Job Experiences, Stakeholder Expectations, and Policy Challenges of Early-Career Social Workers in Hospice and Palliative Care: A Qualitative Study

Abstract

Purpose

This study aimed to explore the job experiences of early-career social workers with <2 years of experience in hospice and palliative care, examine the expectations of related stakeholders, and propose policy recommendations for the advancement of this field.

Methods

Two focus group interviews were conducted with 10 early-career social workers working in hospice and palliative care settings, and the findings were analyzed using a constant comparative method.

Results

The analysis revealed that while early-career social workers experienced personal growth and a sense of fulfillment in their roles, they also faced various challenges as they adapted to the unique environment and intervention approaches of hospice and palliative care teams. Hospice social workers are expected to serve as communication bridges between patients, caregivers, and medical staff while fulfilling their core responsibilities. However, a considerable gap was observed between these expectations and the realities of their work. For the advancement of hospice and palliative care, self-reflection and identity formation by social workers are necessary for personal transformation, while policy-level measures such as human resource management, job systematization, and organizational and systemic reform are also required.

Conclusion

This study provides valuable foundational data and clinical preparation guidelines for early-career social workers entering the hospice and palliative care field. Furthermore, it offers evidence supporting the policy and institutional changes essential for the continued development of hospice and palliative care.

INTRODUCTION

1. Background

Hospice and palliative care refer to comprehensive care provided to terminally ill patients and their families, aiming to address their physical, emotional, social, and spiritual needs [1]. Originally, hospice care focused on alleviating pain and managing symptoms in terminally ill patients. However, as the importance of improving patients’ quality of life has been emphasized, the concept of palliative care was added. Today, the integrated concept of hospice and palliative care has evolved to signify multidisciplinary and holistic care for patients at the end of life [2]. The primary goal of hospice and palliative care is to enhance patients’ quality of life and help them spend their remaining time as comfortably and pain-free as possible. To achieve this goal, interdisciplinary teams collaborate to provide services such as pain management, psychological support, and linkage to social resources, thereby promoting the overall well-being of both patients and families [3].

Hospice and palliative care are delivered by multidisciplinary teams, often referred to as hospice and palliative care teams, in which professionals from diverse specialties collaborate to provide comprehensive and integrated care. These teams typically include physicians, nurses, social workers, dietitians, psychotherapists, clergy, and pharmacists. According to the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life (hereafter, “the Life-Sustaining Treatment Decision Act”), physicians, nurses, and social workers are designated as essential personnel. Terminally ill patients often present with multidimensional needs spanning medical, physical, emotional, social, and spiritual domains. Addressing these complex and interrelated demands requires a holistic approach supported by effective collaboration among professionals. Evidence suggests that individualized care tailored to the specific preferences and circumstances of patients and families substantially contributes to quality-of-life improvement [1,2]. Thus, fostering interdisciplinary collaboration to manage complex symptoms and deliver integrated care remains a critical and meaningful direction for palliative practice.

In hospitals, the employment of medical social workers is mandated to address the needs of patients and families, thereby facilitating effective treatment delivery [4]. Accordingly, it is recommended that hospital-based medical social workers, or professional social workers with equivalent qualifications, serve as members of multidisciplinary hospice and palliative care teams, either through direct assignment or external dispatch. However, under the Life-Sustaining Treatment Decision Act, hospice institutions are required to employ full-time first-grade licensed social workers rather than medical social workers [5]. Furthermore, institutions operating the three types of hospice services— inpatient, home-based, and consultation—must employ at least two first-grade social workers, with staffing requirements determined by service type rather than bed capacity. These regulations regarding hospice social work personnel have been continuously criticized for constraining the delivery of high-quality services to patients and families and imposing excessive workloads on social workers [6-8].

Since the late 20th century, social workers have been recognized as core members of hospice and palliative care in English-speaking countries. Their primary roles have been conceptualized from a person-in-environment perspective and categorized into three major areas: addressing the psychosocial concerns of patients and families; facilitating and contributing to advance care planning; and providing counseling to families experiencing grief and loss [9,10]. Subsequent job analyses of hospice social workers further classified their tasks into four domains: assessment and reassessment; planning and intervention; death, grief, and bereavement; and professionalism. Among these, interventions related to patients’ and families’ socioeconomic issues as well as bereavement support were particularly prominent [11]. Moreover, a systematic review [12] emphasized that for social workers to contribute meaningfully to hospice and palliative care, it is essential not only to strengthen individual competencies but also to establish supportive organizational environments that sustain effective practice.

According to national guidelines for hospice and palliative care in South Korea, hospice social workers are required to perform a wide range of roles for terminally ill patients and their families, including psychosocial assessment, care planning, emotional and spiritual support, linkage to community resources, volunteer and program management, end-of-life care, and bereavement support [13]. These guidelines assume that hospice social workers serve as core members of a multidisciplinary team; however, in practice, their ability to fulfill these roles is considerably constrained. A study analyzing the activities of Korean hospice social workers through literature review and participant observation [6] addressed their roles, qualification standards, education, research, and policy engagement, and highlighted workforce shortages and resulting excessive workload as considerable challenges. Similarly, a nationwide Korean survey [7] identified excessive workload, structural problems within teams, role overlap, and conflicts as primary barriers faced by hospice social workers, underscoring the need to establish appropriate staffing standards to address these challenges.

