Palliative Social Workers' Contributions to Cultivating Prognostic Awareness: A Qualitative Study Using the Prognostic Awareness Impact Scale Framework.

BACKGROUND: Prognostic awareness is central to informed, value-concordant care for patients with serious illness. Although often conceptualized as cognitive understanding of a time-based prognosis, emerging research highlights prognostic awareness as a multidimensional process involving cognitive understanding, emotional coping, and adaptive response. Palliative social workers may be especially well positioned to support this process, yet their specific skills and strategies remain understudied. OBJECTIVE: To describe the strategies hospital-based specialty-level palliative social workers use to cultivate prognostic awareness, using the Prognostic Awareness Impact Scale (PAIS) framework of cognitive understanding, emotional coping, and adaptive response. METHODS: Using a qualitative interpretive description approach, interviews were conducted with 17 Advanced Palliative and Hospice Social Work-Certified (APHSW-C) social workers on hospital-based interprofessional palliative care teams. Participants were purposively selected to provide a specialty-practice perspective. Interviews explored clinical roles and strategies used to cultivate prognostic awareness. Data were analyzed using inductive coding, followed by categorization into the domains of cognitive understanding, emotional coping, and adaptive response. Rigor was supported by team coding, reflexive memoing, and member checking. RESULTS: Cognitive understanding was supported through mapping values and decision-making contexts, identifying gaps in understanding of illness, translating medical information, and reinforcing physician-delivered prognostic information. Distinctive contributions emerged in the emotional coping domain, including assessing emotional capacity, pacing conversations, holding space, centering emotion, applying trauma-informed approaches, and attending to total pain. The adaptive response was bolstered by providing anticipatory guidance and supporting legacy work by fostering the dual awareness of hope and planning, as well as longitudinal reflection during and across admissions. CONCLUSIONS: APHSW-C SWs play an important role in supporting patients' and families' understanding of the likely disease trajectory and prognosis, viewing their work as an ongoing, relational, and emotionally mediated process. Findings suggest that the PAIS may offer a useful framework for identifying profession-specific contributions to this process.