Education: A Complex and Empowering Social Work Intervention at the End of Life (Report‪)‬

As in most practice environments, social workers in health care settings often assume the responsibility of providing information to patients and family members. This is particularly important when patients and their families are coping with the prospects of a life-threatening diagnosis (Adler, 1989; Deja, 2006). The role of educator seems a suitable one for practitioners because the effective exchange of reliable information promotes client empowerment and self-determination (for example, Bern-Klug, 2004; Lee, 1996). Unfortunately, social workers and other health care providers frequently undervalue education (Christ & Sormanti, 1999; Rabow, Hauser, & Adams, 2004), overlooking its complexity and viewing it as a simple, nontherapeutic, and, perhaps, mundane task (Makoul, 2003). Skill and compassion are needed to convey salient health-related information when patients and families are trying to understand what it means to face a life-threatening illness (Csikai & Bass, 2000; Rabow et al., 2004; Rose, 1999). Furthermore, research suggests that many social workers feel underprepared to provide patient and family education on end-of-life issues (Christ & Sormanti, 1999; Csikai & Bass, 2000; Kovacs & Bronstein, 1999). As Kubler-Ross (1969) wrote in On Death and Dying, "The question is not should we tell ...? but rather 'How do I share this with my patient?'" (p. 28). A deeper appreciation of how information is exchanged between practitioners and clients is important because, at some point in their practice, most health care social workers will encounter end-of-life issues (Csikai & Bass, 2000). Whether they work in a dialysis clinic, rehabilitation center, extended care facility, hospice, or hospital, social workers will likely come across patients who are coping with life-threatening health conditions. These illnesses may be recently diagnosed--marking the beginning of the end of life--or may be in the later stages. Social workers should be knowledgeable not only about what informational content is needed, but also about the inherent complexities and barriers involved in the education process. Otherwise, a well-meaning practitioner might unknowingly undermine patient self-determination and empowerment or might neglect key contextual factors that influence how information is processed and understood.