bluuebunny/crossref_metadata_2025 huggingface dataset:
Fixed-Wing and Helicopter Air Transport of ECMO Patients
Authors: Arcadipane Antonio , Martucci Gennaro
Published: March 2022

Thanks to technological advancements, extracorporeal membrane oxygenation (ECMO) through mobile systems has become a reality; therefore, the possibility of benefiting from the highest specialized support can also be offered in peripheral hospitals. After the on-site placement of cannulae, and when the patient is sufficiently stabilized, it is possible to transfer the patient on ECMO to the nearest ECMO center. This centralization of treatments is currently considered a way to improve survival. Aeromedical transport plays a fundamental role in this scenario since it has been adapted to transfer critically ill patients over large distances or in areas with inadequate road networks or geographical and infrastructural barriers. This means of transport grew out of military models into highly sophisticated and integrated civilian systems of care, using fixed-wing aircraft or helicopters that now, in theory, allow safe transport of patients and medical crews across any distance. Extensive anticipation, effective communication, and patient assessment/stabilization before and during travel are mandatory for avoiding critical events during transport. The main issues in air transport are patient movement to and from the transport vehicle, effects of altitude on membrane gas exchanges and the patient, and recognition and management of in-transport emergencies.
Heparin Anticoagulation for Transcatheter Aortic Valve Implantation on ECMO
Authors: Paternoster Gianluca , Maybauer Marc O. , Sanfilippo Filippo
Published: March 2022

Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention option for critically ill patients with cardiac and/or respiratory failure. Worldwide many medical centers started to use ECMO as a rescue treatment option when conventional therapies failed. This chapter describes conventional strategies of anticoagulation for ECMO. Indeed, during ECMO support the continuous flow and the contact between the patient’s blood and nonbiological surfaces such as cannulae or the oxygenator triggers the activation of the coagulation cascade, with formation of clots and consumption of coagulation factors and platelets, leading to peculiar alteration in the hemostasis. Therefore, the activation of coagulation pathways increases the risk of both thrombosis and hemorrhage. Unfractionated heparin remains the anticoagulant of choice for several reasons in patients supported by ECMO, among them the consolidated experience in its use, its low cost, and the presence of protamine, which can be used as an antagonist, even though its use is very rare in ECMO patients. There are different methods of monitoring the anticoagulation level while on heparin infusion for patients supported by ECMO, and among them the two most common are the activated coagulation time (ACT) and the activated partial thromboplastin time (aPTT), while the routine uses of viscoelastic tests and levels of anti-Xa activity are less common.
Bivalirudin for Alternative Anticoagulation in Heparin-Induced Thrombocytopenia During ECMO
Authors: Santonocito Cristina , Sanfilippo Filippo , Maybauer Marc O.
Published: March 2022

Systemic anticoagulation with unfractionated heparin (UFH) is most commonly used for systemic anticoagulation during extracorporeal membrane oxygenation (ECMO). However, some cases need alternative strategies of anticoagulation because the occurrence of heparin-induced thrombocytopenia (HIT) or heparin resistance (HR). The most commonly used alternative is represented by the direct thrombin inhibitor (DTI) bivalirudin, which has been increasingly used not only for ECMO anticoagulation but also during cardiopulmonary bypass (CPB) and percutaneous coronary intervention (PCI). Another option is the combined use of UFH with an antiplatelet medication that reduces platelet aggregation and risk of thrombosis in patients with HIT. This chapter describes a clinical scenario in which after 1 week of ECMO support and treatment with UFH a gradually developing thrombocytopenia was regarded causative for HIT since other causes of thrombocytopenia were not identifiable. Laboratory assays were inconclusive, and UFH was switched to bivalirudin. After prolonged ECMO support with partial recovery, a left ventricular assist device was implanted and anticoagulation with bivalirudin continued. The case discussion is followed by a critical review of the literature and multiple-choice questions, summarizing this chapter as a concise learning and study tool for the management of patients with HIT or HR during ECMO.
Argatroban for anticoagulation in pediatric and adult ECMO
Authors: Capoccia Massimo , Geli Janos , Maybauer Marc O.
Published: March 2022

Direct thrombin inhibitors (DTIs) are being proposed as potential alternatives to heparin during xtracorporeal embrane xygenation (ECMO). In view of their features, DTIs provide direct binding of circulating and clot-bound thrombin; antithrombin independence; and avoidance of heparin-induced thrombocytopenia (HIT). Argatroban is a synthetic, univalent DTI binds directly to the catalytic site of the thrombin enzyme in a reversible manner with a half-life of approximately 45 minutes. A case-based discussion argues the potential for argatroban as an alternative or primary anticoagulant during ECMO support. Bleeding and thromboembolic complications remain critical issues affecting the outcome of patients undergoing mechanical circulatory support. There is significant variability in the need for anticoagulation according to the device used. Argatroban may be a safe alternative even in the absence of HIT due to a potentially more significant platelet-preserving effect than heparin.
ECMO Transfusion and Coagulation Management
Authors: Buscher Hergen , Priyadarshini Shweta
Published: March 2022