Another issue that has been continuously raised is that the professional roles of Korean hospice social workers are not clearly defined in practice and often overlap depending on the area of service delivery. A Delphi study conducted with social workers employed at national hospice institutions [14] identified 11 domains of professional roles; however, the domains of “evaluation and research” and “education and training” demonstrated relatively low content validity. This finding suggests ambiguity in practice standards and professional identity. Furthermore, a qualitative study [15] revealed that hospice social workers experienced various difficulties in the field, including poor recognition of their roles, unclear job boundaries, unfair employment conditions, and emotional exhaustion.

These challenges are closely related to the employment conditions of Korean hospice social workers. A survey conducted across 56 palliative care institutions nationwide [16] found that 62.5% of respondents were early-career professionals with <2 years of hospice practice experience, and more than half of them were employed on a non-regular basis. This can be interpreted as an indicator of difficulties maintaining career continuity and professional expertise among hospice social workers. A follow-up study related to the implementation of the Community Integrated Care Policy [17] suggested the need to revitalize home-based hospice services, strengthen the role of social workers in discharge planning, and deploy them regionally. To fulfill these roles, the study emphasized the necessity of establishing clear qualification standards and supervision systems. These findings provide evidence for the evolving competency requirements of hospice social workers. However, most existing studies have addressed the overall practice experiences of hospice social workers in a comprehensive manner, with limited research independently examining early-career hospice social workers. In other words, most prior research has not sufficiently considered differences in career stage, making it difficult to fully capture the specific challenges and support needs of new social workers entering hospice care.

Previous studies have consistently highlighted the considerable challenges faced by social workers in hospice and palliative care, stemming from personal, institutional, and environmental constraints. Most research on the experiences of hospice social workers in South Korea was conducted between the early and mid-2010s. Although a few recent studies have emerged, many social workers continue to experience considerable difficulties in practice, largely because institutional issues remain unresolved. The hospice and palliative care fields in South Korea have evolved following the enactment of the Life-Sustaining Treatment Decision Act, which has provided a new framework and policy directions for hospice services [18].

The present study aimed to explore the job experiences of social workers and the expectations surrounding their roles in hospice and palliative care in the context of the enactment of the Act, and to identify policy tasks necessary for advancing the field. In this study, social workers with <2 years of practice experience were defined as early-career hospice social workers. These practitioners are at the stage of adapting to their professional roles, with limited proficiency and resource-linkage experience, and are regarded as a group requiring emotional and technical support. Accordingly, this study examined not only the job experiences and expectations of early-career hospice social workers but also the expectations of patients, families, and healthcare professionals. Ultimately, the study seeks to provide clinical implications for supporting early-career hospice social workers and foundational insights for defining the roles and functions of social workers in hospice and palliative care practice.

2. Purpose of the study

This study aimed to explore the job experiences, expectations, and policy-related tasks of early-career social workers with <2 years of practice in hospice and palliative care settings. The specific objectives were as follows:

1) To explore the job experiences of hospice social workers

2) To identify the expectations of hospice social workers, as well as those of patients, families, and healthcare professionals

3) To examine policy tasks necessary for changes and advancements in hospice and palliative care

METHODS

1. Study design

This qualitative study employed focus group interviews (FGIs) with early-career hospice social workers in hospice and palliative care settings.

2. Study participants

The participants were social workers actively providing services in hospice and palliative care institutions, specifically those affiliated with hospital-based hospice teams, social work departments, and palliative care centers offering inpatient or consultation services. The primary participants were early-career social workers with <2 years of experience in hospice and palliative care. The inclusion criteria were: (1) licensed first-grade social workers currently delivering hospice and palliative care services, and (2) those with a maximum of 2 years of experience in providing such services. Early-career social workers often encounter numerous challenges in the initial stages of practice [7]. Those with <2 years of experience typically have limited psychological preparedness and coping strategies for death and loss, placing them under greater emotional burden when supporting dying patients or counseling bereaved families [19]. Therefore, this study aimed to explore their job experiences and expectations to identify ways to support their adaptation, enhance job satisfaction, and suggest policy measures and institutional improvements for the advancement of hospice and palliative care.

3. Data collection and ethical considerations

Participants were recruited using purposive sampling based on institutional and expert recommendations. Suitable early-career hospice social workers were identified through referrals from the Social Work Division of the Korean Society for Hospice and Palliative Care and the Hospice Research Committee of the Korean Association of Medical Social Workers. The researchers explained the study background, purpose, eligibility, procedures, and confidentiality measures by phone. Those who agreed to participate signed informed consent forms via email, with each participant keeping one copy and returning the other to the research team.

Given that the participants were located in different regions and bound by institutional schedules, convening them in one place was not feasible. Therefore, FGIs were conducted online. In mid-April 2024, two FGIs were held with 10 early-career hospice social workers, with five participants assigned to each group according to their availability. Each session lasted approximately 2h. Both FGIs were facilitated by the same primary researcher with the support of one observer and one recorder. The researcher had extensive experience, including 4 years as a clinical medical social worker, >20 years of research experience on patients with cancer, and multiple published qualitative studies. This expertise provided both practical and theoretical insights into hospice care. The research team determined that data saturation was achieved with two FGIs. To ensure credibility, results were reviewed by a medical social worker in a supervisory role. A structured interview guide was used to minimize potential bias across groups. The interview topics included the job experiences, work-related expectations, self-assessment, and perceived changes needed in hospice and palliative care (Table 1). Prior to the interviews, participants provided informed consent for audio recording. All sessions were recorded, transcribed, and analyzed. This study was approved by the Institutional Review Board of the researcher’s affiliated institution (KNU-HR2402003).

