This Learning Pathway contains a comprehensive set of training and tools to help social workers who focus primarily on supporting people with serious illness address the unique needs of patients and families. Clinical topics include assessing patient needs and concerns, understanding patients’ goals for care, addressing symptom burden, and helping patients to avoid crises and plan for the future.

Assess the Needs and Concerns of Patients

Introduction to Palliative Care for Health Professionals

An introduction to palliative care, how it is delivered, its impact on quality of life, and the growing population of patients who need it.

Revised Edmonton Symptom Assessment System (ESAS-r)

Assesses for nine symptoms experienced by patients with serious illness and quantifies their severity. Alberta Health Services.

PHQ-4 Validated Screening Tool for Anxiety and Depression

Brief (4-question) screening tool for anxiety and depression.

Psychosocial Assessment for Patients with Serious Illness

Assessment questions to help nurses understand the impact of serious illness on a patient's relationships, social and spiritual supports, financial stability, and trust in the health care system. Fast Facts, April 2020

Social Needs Screen

Assessment tool and resource list to address social risk factors.

Zarit Burden Interview (ZBI-12)

Self-reported caregiver assessment.

CAPC Palliative Care Referral Criteria

Checklist of triggers for referral to a specialty palliative care team.

Strengthen the Clinician-Patient Relationship and Understand Care Goals

Advance Care Planning Conversations

How to initiate and conduct conversations about advance care planning.

Clarifying Goals of Care

Strategies for eliciting patient goals and preferences to inform treatment decisions.

Delivering Serious News

Communicating serious clinical news to patients and families.

Discussing Prognosis

How to discuss patient prognosis in a manner that is sensitive, clear, and supportive.

Conducting a Family Meeting

Communication techniques for an effective family meeting.

Communication Phrases in Palliative Care
MEMBERS ONLY locked

Phrases to use when talking to members/patients and their families about prognosis, advance care planning, and quality of life.

Unconscious Bias: What It Is, How It Influences Health Care, and What You Can Do About It

Defines unconscious bias and how it influences patient care, and provides ways to reduce the impact of unconscious bias on care delivery.

Talking with Patients About Hospice

This resource lists step-wise tips to foster comfortable, productive dialogue for ‘the hospice conversation’.

Manage Pain and Symptoms

Course 1: Comprehensive Pain Assessment

Conducting a comprehensive pain assessment to guide safe and effective treatment.

Cognitive Assessment Tools

Recommended validated cognitive assessment tools.

Depression in Patients with Serious Illness

This online course teaches how to accurately identify and treat depression in patients living with a serious illness.

Anxiety in Patients with Serious Illness

Take this online course to learn evidence-based strategies to identify and treat anxiety in patients with a serious illness.

Prevent Crises and Help Patients Plan Ahead

Supporting Patients with Serious Illness to Plan Ahead

Considerations for clinicians, patients, and families upon diagnosis, including advance care planning, personal care needs, legal and financial planning, work and retirement planning, and prevention of common medical risks.

Reducing Risks for Older Adults

This course provides context and best practices for identifying older adults at risk for poor outcomes, including falls, delirium, and caregiving challenges.

Supporting the Family Caregiver: The Burden of Serious Illness

Assessing and supporting caregivers of people with serious illness.

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