The interaction between blood and the biomaterials of the extracorporeal circuit causes an inevitable activation of the inflammatory and coagulation cascade, potentially resulting in thromboembolic and bleeding complications. During extracorporeal membrane oxygenation (ECMO), there is a constant interaction between the circulating blood and the foreign surface of the extracorporeal circuit, which when paired with underlying conditions like sepsis and shock causes consumption of coagulation factors and subsequent hemorrhagic complications. Hence, the physiologic hemostatic balance is shifted to a unique mix of hypercoagulable and hypocoagulable states, placing patients at risk for thrombosis and bleeding at the same time. Antithrombotic therapy is necessary to suppress hemostatic activation and prevent thrombosis. Ideally, when using antithrombotic therapy for extracorporeal life support (ECLS), platelet and coagulation factor activation should be inhibited enough to minimize clot formation in the ECLS circuit while maintaining enough endogenous procoagulant activity to avoid bleeding in the patient. However, this can be a difficult balance to sustain.
Challenges of Antimicrobial Therapy in ECMO Patients
Authors: Cheng Vesa , Abdul-Aziz Mohd H. , Shekar Kiran
Published: March 2022

A variety of infections may lead to severe cardiorespiratory failure that necessitates extracorporeal membrane oxygenation (ECMO) support. Equally, infections acquired during ECMO remain a common cause of morbidity. The pathophysiologic mechanisms that predispose this critically unwell population to infections are poorly understood. In this setting, it is important that efforts should be directed at preventing infections and optimizing antimicrobial therapy both to treat underlying pathology and to minimize complications. There are no validated diagnostic criteria to assist with early diagnosis of infections on ECMO, which is a significant limitation. In addition, altered pharmacokinetics and pharmacodynamics during ECMO may lead to therapeutic failure or supratherapeutic concentrations, leading to potential toxicity. Inability to remove potentially infected ECMO catheters is also a major limitation. No specific infection prevention measures have been identified for ECMO-supported patients, and the role of prophylactic antibiotics remains a much-debated issue. This chapter aims to discuss the common challenges in relation to antimicrobial drug therapy on ECMO.
ECMO for Meconium Aspiration Syndrome
Authors: Rashed Avideh , Chapman Rachel L.
Published: March 2022

Meconium aspiration syndrome (MAS) is a major cause of respiratory distress in term and postterm infants and is one of the common etiologies for severe hypoxemic respiratory failure requiring support with extracorporeal membrane oxygenation (ECMO) in the neonate. MAS was the most common indication for ECMO support in neonates in the late 1980s and early 1990s, with excellent survival. Changes in the perinatal and postnatal management of these infants has contributed to a decreased need for ECMO in uncomplicated MAS, but ECMO maintains an important role in the support of patients with severe respiratory failure despite conventional medical management. A case is presented, followed by key questions around the pre-ECMO and ECMO management of a patient with MAS, followed by a discussion and board-style multiple-choice questions.
ECMO for the Pediatric Patient With Status Asthmaticus
Authors: Potera Renee M. , Raman Lakshmi
Published: March 2022

Asthma is a common childhood disease and is estimated to affect six million American children. Status asthmaticus is a severe presentation of asthma that is not responsive to traditional therapies. Patients requiring mechanical ventilation may experience unacceptable complication rates. Extracorporeal membrane oxygenation (ECMO) is a viable rescue option for patients with refractory status asthmaticus. The overall outcomes for pediatric patients with status asthmaticus supported with ECMO are excellent, with 88% survival. This chapter discusses the management of patients with status asthmaticus from their initial presentation to cannulation and discusses management on ECMO. Multiple-choice questions are offered at the end of the chapter to assess understanding of basic principles.
Weaning and Decannulation of Pediatric Cardiac ECMO
Authors: Brooks Bonnie A. , Berger John T.
Published: March 2022

Successful separation of a pediatric patient from extracorporeal membrane oxygenation (ECMO) support requires careful planning. The etiology of a patient’s cardiopulmonary compromise should direct the ECMO provider to develop a timeline for weaning and separation as early as the time of ECMO deployment and cannulation. This chapter reviews common methods of weaning and decannulation of pediatric patients from veno-arterial ECMO support. It also describes difficulties encountered in the weaning process, highlighting scenarios pertinent to the pediatric and pediatric cardiac surgery populations. A case discussion followed by a critical review of the literature, as well as critical care board-type, multiple-choice questions summarizing the chapter, are provided to aid the learner.
Veno-Venous ECMO for Acute Respiratory Distress Syndrome
Authors: Skendelas John P. , Jakobleff William A. , Peek Giles J.
Published: March 2022

