Dona J. Reese

Interdisciplinary Approaches to Assisting with End-of-life Care and Decision Making

The importance of interdisciplinary care for patients and families facing the end of life is examined. Descriptions of varying forms of team functioning are provided with an emphasis on the characteristics of high-functioning interdisciplinary teams. The value of empowering the patient and family to direct the care they receive from their team is emphasized. Interdisciplinary team interventions in end-of-life care focus on the biopsychosocial and spiritual dimensions of human experience and facilitate growth and development in the last phase of life. Despite its great promise for improving patient care, the interdisciplinary model is not—with the exception of hospice care—widely implemented in todays health care system. The contributions of interdisciplinary teams to end-of-life care can be enhanced through the development of interdisciplinary team training programs, the creation of payment structures that support the interdisciplinary team model, and continuing research assessing the dynamics of team functioning and the benefits that interdisciplinary team care provides to patients and families near the end of life.

Psychosocial and Spiritual Care in Hospice: Differences Between Nursing, Social Work, and Clergy

A chart review of the most recent home visits from nursing, social work, and clergy to 37 home hospice patients indicated that all but two psychosocial and spiritual issues examined were addressed by hospice staff on home visits. Spirituality and, secondly, death anxiety were the most frequently discussed variables. Clergy addressed more spiritual issues than the other two professions, and social work addressed more psychosocial issues than the other two professions. These findings underscore the important roles that clergy and social work play on the hospice team, and imply that hospice should make a renewed commitment to psychosocial and spiritual care.

Programmatic barriers to providing culturally competent end-of-life care

Despite many efforts to increase access to end-of-life care, culturally diverse groups are still not being served. Interviews of 22 hospice and palliative care program directors in one southeastern state indicated that directors overestimated how well programs are doing in meeting the needs of diverse groups but were very interested in implementing cultural diversity training for their staff. Those who were more concerned about such issues had recruited more diverse volunteers into their programs. The presence of diverse staff or volunteers predicted a more diverse patient population. A number of efforts were underway to develop cultural competence and provide culturally competent care. Several directors reported no efforts in this direction, however. Directors described programmatic barriers and resources needed. The authors concluded that directors should provide leadership in their agencies in welcoming diversity. Implications for further research and work within the larger end-of-life care field are discussed.

Addressing spirituality in hospice: Current practices and a proposed role for transpersonal social work

Summary Despite evidence of the importance of spirituality to terminally ill patients, the social work profession has developed few curriculum materials, practice models, or research on this topic. This chapter presents theoretical and empirical support for the proposition that transition to the transegoic stage of consciousness can promote a comfortable death for hospice patients and that hospice social workers should address spiritual issues in order to assist terminally ill patients and their families in making this transition. It also presents the results of a national survey describing and testing the effectiveness of some current social work approaches to addressing spirituality in hospice. Implications for practice and social work education are explored.

The Role of Primary Caregiver Denial in Inpatient Placement During Home Hospice Care

ABSTRACT This study conducted with a sample of 68 home hospice patients revealed that primary caregivers in denial of the patient’s terminality were more likely to place hospice patients in inpatient treatment. Moreover, patients placed in inpatient settings were more likely to die there, rather than at home as planned. These findings suggest an impact of primary caregiver denial upon patient self-determination, and indicate the importance of addressing denial in counseling with primary caregivers of terminally ill patients. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com  ]