Table 1.

Major Contents from the Focus Group Interviews (FGI).

Areas	FGI contents
Roles and experiences as a hospice social worker	• Current duties and responsibilities
	•Differences between hospice social workers and medical social workers
	•Competencies required for a hospice social worker
Expectations in job performance	•My expectations while working in the hospice and palliative care team
	•Expectations of patients and medical staff for hospice social workers
Self-evaluation as a hospice social worker	•Strengths and achievements as a hospice social worker
	•Areas for improvement
	•Areas for growth and development
Necessary changes in the field of hospice and palliative care	•Areas that need change within the organization
	•Areas requiring policy changes

4. Data analysis

Data were analyzed using the constant comparative method [20]. This method involves identifying concepts from the collected data, classifying them into categories based on their meanings, and continuously comparing and reviewing these categories until they are finalized. During this process, open, axial, and selective coding were employed to systematically analyze the relationships among categories, thereby deriving the major categories and themes that emerged from the job experiences of hospice social workers. Three rounds of discussion were conducted among the research team to verify the validity of the derived themes and categories and to ensure their alignment with the study objectives. The findings were then shared with the participants for review and confirmation, and this participant-validation process further strengthened the credibility of the results. Throughout the study, covering participant selection criteria, interview question development, data collection, and analysis, expert review and supervision were provided by two senior medical social workers with extensive experience in hospice and palliative care, both of whom are currently practicing in hospital settings. This process enhanced the objectivity of the analysis and the validity of the interpretations. To ensure rigor, triangulation was also applied, incorporating not only interview data but also government guidelines, program manuals, press releases, and academic articles, thereby increasing the reliability of the thematic interpretations. In addition, the researchers continuously reflected on the potential influence of their preconceptions and biases on data interpretation, ensuring transparency in the analytical process and maintaining both sensitivity and balance in understanding the subject matter.

RESULTS

1. Participants’ characteristics

Among the study participants, five were in their 20s, four in their 30s, and one in their 40s, with all but one being female. Their work experience in hospice and palliative care ranged from 2 months to 22 months, with an average of approximately 1 year and 2 months on hospice and palliative care teams. Regarding employment status, seven participants were employed permanently, and three were employed non-regularly. Eight of the 10 participants held medical social worker certifications. Regarding the types of hospice services for which they were responsible, five were engaged in inpatient hospice, two in consultation hospice, two in both inpatient and home-based hospice, and one in both inpatient and consultation hospice care. Except for two participants, all provided hospice and palliative care services in inpatient settings. Ninety percent of the participants were employed in hospitals located in Seoul and the Gyeonggi region, and the institutions were evenly divided into private and public organizations (Table 2).

Table 2.

Characteristics of Participants.

No	Sex	Age	Education	Area	Hospital type	Hospice type	Employment type	Hospice career
A1	F	30s	Bachelor	Daejeon	Private	Inpatient/Home	Non-regular	12 mon
A2	F	20s	Bachelor	Seoul	Private	Consultative	Non-regular	14 mon
A3	F	20s	Master	Gyeonggi	Public	Inpatient	Full-time	19 mon
A4	F	20s	Bachelor	Seoul	Public	Inpatient	Full-time	5 mon
A5	F	30s	Bachelor	Seoul	Private	Consultative	Non-regular	2 mon
A6	F	20s	Bachelor	Gyeonggi	Public	Inpatient/Consultative	Full-time	22 mon
A7	F	30s	Bachelor	Gyeonggi	Private	Inpatient/Home	Full-time	19 mon
A8	F	30s	Bachelor	Seoul	Public	Inpatient	Full-time	3 mon
A9	F	20s	Bachelor	Seoul	Private	Inpatient	Full-time	18 mon
A10	M	40s	Bachelor	Seoul	Public	Inpatient	Full-time	20 mon

2. Qualitative research findings

We explored the job experiences, expectations, and policy tasks of early-career social workers with <2 years of practice in hospice and palliative care settings. The analysis yielded 11 categories, 31 subcategories, and 73 concepts across three major themes: (1) job experiences in hospice and palliative care services as early-career social workers, (2) multifaceted expectations and perceptions of the role of hospice social workers, and (3) changes and developments in hospice and palliative care.

1) Job experiences in hospice and palliative care services as an early-career social worker

Six categories were identified within the theme of job experiences. Specifically, early-career social workers identified the core tasks expected of them within hospice and palliative care teams and reported experiencing personal growth and gaining valuable insights through the performance of these tasks. Simultaneously, they adapted to and found meaning in the distinctive environments and intervention approaches of hospice and palliative care teams, which differ from those of medical social work teams, while also facing various challenges and difficulties. Moreover, they acknowledged the essential competencies required by hospice social workers and the need for self-management (Table 3).

Table 3.

Categories and Concepts Derived from the Topic: “Job Experiences in Hospice and Palliative Care Services as an Early-Career Social Worker”.