Extracorporeal membrane oxygenation (ECMO) is an established life-supporting modality that can be used to support gas exchange while the lungs recover in patients with acute respiratory distress syndrome (ARDS) refractory to optimized mechanical ventilation. Eligible patients include those with reversible respiratory failure, usually aged less than 65 years. Ideally, ECMO should be initiated before the patient has received more than 7 days of ventilation as lung recovery can be delayed in patients who have received prolonged ventilation prior to ECMO. These benefits are only achieved through complementary use of ECMO with lung-protective ventilation strategies. Adjunctive measures such as prone positioning, short-term paralysis, liberation from sedation, treatment of pneumonia, nutrition, and mobilization are also helpful. Successful ECMO utilization requires careful patient selection and attention to the details of treatment in order to optimize outcomes and minimize risk of catastrophic complications.
ECMO in SARS-CoV-2 (COVID-19) patients
Authors: Colombo Sebastiano M. , Bassi Gianluigi Li , Grasselli Giacomo , Pesenti Antonio M. , Fraser John F.
Published: March 2022

Coronavirus disease (COVID-19) is caused by a new coronavirus strain, SARS-CoV-2. The virus originated from China in 2019, and outbreaks rapidly spread worldwide, resulting in a pandemic. COVID-19 is often complicated by life-threatening acute respiratory distress syndrome (ARDS); hence, patients require escalating support from noninvasive to invasive mechanical ventilation. In the worst cases, either veno-venous or veno-arterial extracorporeal membrane oxygenation (ECMO) can be offered to support failing lungs or heart. Given the novelty of COVID-19, some features of the virus remain yet unknown, and appropriate management is still to be fully elucidated. In this context of COVID-19 patients, there is an urgent need to characterize indications, benefits, and potential disadvantages of ECMO, which are valid at the present time and may be updated in the near future.
ECMO in Sickle Cell Disease and Acute Chest Syndrome
Authors: Al-Sawaf Othman , Kochanek Matthias
Published: March 2022

Acute chest syndrome (ACS) is a severe and life-threating complication of sickle cell disease (SCD) and the leading cause of death in adult patients with SCD. This chapter reviews the management of these patients and outlines the possible risks and benefits of the use of extracorporeal membrane oxygenation (ECMO) in the setting of SCD. Use of ECLS in patients with SCD and particularly with ACS is generally feasible and often the only life-saving option in the setting of severe acute respiratory distress syndrome. A case study from an intensive care unit is provided and discussed, together with a critical review of the currently available literature. Finally, multiple-choice questions at the end of this chapter summarize the topics covered.
ECMO for Severe Respiratory Failure Secondary to HIV Infection
Authors: Capatos Gerasimos , Maybauer Marc O.
Published: March 2022

The past decade has witnessed dramatic growth in the use of extracorporeal membrane oxygenation (ECMO) among adults. ECMO used to be a contraindication in the group of immune-deficient patients with human immunodeficiency virus (HIV). However, substantial progress has been made in both the management of HIV-infected patients with advanced antiretroviral (ARV) treatments and the field of ECMO in terms of management and equipment used. HIV-positive patients who present with acute respiratory failure due to lung infection or other syndromes, including septic and cardiogenic shock, may benefit from ECMO when considered timely after presentation with acute respiratory distress syndrome that is difficult to ventilate. Attempting to use ECMO in these patients as a last resort (salvage therapy) is often unsuccessful. A protocol including an aggressive approach such as cannulation within the first 24 hours of initiation of mechanical ventilation and aggressive ARV therapy may lead up to 68% survival. This chapter describes the pathophysiology, diagnostics, proactive management, and advanced therapies for ECMO support of HIV/AIDS patients in a case-based manner and review of the literature. Multiple-choice questions help to review and control the learning effect.
Weaning and Liberation From V-V ECMO
Authors: Rubino Antonio , Villa Giulia , Sangalli Fabio
Published: March 2022

Weaning from the extracorporeal support represents the ultimate objective of assistance. Native lung function must have recovered to a certain degree to make weaning possible, and a weaning trial is performed to ascertain the patient’s independence from extracorporeal membrane oxygenation (ECMO). This test can be performed in various ways, the common feature being a progressive increase in the respiratory workload. Once the patient has succeeded a weaning trial, decannulation can occur. This can be performed surgically or with direct decannulation, depending on the cannulation techniques and patient’s characteristics. Not all patients are ultimately weaned off ECMO. While for some patients (e.g., those bridged to lung transplant) this might be evident from the beginning, in some others the extracorporeal support can become a bridge to nowhere and futility ensues. In these patients, ECMO should be discontinued while ensuring patients’ comfort. Weaning represents a very challenging period, and even once decannulation has been obtained complications can occur, and those must be prevented and promptly treated.
Left Ventricular Venting Strategies During ECMO
Authors: Gramegna Mario , Nardi Giulia , Pappalardo Federico
Published: March 2022

