Improving social work in intensive care unit palliative care: results of a quality improvement intervention.

OBJECTIVE The intensive care unit (ICU) is a focal point for decision making in end-of-life care. Social workers are involved in providing this care for patients and families. Our goal was to examine the social worker component of an intervention to improve interdisciplinary palliative care in the ICU. METHODS The study took place at a 350-bed hospital with 65 ICU beds. We surveyed family members and social workers caring for patients who died in the ICU or within 30 hours of transfer from ICU. Clustered regression was used to assess the effect of the intervention on three outcomes: (1) families' satisfaction with social work, (2) social workers' reported palliative and supportive activities, and (3) social workers' satisfaction with meeting family needs. RESULTS Of 590 eligible patients, 275 families completed surveys (response rate, 47%). Thirty-five social workers received 353 questionnaires concerning 353 unique patients and completed 283 (response rate, 80%). Social workers reported significant increase in the total number of activities for family members after the intervention. Some of the activities included addressing spiritual or religious needs, discussing disagreement among the family, and assuring family the patient would be kept comfortable. Neither social workers' satisfaction with meeting families' needs nor family ratings of social workers were higher after the intervention. Increased social worker experience and smaller social worker caseload were both associated with increased family satisfaction with social work. DISCUSSION The increase in social worker-reported activities supports the value of the interdisciplinary intervention, but we did not demonstrate improvements in other outcomes. Increased social-worker experience and decreased social worker caseload were independently associated with better family ratings of social workers suggesting future directions for interventions to improve care by social workers. Future studies will need more powerful interventions or more sensitive outcome measures to document improvements in family-assessed outcomes.

[1]  Alison Snow,et al.  The Increase of Treatment Options at the End of Life: Impact on the Social Work Role in an Inpatient Hospital Setting , 2008, Social work in health care.

[2]  Fofi Constantinidou,et al.  The interdisciplinary team. , 2008, The Journal of head trauma rehabilitation.

[3]  J. Curtis,et al.  Integrating palliative and critical care: evaluation of a quality-improvement intervention. , 2008, American journal of respiratory and critical care medicine.

[4]  S. Otis‐Green,et al.  Applying the National Quality Forum Preferred Practices for Palliative and Hospice Care: A Social Work Perspective , 2008, Journal of social work in end-of-life & palliative care.

[5]  J. Curtis,et al.  Social workers in palliative care: assessing activities and barriers in the intensive care unit. , 2007, Journal of palliative medicine.

[6]  B. Souweine,et al.  A communication strategy and brochure for relatives of patients dying in the ICU. , 2007, The New England journal of medicine.

[7]  D. Heyland,et al.  Refinement, scoring, and validation of the Family Satisfaction in the Intensive Care Unit (FS‐ICU) survey* , 2007, Critical care medicine.

[8]  M. Levy,et al.  End-of-life care in the intensive care unit: state of the art in 2006. , 2006, Critical care medicine.

[9]  G. Rubenfeld,et al.  Integrating palliative and critical care: Description of an intervention , 2006, Critical care medicine.

[10]  Joan Berzoff,et al.  Innovative Models for Developing Post-Masters Curriculum in End-of-Life Care , 2005 .

[11]  K. Walsh-Burke,et al.  Professional Social Work Education in End-of-Life Care , 2005, Journal of social work in end-of-life & palliative care.

[12]  G. Christ,et al.  A national agenda for social work research in palliative and end-of-life care. , 2005, Journal of palliative medicine.

[13]  E. Salas,et al.  An Integrated Model of Training Evaluation and Effectiveness , 2004 .

[14]  Amber E Barnato,et al.  Use of intensive care at the end of life in the United States: An epidemiologic study* , 2004, Critical care medicine.

[15]  P. Bijttebier,et al.  Needs and Feelings of Anxiety of Relatives of Patients Hospitalized in Intensive Care Units , 2002, Social work in health care.

[16]  C. Barnabe,et al.  A Needs Assessment for Southern Manitoba Physicians for Palliative Care Education , 2002, Journal of palliative care.

[17]  J. le Gall,et al.  Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity , 2001, Critical care medicine.

[18]  D L Patrick,et al.  The family conference as a focus to improve communication about end-of-life care in the intensive care unit: opportunities for improvement. , 2001, Critical care medicine.

[19]  E. Csikai,et al.  Health Care Social Workers' Views of Ethical Issues, Practice, and Policy in End-of-Life Care , 2001, Social work in health care.

[20]  K. Subramanian.  The Nature of Social Work Services in a Large Public Medical Center Serving an Impoverished Multicultural Population , 2000, Social work in health care.

[21]  G. Christ,et al.  Advancing Social Work Practice in End-of-Life Care , 2000, Social work in health care.

[22]  W. Breitbart,et al.  Measuring desire for death among patients with HIV/AIDS: the schedule of attitudes toward hastened death. , 1999, The American journal of psychiatry.

[23]  J. Luce,et al.  A national survey of end-of-life care for critically ill patients. , 1998, American journal of respiratory and critical care medicine.

[24]  J. Luce.  Making decisions about the forgoing of life-sustaining therapy. , 1997, American journal of respiratory and critical care medicine.

[25]  G. Auslander,et al.  Clients' views of social work services in the hospital setting in Israel. , 1996, Social work in health care.