Category	Sub-category	Concepts
Key responsibilities of social workers in hospice and palliative care	Clinical duties	• Counseling for patients and caregivers • Bereaved family care • Case conference
	Human resource management	• Therapist management • Volunteer management
	Administrative tasks	• Execution and management of government subsidies • Monthly hospice events • Patient data registration
Growth and self-discovery in hospice care	Hospice is a challenging field	• Emotional burden of confronting death • Role confusion stemming from a lack of practical experience • Practice-related frustration due to administrative burden
	Hospice care brings concerns and confusion	• Fundamental concerns about hospice care • Confusion about one’s role
	Hospice care is a journey of adaptation and new realizations	• Hospice care requires a period of adjustment • A meaningful field that takes a multidisciplinary approach • A place where the importance of faith and religion is realized
The distinctive nature of the hospice work environment	Difference in the hospice ward environment	• A closely coordinated multidisciplinary approach • The importance of communication • A feeling of loneliness • The environmental difference between an office and a hospital ward
	Differences in content and approach of the intervention	• Emphasis on psychosocial intervention • The need for additional knowledge • Intervention in death and spiritual issues • Intervention in comprehensive and diverse issues • Subtle differences in the approach
Meaningful connections and fulfillment in hospice care	The sense of fulfillment from patients and their families	• The feeling of having done something before the end of life • The patient feels comfortable • Patients and families who warmly welcome • Families visiting the hospital after a patient’s passing
	The role as a bridge	• A bridge between patients and medical staff
	The sense of fulfillment gained from performing the role of a social worker	• The me who has found my identity • The fulfillment found through psychological counseling
Challenges and issues in hospice intervention	Lack of experience in hospice intervention	• Lack of experience with end-of-life care • Concerns due to a lack of counseling skills
	Challenges in a multidisciplinary approach	• Identity confusion as a social worker • The role of a mediator • Challenges in communication with other professions
	Challenges in intervention with specific hospice patients	• Intervention for patients who lack awareness of hospice care • Intervention for uncooperative patients • When there is no information in the initial consultation
	Challenges from an administrative and structural perspective	• Burden due to excessive workload • Limited time for intervention • An approach from a formal perspective • Lack of clarity in job responsibilities
Essential competencies and self-care for hospice social workers	Core competencies required for a social worker	• Communication competence • Proficiency in clinical practice
	Attitude toward job performance	• Agility and proactiveness • Attitude toward life and death
	Physical and mental well-being management	• The impact of my health management on patients

(1) Key responsibilities of social workers in hospice and palliative care

The tasks performed by social workers in hospice and palliative care can be broadly classified into three categories: clinical duties, human resource management, and administrative tasks. Clinical responsibilities included counseling patients and caregivers, providing bereavement support for families, and participating in case conferences. In terms of human resource management, social workers were responsible for overseeing staff, such as therapists and volunteers, who provided services in hospice wards. In addition, they performed various administrative tasks, including managing government subsidies, organizing monthly hospice events, and registering patient records.

“Regarding the psychosocial care of patients and their families, counseling is the primary task, and I also work very closely with therapists, volunteers, and the chaplaincy. I manage those aspects as well, and in addition, I am generally responsible for monthly events and other activities conducted in accordance with our hospice program.” (A8)

“Except for patient counseling, most of my work is administrative… I would say it is about 70–30 or even 80–20, with the majority being administrative tasks.” (A6)

(2) Growth and self-discovery in hospice care

When social workers first began working in hospice care, they encountered many trials and errors, which fostered both personal growth and an awareness of the need for self-management. Within the category of growth and self-discovery, three subcategories emerged: “Hospice is a challenging field,” “Hospice care brings concerns and confusion,” and “Hospice care is a journey of adaptation and new realizations.” As hospice and palliative care are closely associated with death, social workers reported significant difficulties in coping with patient loss, often leading them to reflect deeply on the meaning of hospice care. Many noted that a lack of prior hospice-related experience posed considerable challenges in fulfilling their roles, while others emphasized that excessive administrative tasks contributed to frustration and disillusionment. Thus, although hospice work was perceived as challenging and accompanied by concerns and confusion, social workers gradually adapted, gained new insights, and ultimately regarded it as a field that fosters personal growth.

“As soon as I came to work, I kept hearing things like which patient had passed away during the night, and personally, that made me feel quite fatigued. At some point, I found myself counseling in a rather mechanical way, and sometimes, when administrative work outweighed counseling with patients and their families, I often felt disheartened, questioning, ‘Am I really fulfilling my role properly as a hospice social worker?’ That was quite difficult for me.” (A9)

“Through a multidisciplinary approach…I found it meaningful to look at patients not only from an economic perspective but also in various other ways, and to engage, intervene, and make plans throughout the process.” (A7)

(3) Distinctive nature of the work environment for social workers in hospice wards

Most of the social workers who participated in this study had prior experience in medical social work teams through field practice or training; thus, they highlighted the differences between medical social work teams and hospice wards. These differences were most evident in environmental factors and intervention approaches. From an environmental perspective, participants noted that multidisciplinary team approaches and ward settings had a significant impact on their work. They emphasized that because of the multidisciplinary approach, communication with not only medical staff but also other professionals, patients, and families was critical. However, they also reported often working alone as hospice social workers within the ward, without fellow social workers, which sometimes led them to feel like “outsiders.” Considerable differences were also observed in the content and methods of interventions. In particular, participants noted that in hospice and palliative care, interventions are closely related to death, with greater emphasis on psychosocial and spiritual interventions than in medical social work teams. They further explained that this requires broad knowledge and strong intervention skills to address the diverse aspects of death.