Left ventricular (LV) unloading is a crucial point in the management of patients with severe LV dysfunction supported by extracorporeal membrane oxygenation (ECMO). Indeed, ECMO increases LV afterload, which may ultimately further impair or delay cardiac recovery, worsening prognosis. The choice of the proper strategy at the right time for each patient plays a fundamental role in managing these patients in the intensive care unit. Strict and accurate monitoring of the heart and hemodynamic parameters with echocardiography and pulmonary artery catheter is crucial for decision making about timing of the LV unloading and management of MCS devices, guiding either in upgrading or weaning from mechanical support. A case discussion followed by a critical review of the current literature and multiple-choice questions gives the opportunity to obtain an implementation of new concepts in the management of cardiogenic shock patients by learning more about systematic LV venting.
Mechanical Support for Postcardiotomy Right Ventricular Failure
Authors: Coco Valeria Lo , De Piero Maria E. , Kowalewski Mariusz , Raffa Giuseppe M. , Lorusso Roberto
Published: March 2022

Right ventricular failure after cardiac surgery is a complex disease that may impair the outcome after valve repair/replacement, bypass surgery, as well as left ventricular assist device implantations and heart transplant. This condition is associated with higher mortality and prolonged in-hospital stay as well as failure of the primary graft in case of cardiac transplant or of the implanted durable left ventricular assist device. Despite maximal medical management, severe right ventricular failure may at times be unresponsive to optimal pharmacological treatment and therefore could require the use of mechanical circulatory support. Several strategies have been described to assist the right ventricle in the postcardiotomy setting. New percutaneous devices, specifically designed for the right support, have been introduced into clinical practice. The minimally invasive approach by facilitated implantation and decreased incidence of complications during the mechanical cardiocirculatory support may offer improved results and ultimate outcome.
ECMO for Accidental Hypothermia and Cardiorespiratory Arrest
Authors: Bonnemain Jean , Rusca Marco , Liaudet Lucas
Published: March 2022

Accidental hypothermia (AH) is an unexpected drop of core temperature below 35°C, classified as mild (32°C–35°C), moderate (28°C–32°C) or severe (<28°C), with a spectrum of clinical manifestations ranging from signs of cold adaptation (e.g., shivering) to progressive loss of consciousness and hypothermic cardiac arrest (CA). With appropriate measures of cardiopulmonary resuscitation, external rewarming, and internal extracorporeal life support (ECLS) rewarming in properly selected patients, the prognosis of hypothermic CA is remarkably good, with reported neurologically intact survival greater than 70%. This chapter presents two illustrative cases of AH with opposite outcomes and discusses the numerous challenges in the management of severely hypothermic patients, with a specific insight into the role of extracorporeal rewarming in this setting.
ECMO for Hemorrhagic Shock After Blunt Trauma
Authors: Swol Justyna
Published: March 2022

Traumatic injuries are one of the leading causes of death and disability worldwide. They are characterized by varying occurrence and injury patterns. Trauma underlies a number of insults, including hemorrhage and organ failure. Improvements in extracorporeal life support (ECLS) devices, including centrifugal pumps and heparin-coated circuits, have progressively reduced the amount of heparin required. The rationale for using ECLS in trauma patients is to support cardiopulmonary function and provide adequate systemic perfusion, therefore avoiding consequent multiorgan failure and permitting organ recovery. Recent publications suggested that veno-venous ECLS can be feasibly offered for respiratory support in trauma-related refractory respiratory failure and severe acute respiratory distress syndrome (ARDS). Veno-arterial ECLS has emerged as a salvage intervention to restore the circulation in patients with traumatic cardiac arrest with coexisting bleeding shock. Despite the risks of anticoagulation in patients with multiple injuries, heparin-free ECLS may initially provide survival benefits.
ECMO in patients with burn and smoke inhalation injury
Authors: Maybauer Dirk M. , Maybauer Marc O.
Published: March 2022

Acute Respiratory Distress Syndrome (ARDS) is a severe complication of burn and smoke inhalation injury and is associated with high mortality rates. This chapter reviews the management of burn patients from the prehospital setting to clinical management and cannulation of Extracorporeal Membrane Oxygenation (ECMO) in the intensive care unit. ECMO can be a life-saving bridge to recovery for burn patients with pulmonary edema following excessive fluid resuscitation. A case discussion followed by a critical review of the literature and critical care board-type, multiple-choice questions summarizing this chapter as a concise learning and study tool for the management of burn patients on ECMO.
Neurologic Complications in Adult ECMO
Authors: Holzgraefe Bernhard , Kalzén Håkan
Published: March 2022

