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CAPC Palliative Care Discussion Forum
Social Workers in Palliative Care Settings

Next Reply: Re:Barriers to Palliative Care/hospice referrals
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Post Barriers to Palliative Care/hospice referrals
Author: wenbergm
Date: Jul 10, 2012 3:30 pm
I would love social work input on the "urban legends" and reasons physicians and other healthcare professionals give as to why they won't order an inpatient Palliative Care referral. I'd also love the same legends/reasons why physicians won't order hospice when we know it is appropriate and would be helpful for the patient/family.

I look forward to your input. It will help me prepare for my presentation 11/1/12 at the IHPC annual conference in Des Moines. Hope to see you ALL there! Marcy
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Re:Barriers to Palliative Care/hospice referrals (by Lustbader on 07/10/2012)
Hi Marcy,

You raise excellent points about physician barriers which prevent patients with advanced illness from getting the palliative care they need and want.

It is not "urban legend" but in fact "cold truth" that physicians lack sufficient training in having effective conversations about advanced illness or hospice care with patients and their caregivers. It isn't just ordering hospice, but rather a series of thoughtful conversations over time as the disease progresses. Sadly many clinicians lack skills and time to do this well.

The key is to develop a trained workforce (docs, social workers, nurses) of professionals who can provide generalist level palliative care before the patient is hospititalized. Proactive, rather than reactive.

Dana Lustbader MD
Re:Barriers to Palliative Care/hospice referrals (by StacyRemke on 07/11/2012)
Maybe we could start with observations? In addition to the comments posted on the lack of training that physicians receive, I think there are a lot of politics involved, and perhaps as many reasons for the failure to refer and / or communicate as there are individual docs. However, I often notice well intentioned physicians have a lack of information about what palliative care is and does. Also, there are essentially "turf" issues at play, as well as a genuine desire to take care of their patients and so a reluctance to refer on. The CAPC Public Opinion Survey documents some of these issues well. As a social worker, it is difficult to observe different practices among physicians, and different outcomes for pts and families, and not be in a position to advocate freely for best practices, and open referrals, even information sharing with families on many occassions, without risking the rancor of physician colleagues. This becomes an ethical issue for us, too, I think.

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