“The biggest difference is working in the ward while constantly interacting with various professionals and patients. That part seems to be the most distinct, and because of it, communication and similar aspects become really important. […] Since many different professions work together, there are times when I end up feeling somewhat like an outsider. In fact, with just myself and two physicians, there are hardly any people I know here, and I do not really have anyone to rely on.” (A3)

“I think one of the differences from medical social workers in general social work teams is that, in hospice, there are more opportunities to have conversations about things like death and bereavement.” (A6)

(4) Meaningful connections and fulfillment in hospice care

Social workers employed in hospice settings reported experiencing a strong sense of fulfillment through their work, reflected in three subcategories. First, they derived the greatest fulfillment from supporting patients and their families. Second, they experienced professional satisfaction in serving as intermediaries among medical staff, patients, and others in the hospice ward, particularly when carrying out their responsibilities with diligence and integrity. Third, they recognized a sense of professional value and reward when they deeply understood and practiced the essential roles of social work.

“There were quite a few family members who told me that they really appreciated having counseling sessions with a social worker. Those comments, more than anything else, gave me a great sense of fulfillment.” (A6)

“I felt a sense of fulfillment when I realized, through communicating with family members, that I was truly fulfilling my role as a bridge.” (A4)

“As a hospice social worker, the most fulfilling moments for me are when I feel that I am doing something meaningful for the patients and families, and when they express their gratitude, making me realize the significance of my role here.” (A9)

(5) Challenges and issues in hospice intervention

Within the category of “challenges and issues in hospice intervention,” four subcategories were identified. First, lack of hospice-related experience emerged as the most difficult aspect for early-career social workers when engaging in hospice interventions. In particular, insufficient exposure to end-of-life care and limited clinical experience were cited as major barriers. Second, some social workers reported difficulties with the multidisciplinary approach. As most had prior experience working only within social work teams, they often faced confusion regarding their roles or challenges in communication when collaborating with other professionals. Third, interventions for patients who had little or no understanding of social work or hospice care were perceived as challenging. For instance, when patients admitted to a ward without awareness of hospice care refused counseling or displayed uncooperative attitudes, social workers reported significant difficulties. Finally, administrative and structural challenges also arose. Excessive workload, limited intervention time, formalized approaches, and lack of role clarity were identified as key factors contributing to these difficulties and were highlighted as critical issues requiring improvement in the future development of hospice and palliative care.

“The tasks I need to do for hospice patients… What troubles me most is figuring out what to say and how to express it. Maybe because I still lack experience, I find those aspects very difficult.” (A8)

“Within the hospice team, there are volunteers, chaplains, therapists, nurses, physicians, and many other professionals, so it was difficult for me to find my own identity, and I am still in the process of doing so.” (A4)

“When conducting initial counseling with caregivers, there are times when they respond by saying, ‘I do not want to have counseling with you,’ or ‘Why do I need to have counseling with a social worker?’ […] At this point, I feel that I still lack the necessary skills, which makes such situations quite difficult for me.” (A1)

“When I have to conduct basic counseling solely for billing purposes or for initial documentation, I often feel quite exhausted and start questioning, ‘Do I really need to carry out counseling in this way?’” (A7)

(6) Essential competencies and self-care for hospice social workers

With regard to “essential competencies and self-care for hospice social workers,” three subcategories were identified. First, despite working in the hospice field, the importance of fundamental communication and clinical skills required by social workers was emphasized. Second, agility, proactiveness, and attitudes toward life and death were highlighted as critical elements in carrying out duties. Finally, the need for self-management, including physical stamina and mental healthcare, was underscored.

“Hospice social workers have to constantly communicate and work with so many different professionals in the ward—nurses, doctors, therapists, and volunteers […] Since hospice work is not something I can do independently but requires ongoing communication with nurses, I believe communication skills are the most important competency I need to have and develop.” (A9)

“Because patients’ conditions change from day to day, I feel the need to catch these details more carefully and provide additional explanations to family members as necessary […] In that sense, I think I need to be quicker and more agile in responding to such aspects.” (A8)

“I realized that I need to take good care of myself so that I do not pass on any negative impact to patients or their families, but instead can give them healthier energy…I think that was something I felt quite strongly.” (A5)

2) Multifaceted expectations and perceptions of the role of hospice social workers

With regard to “multifaceted expectations and perceptions of the role of hospice social workers,” three upper categories were identified. Specifically, these included the roles that social workers themselves expected to fulfill within hospice and palliative care teams, the roles expected of them by patients and caregivers, and the roles expected of them by healthcare professionals from other disciplines (Table 4).

Table 4.

Categories and Concepts Derived from “Multifaceted Expectations and Perceptions of the Role of Hospice Social Workers”.

Category	Sub-category	Concept
Perceived role and actual practice of hospice social workers	A communication bridge connecting patients, caregivers, and medical staff	•The social worker as a communication coordinator
	The role of a social worker for hospice patients	•Performing hospice duties for patients •The wish for comfort and peace •An appropriate approach for hospice patients
	The gap between expectations and reality	•The gap between role expectations and actual duties
Patients’ and caregivers’ perceptions and expectations of the social worker’s role	At first, there are no expectations for the social worker	•Perception of being a member of the team
	What patients and caregivers expect	•Being there for someone
		•A person who can provide practical help
		•Bereavement support for the family
Hospice medical staff’s expectations and perception of the social worker’s role	Providing more information to patients and their families	•Information support for patients and families
	Providing information on resource coordination	•Information on care and social services support
	The role is a bridge between patients and medical staff	•Support for effective communication with healthcare professionals

(1) Perceived role and actual practice of hospice social workers

Social workers in hospice and palliative care teams play three major roles. The first is serving as a communication channel between patients, caregivers, and healthcare professionals. This function, widely recognized as a key role of medical social workers, was also emphasized as essential in hospice settings. The second role concerns the direct care of hospice patients, encompassing the clinical approaches required in hospice and palliative care teams. This included a wide range of supportive activities for patients and their families, such as counseling, service coordination, and program management. The third theme relates to the “gap between expectations and reality.” Although social workers were expected to perform diverse professional roles, they reported dissatisfaction because excessive administrative duties and structural constraints prevented them from fully carrying out their intended responsibilities.

