Social Workers' Perspectives on and Participation in Decisions Regarding Life-Sustaining Treatment

Abstract

Background: The decision-making process regarding life-sustaining treatments (LST) for patients, particularly the elderly, involves ethical and emotional complexities. Social workers, as key members of interdisciplinary healthcare teams, contribute a psychosocial perspective that influences these decisions. However, research on social workers' attitudes, beliefs, and participation in LST decision-making remains limited, despite their significant role in advocating for patient autonomy and family involvement. This study aims to explore social workers' views on LST, factors influencing their attitudes, and their involvement in the decision-making process.
Methods: A cross-sectional survey was conducted with 61 social workers from healthcare facilities across the nation. Participants provided their views on the use of three LSTs—mechanical ventilation, artificial tube feeding, and cardiopulmonary resuscitation (CPR)—in hypothetical scenarios involving an 80-year-old patient with metastatic cancer, irreversible mental illness, or irreversible physical state. Additionally, social workers’ perceptions of their role in the decision-making process and their level of involvement in discussions about LST preferences were assessed.
Results: Social workers were more willing to use artificial tube feeding than mechanical ventilation or CPR. Their attitudes toward LST varied depending on the patient's condition, with the least support for LST in metastatic cancer cases. Stronger religious beliefs were associated with a greater inclination to use LST. Social workers expressed strong support for their involvement in LST decisions but reported low levels of active participation in these discussions with patients and families.
Conclusion: Social workers are crucial in the LST decision-making process, particularly in ensuring that patients' wishes and family preferences are considered. However, the study highlights a gap between social workers' emotional preparedness and their active participation in clinical decisions. Further training and integration into interdisciplinary teams are necessary to enhance their involvement and improve patient-centered care in end-of-life decisions.