| Chronic health problems affect millions of older adults each year and the numbers of people living with chronic illness is expected to grow. Meeting the complex needs of individuals with chronic illness and a growing aging population is a challenge for the medical system. Ongoing and open patient-provider communication is essential for chronic illness management. While many older adults are choosing Complementary and Alternative Medicine (CAM) to treat chronic illnesses such as depression, heart disease, back pain and diabetes, few are discussing their use of these treatments with their health care providers. Social workers play a key role in chronic illness management by considering relevant biomedical, psychosocial and spiritual factors and the needs of the individual patient and the patient's family or caregiving network. Based on the literature, it is not clear whether social workers are communicating with older adults regarding CAM use. This dissertation examined social worker-patient communication regarding CAM and how well social workers are equipped to play this role. Thirty-nine semi-structured interviews were conducted with a non-random purposive sample of geriatric social workers. Respondents were recruited from four geographical regions including parts of Michigan (Greater Lansing, Ann Arbor, Grand Rapids); the San Francisco Bay Area; Greater Boston, and Honolulu, Hawaii. The research indicated that social workers in the study did not routinely assess for CAM use, including use of herbs or supplements, nor were they likely to affirmatively recommend CAM modalities. The research also identified a number of institutional barriers that inhibit communication about CAM, made specific recommendations to improve CAM-related social work education and training and to better accommodate CAM modalities at multiple system levels. In addition, the study also revealed cultural competency deficiencies, specifically, reluctance by social workers to ask about CAM use out of fear that they will appear to be stereotyping based on the patient's cultural background. Social worker respondents also indicated a lack of knowledge about CAM use prevalent in particular patient communities. |