“With the identity of thinking, ‘I should be the link within the hospice team,’ I try to serve as a channel of communication between patients, caregivers, and healthcare professionals.” (A4)

“I believe my role and expectation is to facilitate emotional communication so that patients and families can create meaningful moments together—for example, by conducting sessions with me that provide them an opportunity to express their feelings and better prepare for death.” (A2)

“I want to listen as much as possible and spend plenty of time with them, but in reality, that is very difficult. Honestly, when counseling sessions run long, I start to feel anxious, thinking I need to finish quickly and move on to other tasks. Whenever those thoughts cross my mind, I realize how challenging it is to balance reality with what I wish to do.” (A9)

(2) Patients’ and caregivers’ perception and expectations of the social worker’s role

The expectations of patients and caregivers toward social workers can be broadly divided into two categories. The first was the tendency not to hold significant expectations, perceiving social workers simply as members of the hospice team. In these cases, the role of social workers was not clearly distinguished from that of other professionals, and they were regarded merely as staff members working in hospice wards. The second category consisted of patients and caregivers who expressed explicit expectations from social workers. They hoped that, during their stay in the hospice ward, social workers would spend time with them and provide practical assistance as needed. In addition, some patients asked social workers to care for their families after passing.

“Those who have previously encountered social workers have some understanding or expectations, but since the majority of people come without such experience, I think they generally have little to no expectations.” (A3)

“After having counseling sessions, patients often seem to expect that I will also take care of their families. Since patients facing death naturally worry about the loved ones they will leave behind, I have seen many cases where they continue to hope that their families can be followed up and supported afterward.” (A2)

(3) Hospice medical staff’s expectations and perception of the social worker’s role

Hospice and palliative care teams must include social workers as essential personnel. Accordingly, healthcare professionals from other disciplines within hospice teams held particular expectations of them. Specifically, they expected social workers to provide more detailed information through thorough assessments of patients and families, as well as to share information related to resource linkages. They also expected social workers to serve as bridges between patients and medical staff. These expectations largely align with the roles traditionally anticipated of medical social workers.

“Since my role involves asking detailed questions and learning about the patient’s personal circumstances during the initial counseling, I find that I am often asked to provide more specific insights into family relationships and social aspects of the family.” (A1)

“Since social workers are generally more knowledgeable about welfare resources and various other supports, when I provide guidance or make those connections, I notice that people tend to place trust in me in that regard. Also, compared to medical staff, I have a deeper understanding of family roles and dynamics, which is helpful, and I think those are the kinds of expectations they have of me.” (A5)

3) Changes and developments in the hospice and palliative care field

Within this theme, two categories were identified: “self-reflection and identity formation as a hospice social worker” and “changes in hospice and palliative care systems and policies.” These findings suggest that advancing hospice and palliative care requires both individual-level changes—strengthening social workers’ roles as hospice specialists—and broader systemic and policy reforms (Table 5).

Table 5.

Categories and Concepts Derived from “Changes and Developments in Hospice and Palliative Care Field”.

Category	Sub-category	Concept
Self-reflection and identity formation as a hospice social worker	Self-growth and job adaptation	•The me who is adapting well as a hospice social worker
		•The need for advancing counseling skills
	Case management and job attitude	•Burden and concerns in managing bereaved families
		•The need for change in attitude and approach
Changes in hospice and palliative care systems and policies	Human resource management and job systematization	•Hiring additional staff
		•Clear role distinction
		•Placement of a coordinator for administrative tasks
		•Stable employment type
		•Criteria for dedicated hospice social workers
	Structuring communication patterns between collaborative organizations	•A systematic mode of communication within the multidisciplinary team
	Changes in organization and systems	•Changes in the central hospice center
		•Limitations of institutions that only offer consultative services

(1) Self-reflection and identity formation as a hospice social worker

Two subcategories emerged regarding personal changes among hospice social workers. The first involved self-growth and job adaptation, reflecting individual-level changes centered on the “self.” Some social workers reported that they had successfully adapted to their roles, while others emphasized the need to further develop their counseling skills to grow as hospice professionals. The second subcategory focused on work-related changes, particularly in case management and professional attitudes. Many participants reported challenges in supporting bereaved families and acknowledged the importance of adjusting their work methods and attitudes to improve the quality of services provided in hospice settings.

