For me, a social worker working from a community based setting; assessment is an essential aspect of social work. Assessment guides our intervention, and is also an important step in identifying how different members of a family system are affected by the problem. Within the realms of palliative care, there is that additional step to explore further how the patient is emotionally and physically affected by the terminal illness. There is also a need to understand the experiences and need of the caregivers in the family who are inextricably linked to the patient.
Having used systemic lenses to assess my cases in the community, a bio-psychosocial assessment is a perspective that fits well with me when trying to make sense of the needs of patients in palliative care. Tools such as the Genogram, Ecomap, and Problem Timeline are useful in understanding how the various systems interact with the family, to better understand the impact of the illness on the family’s emotional, cognitive, physical and financial functioning. Erickson’s life cycle development stages, as well Carter and McGoldrick’s family life cycle model are also useful concepts to explore how families and individuals are meeting (or not meeting) their development needs at any given point in time.
After experiencing the palliative care classes, as well as the agency visit at the National Cancer Centre, two important aspects of assessment stood out for me. The first was the need to also understand the illnesses that patients face, and the interface of this chronic illness with the family life cycle. The second, was the need for pain assessment, where not only physical pain is assessed, but also pain the realms of the emotional, psychological, and social.
The first aspect is something that I feel social workers in the community may take for granted, not being as closely linked to the medical setting as medical social workers are. Many times I may have tended to categorize a plethora of different illnesses under the label “chronic illness”, without fully understanding the impact of these medical issues at the various stages of the illness development. When it came to issues such as cancer or kidney failure, I realized that there is a need to also understand the various stages of the illnesses, and the immediate and potential impact these developments in the illnesses would have on the life cycle needs of the family. For example, there may be different issues facing a patient who may be suffering from stage 2 cancer, as opposed to one facing stage 4 cancer. The patient at stage 2 may still have strong hope and resilience towards fighting the disease, as opposed to the same patient at stage 4, who may be overwhelmed by the disappointment of treatment failure, and may be depressed over the likelihood that he may be approaching the end of his life.
John Rolland (1987) discussed a conceptual framework towards understanding the interface of chronic illness with the family life cycle, which would be an important tool towards having a common language across the medical and community based settings. Adding this framework to my own understanding of life cycle theories, would help me gain a better understanding of how the illness affects psychosocial development. Such information is also important for me to interface with the medical social workers and doctors in the hospital, for example, if we were to conduct case conferences to discuss care options and assessments to support the needs of the patient in the community.
The second aspect of Pain assessment and subsequent management is another factor that Social Workers in the field may need to take note of when working with clients with palliative needs. As social workers, we strive towards increasing the quality of life for our patients, and for patients facing end-of-life issues; pain management plays a crucial role. Assessing our patients’ pain is also important for the caregiver as well.
Some time ago, my wife suffered pains in her abdomen caused by kidney stones. During the period where she was in extreme pain, I was at a loss of what I could do to alleviate her situation. I observed that it had gotten so bad to the point where I wished that I could take the pain away and even share it with her. As I stood by her side in the hospital, I was able to obtain information about how sharp the pain was, and where it was on her body. Such information was useful in relaying to the doctor who would be able to assist in providing medication to alleviate the pain, especially if my wife was not able to articulate her needs when the doctor came to treat her.
At that moment, having information from the doctor about her situation and how the medication would assist her, was important information for both patient and caregiver. As social workers in the community, we should strive to have regular contact with the medical setting and correspond with the medical social workers and the doctors in order to obtain information about the illness that may assist in reducing the stress the patient faces, and also alleviates the worries held by their family members.
After the whole episode, I realized how pain issues could also be traumatic for patients’ caregivers, and that as social workers we would also need to process their experiences in caring for their family member who has a chronic illness. I also realized that, although we may not be able to take away our family member’s physical pain, caregivers are able to do things to support them through the pain, which can be simple pragmatic things such as assisting them with food or helping to move them about the house, or providing emotional support by being by their side and using touch (for e.g. holding hands) to be with them through the crisis.
The experiences of taking a module in palliative care during my Masters course in university has brought about a renewed awakening of the needs of patients in palliative care, not only within the medical setting, but also extremely relevant for me as a social worker in the community. I feel that such knowledge is pertinent for social workers in the generalist setting who would have had experience working with clients facing end-of-life issues. Being able to assess such cases with knowledge of their illness life cycle, as well as skills in understanding pain management, would support a better quality of life for our clients, in line with the mission of the social work profession.
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