Treatment with extracorporeal membrane oxygenation (ECMO) has increased tremendously during the last decade due to high survival rates during the H1N1 2009 pandemic and positive technical development. ECMO is used in the veno-venous configuration (V-V ECMO) for pulmonary support in severe respiratory failure with preserved cardiac function or as veno-arterial ECMO (V-A ECMO) to bypass the heart and lungs during cardiac failure with or without pulmonary support. Neurological complications after critical illness occur frequently. Short-term mortality and long-term disabilities are high in patients with neurological complications. Some of these complications may be directly related to ECMO treatment (e.g., intracranial hemorrhage, stroke, and peripheral nerve lesions). This chapter presents a virtual case of a patient who presented with neurological sequelae after being treated with V-V and V-A ECMO for severe respiratory failure with circulatory complications. Diagnosis, treatment options, and possible prophylactic measures are developed through questions and answers regarding the case, followed by a discussion of the current available literature and clinical experiences. At the end of this chapter, nine review questions give the opportunity to test the learning outcome of this chapter.
Social Work and Palliative Care—The Early History
Authors: Saunders Dame Cicely
Published: March 2022

This historic reprint of an article written by Dame Cicely Saunders for the British Journal of Social Work was adapted from a talk given in 2000 to the Annual General Meeting of the Association of Hospice and Palliative Care Social Workers. It was also published in the Oxford Textbook of Palliative Social Work (2011), edited by Altilio and Otis-Green, as it highlights the influence of Saunders’ social work background in her development of the concept of “total pain,” which recognizes the need to assess and address the multidimensional aspects of human suffering if we are to improve quality of life for those facing end of life.
Social Work in Pediatric Palliative Care
Authors: Jones Barbara L. , Remke Stacy S. , Carnahan-Metzger Rachel , Phillips Farya
Published: March 2022

Social workers have long been integral to efforts to improve care for children and their families along the continuum of illness and strive to address the unique needs of children with serious illness. Pediatric palliative social workers are often in a position to assist families in identifying and addressing their greatest concerns at a time of overwhelming stress, identifying the psychosocial, social justice, and family systems variables that influence and inform their responses and needs. The social work skill sets that include person-in-context assessment, therapeutic counseling, interpersonal skills, group facilitation, and systems knowledge are of great value in pediatric palliative care teams.
Adolescents and Young Adults Living with Serious Illness
Authors: Cheung Christabel K. , Wiener Lori
Published: March 2022

Adolescents and young adults (AYAs) living with serious illness are uniquely challenged by the conundrum of possessing the cognitive capacity to understand the gravity of their illness, yet lacking skills to cope with that understanding. They are tasked with navigating transitions from childhood to adulthood that are already characterized by tremendous growth, change, and heightened vulnerability to stress. AYAs benefit from early introduction of an integrated approach to palliative social work—combining knowledge and strategies from pediatric and adult settings, with uniquely AYA interventions that reflect their sociodemographic and contextual complexity. In this chapter, we define and characterize the AYA patient care population; describe the significance of palliative social work; highlight clinical strategies and skills for working with AYAs; detail a developmentally appropriate approach to advance care planning; and conclude by discussing self-care practices for palliative social workers interested in sustaining a rewarding career, infused with personal and professional growth.
Beyond Vulnerability
Authors: Gehlert Sarah , Moro Teresa
Published: March 2022

Living with chronic and serious illness confers vulnerability for many at the time of diagnosis and for some throughout the course of the illness as functional abilities decline. Individuals with disabilities often experience worse health and more systemic barriers to accessing quality healthcare than members of the general population. In addition, many individuals with disabilities experience healthcare disparities and engage with systems ill equipped to provide them with quality healthcare. In the United States, individuals with disabilities are often underserved and are without healthcare insurance coverage, access to quality palliative care services, and the ability to pay for needed services. Social workers will engage with individuals with these and other conditions in a variety of settings and need to be prepared to adapt their practice approach based on their individual needs and advocate for policy and systems of care that maximize agency and enhance access to care.
Dying in a Foreign Land
Authors: Carrion Iraida V.
Published: March 2022

Identifying diversity among immigrants in the palliative care setting is essential. It is vital to understand the country of origin and to have an understanding of the country’s regions, customs, specific characteristics, and geographical features that facilitates engagement and interventions with immigrants and their families. The ability to identify language preferences, religious/spiritual beliefs, and health beliefs during serious illness and at the end of their lives enables communication regarding treatment decisions. Social workers need to inform patients and their family members that they will maintain their confidentiality with regard to immigration status issues. Recognizing, validating, and exploring beliefs related to truth telling is important in serious illness and end-of-life care. Additionally, immigrants’ requests for palliative treatment and their wishes concerning the place of death and burial must be proactively assessed in the context of serious illness and its impact on mixed-status families.
Palliative Social Work and Heart Failure
Authors: O’Donnell Arden , Ng Tracy
Published: March 2022

