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Original Article
ARTICLE IN PRESS
doi:
10.25259/IJPC_159_2025

Palliative Care Training in Social Work Education: An Exploration of Stakeholder Perspectives and Curriculum Review

Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Department of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Calicut, Kerala, India
School of Liberal Arts and Design Studies, Vidyashilp University, Bengaluru, Karnataka, India,
Employment and Social Services-Ontario Works, City of Ottawa, Canada.

*Corresponding author: Priya Treesa Thomas, Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. priyathomasat@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Aswathi C, Arun M, John M, Kumar GS, Thomas ES, Thomas PT. Palliative Care Training in Social Work Education: An Exploration of Stakeholder Perspectives and Curriculum Review. Indian J Palliat Care. doi: 10.25259/IJPC_159_2025

Abstract

Objectives:

Social work practice in palliative, rehabilitation and long-term care settings has long been recognised as an important component of healthcare service delivery. However, limited studies have explored the preparedness for palliative care social work in post-graduate social work education in India.

Materials and Methods:

Seven semi-structured in-depth interviews were conducted with professional social workers working in various palliative care settings in India to assess their educational preparedness for palliative care. The interviews were recorded and transcribed. The collected data were thematically analysed. Subsequently, a review of the postgraduate social work curriculum in universities recognised by the University Grants Commission was conducted using template analysis.

Results:

A lack of educational preparedness of social work practitioners in end-of-life (EOL) care is identified through the in-depth interviews. The major themes from the interviews included content on palliative and EOL in social work curricula, fieldwork exposure to EOL, continuous education programmes, job education training and development of basic therapeutic skills. The review of curriculum using template analysis revealed that out of the 521 (Central and State) universities registered on the website, 25 had palliative care components incorporated into their curriculum. In these curricula, most included the content as part of the medical and psychiatric social work specialisation training. The curriculum made limited reference to the supervised practicum in this field.

Conclusion:

With the increasing recognition of the need for palliative and long-term care and the integral role of psychosocial care in these settings, there is a need to acknowledge the current lack of preparedness expressed by the practitioners in the field and to work towards a well-articulated training curriculum with an equal focus on content and skill building in social work education.

Keywords

Curriculum
Palliative care training
Social work education
Stakeholder perspectives
University education

INTRODUCTION

Palliative care is an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illnesses through prevention and relief of suffering by means of early identification and comprehensive assessment and treatment of pain and other problems – physical, psychosocial and spiritual.[1]

The rapid demographic transition has resulted in significant greying of the population, adding to the global burden of diseases, with more people requiring long-term care support.[2] The social system is also highly collective, and family caregiving continues to be the norm, with limited organised support. The need for effective palliative care services is profound, but must be understood within this unique sociocultural context.[3]

India’s healthcare system, like that of other developing nations, frequently struggles with the dual burden of communicable and non-communicable diseases. Other systemic issues include a lack of funding, cultural differences and disparities in access to treatment. Palliative care remains underdeveloped in many regions, with significant gaps in service provision and education in the different healthcare professions involved.

Social workers are recognised as core members of the hospice and palliative care team, supporting patients and families throughout serious illness and following the patient’s death. Responding to the increasing demand for long-term care and palliative care systems, social work educators have taken important steps to increase the number of social workers trained and competent to deliver effective psychosocial care.[4,5] Most palliative care social work is undertaken as part of a medical speciality that draws on the multidisciplinary professional team aiming to meet the practical, psychological, physical and spiritual needs of dying people and their families.[6] The role of social work in mediating the transitions towards death, both for the dying person and those who are bereaved, is often significant, particularly for those with difficult life histories.[6]

Compared to other healthcare professions, social workers who want to specialise in this field have access to proportionally fewer training programmes, even though social work is a crucial component of palliative care.[7] To improve social work practice in hospice palliative care and ensure that new students and current practitioners receive appropriate education and training, the profession must clearly define its roles and responsibilities.[8]

In India, efforts to enhance palliative care skills amongst professionals are limited. However, some initiatives, such as the Indian Association of Palliative Care, offer certificate courses on palliative care for skill building of professionals, such as essentials of palliative care, palliative care for volunteers, palliative care pharmacy, physiotherapy in palliative care and psychosocial issues in palliative care.[9] Similarly, certain hospitals in the country have included the palliative care training programme for medical interns at the beginning of their posting in the Department of Community Medicine.[10] In addition, the nursing council mandates a 20-hour palliative care module in the nursing curriculum.[11] Graduate and postgraduate social work training programmes in the country play a crucial role in training and preparing social work professionals to meet the diverse needs of the population diverse needs. However, the extent to which palliative care is integrated into the master of social work (MSW) curriculum varies widely across institutions. This paper aims to analyse the current state of palliative care education in MSW programmes in India, exploring the extent of its inclusion, the challenges faced in incorporating this vital subject and the potential benefits of a more standardised and comprehensive approach. In addition, it will provide recommendations for enhancing the curriculum to better prepare future social workers for their roles in palliative care settings. We focused on answering the following research questions:

  1. What is the perspective of social workers on their educational preparedness for palliative care service?

  2. To what extent is palliative care training included in the postgraduate social work curriculum of government (public) universities in India?’