“I feel that my skills and competencies in counseling are still quite lacking, so I think continuous learning and personal development are necessary in that regard.” (A7)

“Because I have no personal experience with bereavement, I find myself being very cautious when choosing words to say to patients’ families. Each time, I question whether I am doing it properly. I recognize this as one of my shortcomings and believe it is an area where I need to grow further, which will only come through continued experience.” (A10)

“I think it is important to set clear priorities so as not to lose my identity as a hospice social worker, and to actively take the lead in carrying it forward.” (A5)

(2) Changes in hospice and palliative care systems and policies

Three categories were identified regarding institutional and policy changes: “human resource management and job systematization,” “structuring communication patterns between collaborative organizations,” and “changes in organization and systems.” In human resource management and job systematization, participants emphasized the need for clearer standards and systematic reforms in hospice and palliative care policies. Key issues included staff expansion, stable employment conditions, clear role differentiation, the assignment of coordinators for administrative tasks, and the establishment of criteria for full-time hospice social workers. In structuring communication patterns between collaborative organizations, early-career social workers reported challenges in fulfilling their roles within multidisciplinary teams because of their limited experience. This highlights the necessity of structuring communication methods within collaborative organizations such as hospice and palliative care teams to foster a team culture that enables more efficient and effective role performance. In changes in organizations and systems, participants pointed to the need for reform in the central hospice center and noted limitations of consultation-based institutions. These concerns highlight the necessity of reorganizing and strengthening future organizational and systemic structures.

“There are changes for physicians and nurses where staffing standards are now based on the number of patients rather than the number of beds, but this does not apply at all to social workers. I thought it would be good if the same standard could be applied to social workers as well, so that there would be a basis for increasing their staffing.” (A4)

“It is difficult for a social worker to raise their voice alone in the ward, so I wish the team leader or someone in a higher position could help coordinate such matters. But in reality, since the team leader is also a nurse […] I am the only one who can speak up for my rights or interests […] Yet, as I am still relatively new in terms of seniority, it is very difficult to make my voice heard in that regard. That is why I strongly feel that the institution should be more considerate and provide some form of support for social workers.” (A9)

“Every year, the central office provides us with program guidelines, but in our team, we always say that they are far too unrealistic. The guidelines seem excessive and show little consideration for the actual field situation […] If those aspects were improved, I think we would be able to work in a more practical way and carry out our roles in the field with greater professionalism.” (A7)

DISCUSSION

This study aimed to explore the job experiences and expectations of early-career hospice social workers with <2 years of practice in hospice and palliative care and to present policy tasks for the future development of this sector. With the recent trends of population aging and extended life expectancy, the demand for and interest in hospice and palliative care have been expanding. Following the announcement of the government’s Comprehensive Plan for Hospice and Life-Sustaining Treatment in 2024, the number of service users is expected to continue to increase. However, the roles, duties, and related policies concerning social workers, who are designated as essential personnel in hospice services, remain stagnant, with little significant progress. In South Korea, hospital-based hospice and palliative care teams have been operational since 1988, and social workers have been part of these teams from the outset. Nevertheless, due to an employment structure characterized by a high proportion of non-regular positions, many hospice social workers have relatively short careers. Although no official statistics on the proportion of non-regular workers are available, a nationwide survey indicated that 15.5% of hospice social workers had <1 year of experience, and 34.5% had between 1 and 3 years of experience [7]. Qualitative studies have also pointed out that the prevalence of contract-based employment makes it difficult to ensure continuity of work and maintain professional expertise [8]. In this context, sharing the initial experiences and perceptions of early-career hospice social workers and discussing directions for policy and institutional reforms based on these insights can provide a critical foundation for supporting social workers’ adaptation and enhancing their professional competence in hospice and palliative care.

The analysis of hospice social workers’ job experiences revealed that their primary duties could be categorized into three areas: clinical, human resource management, and administrative tasks. Early-career social workers in hospice and palliative care reported facing significant difficulties in carrying out these responsibilities, yet they also experienced growth and self-discovery through this process. Currently, the qualification requirement for hospice social workers in South Korea is to hold first-grade social worker certification. This structure allows individuals to work in hospice settings immediately after graduation and certification, even without prior experience in healthcare or hospice care. However, because hospice settings are closely tied to issues of death and dying, providing hospice services and conducting end-of-life counseling without adequate training, education, or experience poses considerable challenges. In contrast, nurses are required to complete a specialized hospice nursing program and have ≥3 years of clinical experience before working in hospice care. Compared to this, the current qualification system for social workers—where a first-grade license alone suffices—creates substantial limitations not only in fulfilling the expectations placed upon them within interdisciplinary hospice teams, but also in meeting their own professional aspirations [21]. The findings of this study further indicate that early career hospice social workers experience significant difficulties when counseling patients and families, and they often struggle with workplace concerns and confusion about their professional roles. These results align with those of previous research showing that personal support, professional competencies, and work-related values and beliefs are crucial protective factors against burnout for social workers with less work experience, highlighting the importance of providing robust job training opportunities [22]. Unlike medical social work teams, hospice environments require distinct modes of intervention, making it difficult for early-career hospice social workers to share their current struggles or receive regular supervision, which is a major challenge. Therefore, the results of this study underscore the absolute necessity of establishing systematic education and supervision to help early-career hospice social workers adapt and grow within hospice and palliative care practices.

This study found that hospice and palliative care social workers experienced both a sense of fulfillment and a range of challenges in providing services. Their primary roles were identified as interventions with patients and families and serving as a bridge between patients and medical staff. Although these roles do not differ significantly from those of medical social workers in general healthcare settings, they contrast with the latter’s greater emphasis on financial assistance and connecting clients to community resources [23]. Providing effective psychological interventions for patients and families requires additional training and experience, which presents a critical challenge for early-career social workers. Many participants expressed concerns about their lack of end-of-life care experience and limited confidence in their counseling skills, underscoring this issue. Therefore, it is necessary to strengthen the qualifications of hospice social workers and address their limitations through continuous in-service education and training programs.

