Psychosocial care provision for terminally ill clients in rural Australian communities: the role of social work

Introduction: Despite being one of the most avoided topics of all time, death is a guaranteed eventuality for us all. However, quality psychosocial care as death approaches is not a guarantee. Where people reside is likely to impact a person’s accessibility to quality psychological, emotional, social, spiritual and cultural support. Structural forces such as funding and resourcing will also be a contributing factor. Social workers have specific expertise in the psychosocial domain, yet enablers and inhibitors to social work referrals to support terminally ill clients in rural and remote communities have not been well explored. This study had two primary aims, 1) to investigate the provision of psychosocial care for palliative clients in rural Australian communities, and 2) to identify barriers and facilitators of social work referrals to address psychosocial concerns for palliative care clients.

Methods: Using qualitative interviews, thirty-eight rural participants were interviewed across twenty-four rural and remote communities. The researcher travelled 7,500 kilometres to conduct these interviews over a five-week period. The Rural, Remote, Metropolitan Areas (RRMA) classifications provided guidance on determining which communities would be considered regional, rural or remote communities. To explore the aims of the study, four participant groups were selected to participate in semi-structured qualitative interviews: Group 1) social workers, Group 2) community health nurses, Group 3) community workers and Group 4) palliative clients/carers. For a comprehensive analysis, it was important to not only hear the views of those addressing psychosocial needs, but also include the voices of those receiving psychosocial care, resulting in all perspectives being captured. A thematic analysis was utilised, from which prominent, recurring themes were identified to form the basis for recommendations for future psychosocial care provision.

Results: Findings revealed that psychosocial needs for terminally ill clients were addressed in an ad-hoc, inconsistent manner across the State of Queensland, Australia. Eligibility and access for Palliative Care Program (PCP) funding impacted service delivery and what support could be provided. Furthermore, social workers were limited in what they could offer due to the vast geographical distances, which inhibited quality face-to-face interventions and the capacity to address urgent psychosocial concerns. This resulted in community nurses assuming the role that social workers would usually undertake in more urban settings. In communities where a generalist social worker was employed, referrals were often impacted by the perceptions of other professionals of social work competencies. Finally, the results highlighted that a disparity exists between the perspectives of palliative care clients and their caregivers and understanding of health care professionals of what were identified as important psychosocial concerns.

Conclusions: Palliative care funding in Queensland is insufficient to effectively address the existing demand. Resourcing for rural and remote palliative care in Queensland is inadequate to ensure holistic and quality approaches to psychosocial care in the end stages of life. Increased resourcing would result in better care, for longer time frames throughout a disease trajectory. Education and training for health practitioners to address skills and competencies in psychosocial care for terminally ill clients is a recommendation for professional development. Furthermore, there is a need for social work to develop National Standards and Competencies to enhance practitioner confidence to efficiently address psychosocial concerns for terminally ill clients. Whilst this study was undertaken in Queensland, Australia, the findings are echoed in other international rural communities.