Seeking Public Comments by March 31, 2025 for Serious Illness: Palliative and End of Life Care

Very comprehensive of the social worker role in serious illness and palliative care. Thank you for bringing together well respected social workers to complete this effort. I worked in pediatric palliative care for 22 years as a social worker and bereavement coordinator.

Nancy Carst, MSW, LISW-S, CT, APHSW-C

Hello,
My colleagues and I would like to sincerely thank the NASW Task Force for preparing and drafting this amazing document on NASW Standards for Practice in Serious Illness: Palliative and Hospice Social Work.

Working firsthand with physicians to improve their access to palliative care, we recognize that having such practice standards in place is crucial. After sharing the document with fellow social workers and colleagues at my placement, we collectively want to suggest a few enhancements to refine the wording.

We recommend including “advanced practice providers, chaplains, and other essential team members” on page 6, lines 95–96, with the intention that “advanced practice providers” refers to nurse practitioners (NPs) and physician assistants (PAs).

Our second recommendation is to eliminate the word “competence” on page 15, line 173. Instead, we suggest shifting to “Cultural Humility and Accountability” (or “Cultural Sensitivity and Accountability”). The term “cultural competence” emphasizes knowledge and skills about different cultures, implying a level of mastery that can be achieved. However, the alternative wording encourages continuous learning and curiosity rather than suggesting a point at which learning is complete. This change would also better align with language used later in the document, specifically on page 35, line 625.

We also wanted to bring to your attention that the NASW Standards and Indicators for Cultural Competence (2015) may warrant updating due to these same language considerations.

Additionally, on page 17, line 215, we suggest adding “advanced practice providers” to the core palliative care team.

Another recommendation is for page 22, under the heading “Ethical Responsibilities to Colleagues”. This section was incredibly in-depth and critical to include, as our responsibilities to colleagues are often overlooked. We recommend adding specific language about the need to keep colleagues updated regarding new information shared by the patient/caregiver(s) and to collaborate and communicate frequently as the patient’s care evolves.

Lastly, we deeply appreciated and honored the section on “Interprofessional Teams” on page 33, which highlights the importance of recognizing biased and potentially harmful language and modeling reframed language for the team and/or caregivers.

Thank you for considering our comments and recommendations for this document. We hope they are helpful!
Have a great day!

Best,
Hana Kisswani, BSW Student Representative,

The only addition I might consider is screening for financial exploitation and elder abuse. I didn’t see this explicitly mentioned, but I wonder if there’s a correlation between elder abuse, financial exploitation, and marginalized populations. I bring this up as a potential area for further exploration. I hope this suggestion is helpful in some way—overall, I think the document is fantastic!
Warm regards,
Amanda Jones, LCSW-S (Texas)

Limited Practice Examples

The NASW Standards document establishes a strong theoretical framework for palliative and hospice social work, but it would be far more effective with the addition of real-world examples. While the document thoroughly outlines guiding principles and ethical standards, much of it remains theoretical. Without concrete applications, social workers may find it challenging to translate these standards into their daily practice.

Currently, the document presents fundamental frameworks and ethical considerations, yet it does not illustrate how these principles apply in practice. Standard 3 on cultural and linguistic competence emphasizes the importance of cultural awareness in end-of-life care, but it lacks practical examples of how social workers might approach these situations. Without context, practitioners may struggle to implement these principles effectively, especially in culturally diverse settings.

The Value of Practical Examples

Adding real-world case examples would enhance the document's usefulness by:

1. Bridging Theory and Practice – Showing how abstract concepts translate into real-world decision-making.
2. Providing Actionable Guidance – Giving practitioners clear models for applying standards in different contexts.
3. Demonstrating Complex Problem-Solving – Showcasing how multiple ethical considerations intersect in real-life scenarios.
4. Supporting Different Learning Styles – Offering concrete examples for those who learn best through experiential or visual methods.

Suggestions for Improvement:

1. Adding brief illustrative case studies showing how specific standards apply in real-world situations, for example:
• Handling an ethical dilemma where a patient's advance directive conflicts with their family's cultural beliefs.

2. Including examples that break down the thought process behind ethical and professional decision-making, for instance:
• A case where a social worker must balance a patient's autonomy with family expectations in end-of-life care.

3. Having scenarios that illustrate how multiple NASW standards work together in real cases, for example:
• A palliative care social worker balancing cultural competency, ethical considerations, and advocacy in an end-of-life scenario.

4. Providing practical applications tailored to different care environments, for instance:
• Hospital-based palliative care – Addressing family conflicts over treatment options.
• Home hospice – Helping caregivers manage a loved one's end-of-life needs at home.
• Rural settings – Working with patients who have limited access to healthcare.
• Urban settings – Navigating diverse linguistic and cultural needs.

Respectfully,
Pedro Hernandez, MS, MSW, PhD (Mississippi)