Heart failure affects the lives of millions of Americans each year and results in significant physical and psychological stressors that can negatively impact quality of life. Palliative social workers possess unique skills that can benefit patients living with heart failure by supporting increased understanding of disease and its trajectory and enhancing communication with other clinicians, as well as maximizing quality of life. This chapter provides basic education and explores common interventions used to support this patient population. Key interventions include in-depth psychosocial assessment, facilitating goals of care conversations, and addressing patient-centered concerns commonly arising as patients navigate complex decision-making that sometimes accompany this disease.
Clinical Trials and the Role of Social Work
Authors: BrintzenhofeSzoc Karlynn
Published: March 2022

Increasing the role of palliative social workers in clinical trials can improve quality of life, access to good medical care, and access to state of the art treatments. In order for social workers to have a role on clinical trial multidisciplinary teams, their knowledge base needs to include many aspects of clinical trials. This chapter includes an introduction to this knowledge. It also offers ways social workers can add value to clinical trial multidisciplinary teams in terms of helping to improve recruitment of participants (e.g., improve diversity of participants through advocacy, ensuring participants are fully informed about the decision to join or withdraw from a study). This improvement will come from bringing expertise on minimizing social injustice issues and providing psychosocial support to the team and the participants.
Palliative Social Work in the Emergency Department
Authors: Lawson Robin Rudy , Genovesi Maya
Published: March 2022

Patients with serious illness and their families go to the emergency department (ED) for acute crises with symptom management, caregiver distress, or for management of end-of-life issues. Unmet palliative care needs in the ED include clarification of advance directives, goals-of-care discussions, symptom management, and engaging with families and patients who may die in the ED. Many factors in the emergency department can influence the occurrence and success of these conversations, including provider comfort in having these conversations, availability of social work and palliative care resources, as well as the physical environment of the ED. Social workers within the context of the emergency department are uniquely positioned to build rapport and have advance care planning discussions with seriously ill patients who may also experience mental illness, substance abuse, and homelessness, and may be unlikely to access care in outpatient settings. For our most vulnerable patients, the ability of a social worker to build rapport across multiple ED visits and to outreach community partners, can improve patient autonomy and inform future treatment decisions. Both ED and palliative social workers can improve the care that seriously ill patients receive in the ED by identifying unmet palliative care needs and providing primary and specialist palliative care interventions.
Surviving the Intensive Care Unit
Authors: Laing Nina , Lewis Anna
Published: March 2022

As medical technology becomes more accessible and complex, survival from critical illness is not uncommon, and programs are evolving to meet the post–intensive care unit (ICU) needs of patients and families. Survivors of critical illness are often faced with a constellation of new or worsening physical, psychological, and cognitive disabilities known as postintensive care syndrome (PICS). Family members are also susceptible to mental health concerns as a direct result of their family member’s critical illness and ICU admission. Palliative social workers have expertise in comprehensive assessment, systems analysis, collaborative communication, supportive care, and a range of intervention techniques which inform quality care for patients and their families in the ICU, through discharge or death and, for some, posthospitalization visits to a critical illness recovery center.
Palliative Care in the Perinatal and Neonatal Setting
Authors: Leimena Meagan Lyon , Rusch Rachel
Published: March 2022

Palliative care in the perinatal and neonatal setting brings unique considerations for social workers and interdisciplinary teams. Discussions during pregnancy or following the birth of a child explore a variety of interventions, ranging from comfort-focused treatment to life-prolonging medical care provided with the concurrent intention to make meaning, build legacy, and support family values and priorities. There are myriad opportunities for joining with families to co-construct meaning, accompany them, and advocate for them and their children during some of the most tender and intense times of their family trajectory. Attunement to family systems, culture, race and ethnicity, spiritual and religious beliefs, community support, language, and continual advancements in medical care creates opportunity for comprehensive palliative care support throughout a child’s life or into bereavement.
Palliative and Hospice Care for Incarcerated Persons
Authors: Supiano Katherine P. , Boudreaux Jamey
Published: March 2022

The United States (US) correctional system has experienced an exponential rise in the number of aging and chronically ill incarcerated persons, many of whom will die while incarcerated. This changing demographic necessitates the implementation of evidence-based, interdisciplinary hospice and palliative care within corrections facilities. Social workers practicing in prisons must be knowledgeable about palliative care philosophy and practices and skilled in delivering palliative care within the institutional policies and culture of corrections. This requires the balancing of the corrections goal of maintaining public safety with the provision of humane person-centered care. Effective and compassionate end-of-life care in correctional facilities is congruent with social work values, and it may be transformative for hospice inmate patients, hospice inmate volunteers, corrections staff, and criminal justice institutions.
Palliative Care in Long-Term Care Facilities
Authors: Bern-Klug Mercedes , Carter Kara A. , Simons Kelsey
Published: March 2022

