OCCUPATIONAL SUMMARY
The Palliative Care Social Worker (PCSW) Provides intensive psychosocial therapeutic support services to palliative care patients and families to help meet social, emotional and financial needs related to the impact of a chronic or terminal illness, grief, and loss.
PRIMARY DUTIES AND RESPONSIBILITIES
- Psychosocial assessment and support:
- Palliative Care Social Worker (PCSW) will perform a comprehensive patient and family biopsychosocial-spiritual assessment.
- Counseling:
- PCSW will engage with patient and family to facilitate trust, rapport, and communication.
- PCSW will provide brief supportive counseling, referral for crisis intervention, or refer to therapeutic supports as needed to the patient, family group or individual family members.
- Treatment Plan:
PCSW will develop a treatment plan based on the assessment, incorporating
counseling referral, advance care planning, and educational components as
needed.
- Advance care planning:
PCSW will act as liaison to promote discussion between the patient, family, and medical team, in order to facilitate understanding of the patient’s medical condition and treatment options, and to establish clear, patient-centered goals of care and care plans.
- Education:
PCSW will provide education and guidance to the patient, family and care team members pertaining to palliative and end-of-life care.
- Referral:
PCSW will refer the patient and family to appropriate supports and resources
- Advocacy:
PCSW will play a unique role in advocating for the patient and family to ensure respect for patient autonomy and to maximize the safety of the patient’s care plan.
- Disposition:
- If a palliative care consultation is requested and the patient and family opt for a palliative care meeting, the PCSW will make recommendations for care plan and disposition, and will remain available to unit SW, team, patient and family for ongoing consultation while the palliative care team is an active consult
- If a Palliative Care Team consultation is requested and the patient and family opt against a palliative care plan (e.g. curative treatment or other ‘aggressive’ care, which may include acute rehabilitation, dialysis, surgery, or long-term care at a ventilator facility following placement of tracheotomy and feeding tube), the PCSW will sign off on the case and remain available for re-consultation.
- Palliative Care Team participation
PCSW will act as part of the larger Palliative Care Team, communicating clearly and effectively with other team members to provide quality patient and family care, meet individual patient and family members care needs, and achieve appropriate palliative care plans.