Sexuality and life-threatening illness: implications for social work and palliative care.

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Sexuality and life-threatening illness: implications for social work and palliative care.

We must grapple with the fact of our own mortality and the realization that intimacy occurs in the face of eventual loss.

--John S. Rolland, 1994

In 2001, the National Hospice and Palliative Care Organization (NHPCO) identified the assessment of sexuality as a core competency for social workers in end-of-life care settings (Hay & Johnson, 2001). Other prominent organizations and social work leaders have agreed, recognizing sexuality as a fundamental dimension of a comprehensive assessment when working with people who are critically ill (Gwyther et al., 2005; Lynch, as cited in Moore, 1984; National Association of Social Workers [NASW], 2003; National Consensus Project for Quality Palliative Care [NCPQPC], 2004). Although sexuality has been identified as an important part of a thorough psychosocial history, little guidance has been offered about how practitioners can address the subject. In response to this lack of direction, this article summarizes the available literature on sexuality during terminal illness; explores the role of social work in assessments of, and interventions regarding, sexually related issues at the end of life; describes clinical skills needed to address barriers to sexuality in palliative care settings; and identifies four instrumental dimensions of a comprehensive sexual assessment. Implications for interdisciplinary teamwork are also discussed.

Of course, when it comes to addressing issues of intimacy and sexuality at the end of life, social workers do not hold a monopoly. Practitioners in a variety of other health disciplines--such as nursing, medicine, and psychology--may have the clinical skills to adequately attend to these types of concerns. However, with their extensive training in relationship dynamics and communication patterns, social workers may be uniquely prepared to handle the complex issues of sex, intimacy, and romantic interactions during a terminal illness (Cort, Monroe, & Oliviere, 2004).Although this article focuses primarily on the social work discipline, readers should not infer that social work is the only discipline that should be involved when sexuality-related concerns arise. In fact, we believe these issues are best addressed using a collaborative, interdisciplinary approach.

A fair amount of literature exists on the topic of sexuality in palliative care, but the vast majority of the scholarship has been written by, and addressed to, nurses and physicians. This article intends to contribute to the knowledge base in two key ways: (1) focusing on the social worker's role in addressing sexuality within the context of an interdisciplinary approach to palliative care and (2) id...

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