The provision of palliative care in nursing homes is consistent with aims to improve residents’ quality of life, in part by making the setting more person-centered. After discussing long-term care and more specifically nursing home care in the United States, this chapter describes the important role nursing home social workers play in anticipating, assessing, and addressing the palliative care concerns of residents, including social work involvement in palliative psychosocial assessment, care planning, group work, and upholding of resident rights. National Association of Social Workers (NASW) standards for the provision of social work services in long-term care settings are discussed as well as more recent work to articulate social work competencies in this area. The chapter concludes with a call to focus on palliative care in nursing homes as a way to improve the quality of life for all residents.
Palliative Social Work in Rural Communities
Authors: Washington Karla T. , Lero Christine M.
Published: March 2022

Palliative social work in rural communities supports seriously ill patients and their families in the places they call home, from remote rural Alaskan fishing villages to small Appalachian mountain towns and countless locations in between. Social work’s person-in-environment perspective provides a useful lens for understanding the biopsychosocial and spiritual realities of living with serious illness and enables an in-depth understanding of how those realities are shaped by rural ways of life. Providing access to high-quality palliative care in rural communities remains a pressing challenge for social workers, as does ensuring that care is responsive to the unique values, preferences, and experiences of rural patients and their families. Social work leadership is needed across the full practice continuum in rural palliative care as social workers harness community strengths to provide patient- and family-centered care.
Palliative Social Work
Authors: Hunt Jennifer , Maasdorp Valerie
Published: March 2022

Africa comprises 54 diverse countries with multiple cultures, tribes, races, and faith systems representing approximately 15% of the world’s population. Palliative care was introduced in 1979 in Zimbabwe and has expanded rapidly across the continent. Specific issues facing Africa, such as poverty, political and economic instability, the interface of traditional/Western medicine approaches, and a wide array of religious/spiritual belief systems, result in widely diverse evolutions of palliative care services. Although there is still limited development, there has been a significant increase in the number of hospice and palliative care services in several countries.
Culture-Sensitive Palliative Social Work with Chinese Populations
Authors: Cheng Ming Ming , Chan Cecilia Lai Wan
Published: March 2022

Chinese people are typically family oriented with strong intergenerational obligations and often regard discussion of death as a taboo. Palliative social workers carefully assess the needs of patients as well as those of the extended family network in situations of critical and serious illness. It is important for social workers to be sensitive to the Chinese cultural norms and expectations in order to effectively foster communication related to the evolution of serious illness and advance care planning among patients and family members. This chapter introduces a palliative social work intervention (LET Go) framework: Living fully despite illness, Empowering family, Transforming loss, so that patient can Go in peace. The LET Go framework focuses on person-centered holistic care that stress capacity building for the patient and family.
Palliative Social Work in Switzerland
Authors: Berthod Marc-Antoine , Probst-Barroso Laetitia
Published: March 2022

Palliative care has gained strength and recognition in Switzerland in the past decade. Within a well-organized and effective health system, improvements have been made to facilitate access to palliative care for specific groups (migrant communities, persons with disabilities, children and youth). While social workers are contributing to these improvements, they still lack specialized education in this field and need to become more aware of the fact that palliative care not only concerns end-of-life and death issues but also must follow the entire continuum of life. Moreover, the possibility in Switzerland to request suicide assistance, mainly provided by associations at the persons’ home but also, less frequently, within institutional or hospital contexts, contributes to the openness of the public debate on death and end of life. This possibility may nevertheless represent a challenge to palliative care workers when they are confronted with such a request.
Families and Family Conferencing
Authors: Fineberg Iris Cohen
Published: March 2022

The importance of family becomes magnified at times of serious illness, when people must grapple not only with the illness experience but also with facing end of life. The importance of family remains central regardless of family configuration or degree of presence. Social workers’ language and behaviors signal respect and support for diverse family variations. This chapter discusses the concept and complexity of family, family assessment, and common challenges for families in the palliative care context. The importance of attention to families’ nuanced experiences of culture, discrimination, and loss is punctuated. Information about communication and conducting interprofessional family conferences is presented. As members of interprofessional healthcare teams, social workers must articulate, model, and apply their expertise to advocate for and optimize family care experiences, recognizing their significance for bereavement.
Family Caregivers in Palliative Care
Authors: Glajchen Myra , Wilkins Christine
Published: March 2022

Family caregivers are essential to the overall care and well-being of individuals with chronic and serious illness. As important partners in healthcare, caregivers provide critical assistance to ill relatives, caring for their day-to-day needs, assisting with decision-making, assessing symptoms, administering medications, and providing companionship. Palliative care teams recognize the importance of family caregivers in care planning. The palliative social worker is uniquely trained in caregiver assessment with the requisite skills to directly address caregiver needs, promote coping, link caregivers with community resources, and provide continuity and support throughout the illness trajectory. This chapter provides an overview of caregivers in the United States, including policy developments and needs during the COVID-19 pandemic. Caregiver assessment is discussed using the framework of the National Consensus Project domains. A wide range of social work interventions are shared. The chapter ends with a call to action in the areas of clinical social work, research, and education.
Mental Health Risk in Palliative Care
Authors: Walsh Katherine , Hedlund Susan
Published: March 2022

