Assessing for Barriers Prior to Advance Directive Execution: A Descriptive Study of Social Work Practice Behaviors

Existing research indicates that social workers are active, interdisciplinary participants in the facilitation of advance directives (Black, 2005). Despite policies designed to increase completion rates, only 36% of adults report having an advance directives (Rao, Anderson, Lin, & Laux, 2014; U.S. Department of Health and Human Services, 2008). There are known barriers at the patient level that ultimately prevent advance directive documentation (Shickedanz et al., 2008). This study aimed to understand whether social worker awareness of patient-level barriers influence perceptions of advance directives and related practice behaviors. Social work setting, expectations, and sense of competency were also assessed for mediating influence. This study surveyed 56 medical social workers at five Minneapolis-St.Paul metropolitan-area hospitals. Data was collected through a self-administered 55- item questionnaire designed by the researcher. This study found that social workers who felt a greater sense of personal responsibility and competence around facilitating advance directives were significantly more likely to assess for patient barriers to advance directive completion. Based on this research, it is recommended that medical settings provide comprehensive advance directive training targeted to social workers. This research also suggests that settings ought to clarify the responsibility social workers have to facilitating advance directives so as to improve assessment of and responsiveness to patient-level barriers