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Modules:

  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
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  • Clergy and Faith Communities
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    Back to Module 3: Whole-Patient Assessment
    Nine Dimensions

    Step 6. Social Step 7. Spiritual

    Step 6. Social

    Introduction to Social Assessment

    • Illness impacts the social aspects of life
    • Conversely, social circumstances impact illness
    • The discipline of social work should be appropriately integrated into the treatment team to assist the patient, family, and physician
    • However, outside of hospice and a few other programs, patients with serious illness do not receive comprehensive social assessment by a qualified social worker as a routine part of medical care
    • Therefore, while the physician cannot perform the work of a social worker, the physician should be able to make an initial assessment of the patient’s social needs
    • The following areas of a person’s social environment are relevant to the evaluation of suffering in the social dimension:
      • Family and family dynamics
      • Community support available to the patient
      • Financial resources available to the patient

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    Community

    • Some cultures have a more positive attitude toward care of the dying than others, but in general in the United States, there is little care offered routinely to the dying
    • A tiny percentage of life-threateningly ill patients get practical assistance from their community
    • However, services may be available and should be sought wherever possible
    • Again, social workers may know much more than the physician about a community’s resources
    • Examples of community resources may include:
      • Many religious communities from all denominations have not only a tradition of care, but also have service systems

      • There are disease-based advocacy groups that offer practical advice in some cases

      • Other local resources:

        • Library reading services
        • Work-site
        • School
        • Neighborhood
    • Physicians who take the trouble to contact, or ask a member of the team to contact, possible sources of community support may find that there is a network of care that springs up

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    Financial

    Spending Down

    • About 30% of families with a life-threateningly ill member spend a considerable portion or all of their life savings for the care of the patient
    • A similar percentage loses a major source of family income due to the illness
    • The result may be significant economic hardship

    Medical Bills

    • Patients often receive medical bills that they do not understand and cannot pay
    • Some may be reimbursed slowly, but patients who have prided themselves in keeping up with the bills may feel shame

    Family Sacrifice

    • A major source of shame and even desire to hasten death stems from the financial burden on family members
    • The desire to leave a financial legacy is strong
    • Savings for the grandchildren or for education may be spent on medical care, much to the misery of the family and the patient
    • Ask about this aspect
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