Psychosocial Care: an Important Element of Palliative Care

Death is a universal experience, and yet how we live until the time of our death is embedded in the unique manifestations of each of our cultural and social worlds. As the need for palliative care around the world is increasingly recognized as an essential component of health care services, corresponding attention must be paid to social work and the role of psychosocial care within the palliative care team.

Psychosocial care is an integral component of the support systems provided to people, families and communities at the end of life. Advocacy, assessment, counseling, education, resourcing and ethical problem-solving are key functions of psychosocial care providers working in this context. Social workers, counselors, volunteers and spiritual care providers all play a vital role in the interprofessional health care teams endeavoring to provide holistic support and respond to the diverse needs of patients, families and communities.

The INCTR PAX program has been collaborating with our international colleagues in a number of areas around psychosocial care. Two of these initiatives are highlighted here.

Psychosocial Needs Assessment

In December 2006 a brief questionnaire was distributed to oncology and palliative care teams in Nepal to facilitate knowledge and understanding of the status of psychosocial care services in the region.

The questionnaire focused on three key areas:

(1) Current provision of psychosocial care

(2) Barriers and issues faced by patients, families and health care providers

(3) Health care provider educational needs.

Ten respondents from four facilities in the Katmandu Valley provided feedback. Respondents included nurses and physicians that serve both pediatric and adult populations.

The psychosocial needs expressed by respondents, although situated in the cultural and social contexts of Nepal, are familiar to the end-of-life needs of people, communities and health care teams in many regions of the world. Coping with the life changes that illness and disease present – pain, distress, anxiety, isolation, the need for connection and meaning, financial barriers and spiritual / existential explorations are universal concerns for psychosocial care providers worldwide.

For some facilities, more often than not, it is nurses and physicians who are routinely providing this aspect of care. While attention is paid to the psychosocial needs of patients and families, increasing caseloads, limited time and limited resources (financial, human, policy or otherwise) continue to present challenges in providing psychosocial care exclusively through physicians and nurses.

Respondents to the questionnaire highlighted the importance of continued psychosocial education and training opportunities for health care professionals in areas such as assessment and counseling skills. Although some centers have a dedicated social worker or volunteers to support patients and families, there is an expressed need to have access to trained personnel who can facilitate the ongoing multidimensional care needs of patients and families throughout the illness continuum, including bereavement support.

INCTR PAX will continue collaborating with colleagues in Nepal towards strengthening capacity in this essential area of palliative care and the valuable feedback received from the questionnaire will inform these efforts.

Doug Ennals,
Social Work Consultant, INCTR PAX Program