In addition, many hospice social workers have reported difficulties arising from the unique work environment of hospice wards, particularly the emphasis on multidisciplinary team approaches. Compared with social workers in other fields, those in hospice settings face greater demands for collaboration. Oliver and Peck [24] emphasized that effective team approaches require continuous communication, relationship building, trust development, and mutual respect among team members. For experienced social workers, forming relationships and communicating within a team may not pose significant challenges; however, for early-career social workers, these demands often represent new and significant challenges. In most cases, hospice wards employ only one social worker, often hired on a contractual basis, making it difficult to establish a clear professional identity. Moreover, the absence of supervisors who can provide guidance or oversight, combined with the fact that social workers are often younger than other professionals, increases the likelihood that they will be assigned administrative tasks outside their core responsibilities, further contributing to identity confusion. With the growing emphasis on team-based services in healthcare, the most crucial factors for effective service delivery through multidisciplinary teamwork are clearly defined role allocation and open communication to ensure that each profession’s responsibilities are properly fulfilled. The effectiveness of such teamwork can be maximized when role distribution and communication are well established. Therefore, to enhance the efficiency of multidisciplinary approaches, it is essential to implement policies that clarify role allocation and provide education and training programs that foster constructive communication within teams.

This study examined the roles that hospice social workers perceive for themselves as well as the expectations of medical staff and patients. Regarding self-expectations, hospice social workers emphasized their role as communication mediators connecting patients, caregivers, and medical staff, as well as their professional responsibilities inherent to the discipline. However, some participants noted a considerable gap between their expectations and reality. Specifically, although they are expected to provide services to patients and their families, excessive administrative tasks often prevent them from fulfilling their core responsibilities. This finding underscores the need for institutional change and systemic support to enable hospice social workers to effectively perform their essential roles. Expectations of other professionals tended to align more closely with the functions of medical social workers, such as providing information and linking patients to resources. In contrast, hospice social workers placed greater emphasis on psychological and family counseling. This aligns with previous research [10], suggesting that other professional groups may hold different perspectives on the role of hospice social workers. Therefore, it is crucial to establish clear guidelines on the roles and responsibilities of hospice social workers to ensure that they and other professionals share a consistent understanding of their functions. Such efforts are expected to enhance interdisciplinary collaboration within hospice teams and positively influence the delivery of social work services.

Two overarching categories were identified in relation to changes and developments within the field of hospice and palliative care: self-reflection and identity formation as internal changes required by hospice social workers, and institutional and policy-level changes. In particular, the need for improvements in workforce management, systematization of job responsibilities, and organizational restructuring was strongly emphasized. These discussions are largely consistent with the directions of policy changes proposed in the 2010s. Nevertheless, following the implementation of the Act on Decisions on Life-Sustaining Treatment, various policies have been introduced to enhance access to hospice and palliative care services and improve their quality. These include the establishment of qualification criteria for social workers, clearer definitions of their role within interdisciplinary hospice teams, expansion of hospice-related training, and extension of their functions through a pilot project on consultation-based hospice care [25]. However, compared to the pace of change in hospice and palliative care services and their growing demand, institutional progress specific to social work has been relatively slow. Thus, while in the 2010s the introduction of hospice and palliative care policies for social workers was urgently needed, in the 2020s, after the implementation of the Act on Decisions on Life-Sustaining Treatment, the focus has shifted toward supplementation and expansion of policies to ensure that social workers can be stably integrated into the system. Notably, the inclusion of social workers as essential members of interdisciplinary teams and their recognition within the reimbursement system highlight their indispensable role in hospice and palliative care. To further consolidate their position in this evolving field, it is crucial to expand their workforce, establish stable employment structures, and develop recruitment criteria that reflect the growing demand for services. Such measures are necessary to ensure consistent delivery of high-quality services across care settings.

This qualitative study explored job experiences, expectations, and perspectives on future development among early-career hospice social workers with <2 years of experience in hospice and palliative care. The findings provide insights into what newly employed social workers in hospice care need to prepare for, as well as the challenges and expectations they face in their roles. Moreover, this study has significant implications by suggesting policy directions that can help create an environment in which hospice social workers can perform their duties more effectively. However, this study had some limitations worth noting. First, most participants were employed in tertiary or general hospitals, indicating that the study primarily focused on inpatient- and consultation-based hospice services. Given that many social workers are active in clinics, long-term care hospitals, and home-based hospice care facilities, the generalizability of the findings is limited. Second, the majority of participants were from Seoul and Gyeonggi Province, making it difficult to capture the experiences of hospice social workers working in other regions of South Korea. Finally, owing to geographic constraints, the study was conducted via an online platform, which made it difficult to fully observe the interactions and group dynamics among participants that might have emerged in face-to-face FGIs.

Despite these limitations, this study holds significant value in identifying the core tasks of early-career hospice social workers and highlighting areas that require transformation for them to function effectively in hospice and palliative care settings. The findings are expected to contribute meaningful by enabling proactive identification of the competencies and considerations necessary before social workers are deployed in hospice practice. Furthermore, as this study demonstrates, many aspects must be addressed for hospice social workers to fulfill their expected roles with clarity. This underscores the need for ongoing improvements and reforms, not only within the scope of social work practice but also at the policy level. Through such efforts, social workers are anticipated to play a critical role in hospice and palliative care, grounded in meaningful policy advancements.

SUPPLEMENTARY MATERIALS

Supplementary materials can be found via https://doi.org/10.14475/jhpc.2025.28.3.99.