Disease-modifying treatment and medical advancements have extended life expectancy for those with serious or chronic illnesses, and providers and insurers have recognized that patients and families may live for long periods of time with debilitating symptoms, side effects, and psychosocial distress. These may create or exacerbate risks for mental health conditions that can impede medical care. These risks must be accurately assessed if they are to be treated effectively. Social workers play an integral role as the primary mental health providers on palliative care teams. Training in biopsychosocial assessment, including assessing for symptoms that represent the diagnostic criteria for mental disorders, equips social workers to collaborate with the interdisciplinary team and provide therapeutic interventions to address these. This chapter utilizes a review of the literature and a case narrative to illustrate the complexity of assessment and the importance of a multifaceted team approach to the care of patients and families experiencing distress.
Advance Directives from a Social Work Perspective
Authors: Bullock-Johnson Ramona , Bullock Karen
Published: March 2022

A review of the literature since the year 2000 erases all doubt about the increasing cultural, racial, ethnic, and religious diversity of the United States, which has ushered in demographic trends that lead to complex sociocultural care dynamics and the likelihood that our patients’ values may not be concordant with those of traditional Western-based medicine. Palliative social workers face the challenge of implementing and evaluating healthcare practices and approaches that effectively and respectfully meet the demands of diverse populations in need of serious illness care. Moreover, care for diverse patients and families with life-limiting illness is compromised when there is a lack of understanding about culturally bound treatment preferences and or distrust for the healthcare system. This chapter recommends cultural competence in advance care planning as a means for equipping social workers with the tools needed to engage individuals and family members in conversations early and increase the utilization of advance directives among diverse populations.
Meaning-Centered Therapies
Authors: Nichols Jordan
Published: March 2022

Meaning-centered therapies include evidence-based interventions that provide accessible, structured approaches to address existential distress in people with serious illnesses. In palliative care settings, we often meet patients and their families as they realize a disconnect from that which gives meaning, worth, and purpose to their lives. These losses frequently result in demoralization, increased symptom burden, a desire for hastened death, and a multitude of other physiological and psychosocial sequelae. Informed by existential thinkers, spiritual practices, and human wisdom, meaning-centered therapies help patients focus on recapturing, creating, experiencing, and maintaining a sense of meaning while living with advanced illness and when approaching end of life.
Supportive Counseling
Authors: Cooper William Michael
Published: March 2022

Supportive counseling, founded by Carl Rogers, is a therapeutic intervention that focuses on the relationship between the counselor and the client. Rogers asserted that psychological change for the client could only happen in relationship regardless of the therapeutic intervention, school, or approach of the therapist. He defines six “necessary and sufficient conditions” for therapeutic change. The therapist strives to incorporate unconditional positive regard and empathic understanding as they explore and reflect the client’s subjective view of self in relationship to their ideal self. This chapter describes the background and efficacy of supportive counseling with a review of core concepts, evidence base in the literature, and practical applications of supportive counseling in palliative care.
Hospice and Palliative Social Work’s Ethical Challenge
Authors: Schroepfer Tracy , Goldberg Jaime , Wladkowski Stephanie
Published: March 2022

This chapter explores the timely and multifaceted controversy surrounding the legalization of aid in dying (AID) in the United States, highlighting the clinical and ethical implications for hospice and palliative social workers. Though the debate about AID continues, legislation in several states has passed in the last decade with more pending. Currently, hospice and palliative social workers, along with their team members, are navigating the legal, ethical, and clinical complexities of this issue. This chapter examines the often value-laden terminology used in describing AID, current state AID laws and proposed legislation, professional organizations’ positions on AID, and agency and organizational policies and procedures related to AID. Ethical issues faced by social workers, particularly in relation to inequities and disparities in AID, and their preparedness to contend with AID in their practice are discussed. Implications for practice, policy, and research are provided.
Advancing the Social Work Profession within Palliative Care
Authors: Cagle John G.
Published: March 2022

This chapter serves as an introduction to the Professional Issues section of the Text. It highlights the growth of the palliative social work profession and its essential role within palliative care teams. While many laudable accomplishments have helped to advance the field in recent decades, much exciting and important work remains to address gaps in the research base and pervasive social inequities.
The Influence of Policy on End-of-Life and Palliative Care
Authors: Kusmaul Nancy
Published: March 2022

End-of-life and palliative care in the United States is influenced by a web of policies that impact access to—and payment for—curative, life-extending, and comfort-based treatments. This chapter examines three specific sets of policies: Medicare Part A and its influence on access to curative, restorative, and hospice services; the Patient Self-Determination Act and its role, and related policies in healthcare decision-making; and state-specific policies that allow access to medical aid in dying for people who meet specific criteria. The chapter concludes with an overall view of the ways social workers and other healthcare workers can influence policy to eradicate barriers and enhance care along the continuum of illness and at end of life.