In her presentation “Whose Death Is It Anyway? How Clinical Social Workers Mitigate Conflict with Patient, Families, and Staff During End of Life,” at the Association of Oncology Social Work (AOSW) conference, Vickie Leff, Palliative Care Clinical Social Worker of Duke University Hospital (Durham, NC), observed that, at the end of life, the issues in the hospital setting usually get very complicated: family, specialists, primary team, and RNs/staff all compete for the care of the patient, whose voice is sometimes lost in the cacophony.

Seeing the Whole Picture

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These conflicts and complications are “tailor made for clinical social workers,” per Leff. “Out of chaos,” she said, “clinical social workers are the ones who see the whole picture.”  Their role is essential to the intervention, and must be asserted: “We need to step in,” she said, “and not wait to be invited.”

Using clinical skills and a big-picture approach, the clinical social worker interprets behaviors to all concerned, from family to specialists to staff, conversing with each party to reframe, give perspective, and bring closure to the inevitable “drama that can’t be fixed.”

The outcome of the clinical social worker’s efforts, as of the intervention itself, can never be precisely predicted, but the clinical social worker’s role—as problem-solver, patient-advocate, and upholder of the bio-psycho-social point of view—is always crucial to the intervention. And, finally, per Vickie Leff, clinical social workers should take the further step of writing papers and participating in research, “and not leave that to other professions.”

Do you, as a clinical social worker, have the sense of your own professionalism and the importance of your role to assert yourself in multidisciplinary endeavors, knowing that it is likely that you are the only one who can bring order to the chaos, focus to the team, and assurance to the family and patient?


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