].
Involvement in ACP Findings related to ADs
• 96% of the respondents reported that social workers in their department are conducting ACP discussions with patients/families [44].
• 80% of the respondents reported that social workers are responsible for educating patients and/or families about ACP options [44].
• 93% of social workers said they often or always educate families about ADs [43].
• 68% of the respondents reported that social workers are responsible for documenting ACP [44].
• 85.6% of the respondents stated that social workers are completing the care plan form, while 49% of the physicians and 25% of the social workers said that physicians are involved in completing the care plan form [48].
• 90% of social workers said that they often or always provided written information regarding ADs to newly admitted residents and family members (a PSDA requirement) [42].
• 93% of social workers said they are often or always involved in care planning for residents with dementia [43].
• One third of social workers stated that they 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 [24].
• 73% of social worker assistants stated that they have conversations about AD during care meetings [24].
• 31.2% of social workers reported never or almost never being involved in asking patients about their wishes [22].
• 40% of social workers indicated that they provide a facility-specific form to residents regarding ADs, and additional 40% noted that no AD forms are provided at all [24].
• 55.3% of the social workers (in South Korea) had experience aiding elderly patients and/or family members by providing information about ADs [20].
• 83.3% of the social workers (in South Korea) reported that they did not have any experience working with terminally ill patients; only 2.8% reported that they had ever provided AD planning [19].
• The area in which social workers reported being more involved was activities related to family members [22].
• 64% of social workers indicated that they had direct responsibility in discussing ADs with patients’ families [47].
• 52% of social workers reported spending 0.5-1 h daily in their AD communication practices with hospitalized elderly patients and their families, and 82% of them reported that the time they spent in AD communications was inadequate [41].
• Compared to physicians and nurses, social workers spent more time daily in their AD communication practices with hospitalized elderly patients [46].
Findings related to HCP
• 72.3% of health care social workers had completed a HCP, compared with 48.8% of other social workers [35].
• 44% of social workers stated they are very often involved in discussing the HCP with clients, and 37.3% are very often involved in counseling clients regarding HCPs [39].
• Almost 25% of social workers 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 [39].
Social workers’ roles in interdisciplinary health care teams • 100% of MSWs and 82.4% of doctors considered ACP discussions as part of their role, but only 37.1% of nurses thought likewise [21].
• 72.5% of social workers rated education as an important role and 31.5% said that facilitating decision making was an important role for them in EoL planning [39]
• In Singapore, 53.9% of MSWs occasionally or never discussed ACP with their patients compared to 66.6% of physicians and 90% of the nurses. Of those who discussed ACP with their patients, 90% of MSWs and 82% of the physicians initiated the discussions themselves compared to 18.6% of nurses [21].
• Social workers reported consistently stronger beliefs than nurses regarding their role with patients and family members in the decision-making process [23].
• Compared with physicians and nurses, MSWs appeared to be the most confident in conducting ACP discussions [21].
• Nurses acknowledged particular expertise among social workers as good communicators, and social workers perceived nurses’ primary role with patient [26].
• Social workers reported being more involved in discussions with patients and family members, whereas nurses reported being more involved in the daily care of terminally ill patients [23].
• For nurses, ADs were addressed routinely with almost all of their patients through institutional admission procedures and routine nursing care. Social workers’ AD communication practices were limited to patients encountered through screening or referrals that typically did not originate for ACP purposes [26].
• Social workers indicated an awareness of their roles as advocates in promoting the content of the patient’s wishes with family members and health care providers [26].
Ethical issues related to the use of ACP • 97% of social worker students indicated that self-determination is a very important principle in social work practice [11].
• 75% of social worker students answered that they would be troubled if problems of self-determination resulted in conflicts [11].
• 77% of social workers said they often or always were involved in conflict resolution with families [43].
• Nearly 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 [24].
• 72% of social workers reported that they helped families clarify their thoughts about LST choices [42].
• 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 [25].
• Social workers working in hospitals were more likely to report encountering patient and family conflict regarding treatment decisions, difficulty in communicating with the patient and family and lack of adequate guidance from the medical staff [47].
• Continued communication with all parties involved was key in resolving ethical problems [25].
  1. ACP advance care planning, AD advance directive, HCP health care proxy, LST life-sustaining treatment, MSWs medical social workers, POLST physician’s order for life-sustaining treatment