MATERIALS AND METHODS

To answer the research questions, we interviewed stakeholders working in the field of palliative care. Subsequently, we undertook a review of the current curriculum followed in social work education in Indian universities.

Stakeholder perspectives

Participants and setting

Professional social workers are the stakeholders in this context. Professional social workers from the southern region of India constituted the study population, and participants were selected using convenience sampling. The inclusion criteria for the professional social workers were a minimum qualification of MSW from University Grants Commission (UGC) recognised universities, with a minimum of 4 years of work experience, and currently working as professional social workers. The ethical aspects of the study were discussed with the participants, and written informed consent was obtained from them. The participant recruitment was stopped when data saturation was reached.[12]

In-depth interview guide

An interview guide was developed based on the literature and clinical experience with these populations.[13] Probes were used to clarify the meaning of the responses and pursue sensitive topics about dying. In-depth interviews were conducted with professional social workers to systematically address the proposed research questions, with ethical approval from the institute’s ethical committee.

Data collection

In-depth interviews with seven professional social workers were selected using a purposive sampling method, which lasted 60–90 min. The study had received ethical clearance from the institute’s ethical committee. The interviews were guided by the topic guide, where the researcher encouraged the participants to explore their viewpoints on the social workers’ education preparedness through professional and continuous education [Table 1]. Interviews were transcribed, and a preliminary analysis was conducted to elicit the major themes. The interviews were discontinued once data saturation was evident, indicating that no new information was being gathered.[14]

Table 1: Interview topic guide.
Question How has your professional social work training helped you to provide services at the end of life?
Prompts Could you please share some of your experiences in palliative and life end-of-life care?
What needs have you observed in patients and families facing the palliative and end of life?
How do you recognise the needs of the patient and family?
How do you work to meet the psychosocial needs of patients and families?
What skills do you believe are required for providing quality palliative and end-of-life care?
To what extent has your professional education equipped you to develop those skills?
How prepared yourself to deliver palliative and end-of-life care to patients and families?
When did you start your practice in this field? What constraints did you face when you started practice?

Data analysis

Interviews were recorded and stored on an electronic device. The collected data were translated from the vernacular language to English and transcribed. Data transcription was done manually, and no software was used to ensure the rigour of the collected data. Data were transcribed in Microsoft Word.

To analyse the interviews, thematic analysis guidelines were used.[15] To establish the validity of the results, the codes that emerged from the data were discussed with independent experts from the same department who are specialists in qualitative research. Two independent researchers reached a consensus in the data analysis to avoid ambiguity.

Curriculum review

Understanding the current state of affairs at universities with relation to the integration of palliative care education in their curricula was the main goal of the curriculum evaluation. We aimed to find out how many universities in the country have included palliative care and its components in their syllabi for postgraduate social work [Figure 1].

Flow chart of the postgraduate social work curriculum review. UGC: University Grants Commission
Figure 1:
Flow chart of the postgraduate social work curriculum review. UGC: University Grants Commission

Methods

The analysis of postgraduate social work curricula across the country was conducted subsequent to the stakeholder interviews. Template analysis was used for this since it establishes a priori themes before analysing the textual data.[16] The template data analysis approach uses a hierarchical coding system to organise and analyse large textual data.

Data collection

The research team explored the extent of palliative care training content included in the published social work syllabi in the government educational institutes in the country[17] list of central and state universities was sourced from the UGC website.[17] Following this, the official websites of each university were systematically reviewed to extract the curriculum for postgraduate social work programmes (MSW and Master of Arts in Social Work).

Data analysis

A template consisting of specific variables was framed for extracting data from the curriculum. The template included the name of the university, details of the curriculum, fieldwork and reading materials, semester and grade points. The researcher reviewed the content of the curriculum and identified the details as per the template. The identified details were mapped out in an Excel sheet, allowing for the synthesis of the salient findings.

RESULTS

Stakeholder interviews were conducted with social work professionals in palliative care to understand their perspectives. The participant profile is described in Table 2. The professional social workers’ responses to the in-depth interview provided a rich understanding of social workers’ preparedness for working in palliative and end-of-life (EOL) care settings. The main themes identified were content on palliative and EOL in the social work curriculum, field exposure to EOL care, continuous education programmes, job education training and development of basic therapeutic skills.

Table 2: Sociodemographic profile of the participants.
Sr. No Gender Age Education Nature of work Experience (in years) Designation
1. F 47 MA (SW) MPhil Clinical practice and supervision 04 Medical social worker
2. F 50 MA (SW) MPhil Clinical practice, administration and supervision 15 Medical social worker
3. F 55 MA (SW) MPhil Clinical practice, administration, teaching and supervision 30 Social welfare officer
4. F 34 MSW, PhD Clinical practice, supervision and research 6 Clinical social worker
5. F 31 MSW, MPhil Clinical practice, supervision and training 3 Social worker
6. M 33 MSW, MPhil Clinical practice and training 4 Social worker
7. F 50 MA (SW) Clinical practice, supervision and training 15 Social work consultant

SW: Social work

Many participants emphasised the importance of including dedicated palliative and EOL care content within social work education. Some reported that their academic programmes provided theoretical exposure to these concepts, while others indicated a lack of structured coursework on this topic (content on palliative and EOL in social work curricula). The social workers who had opportunities for hands-on experience in palliative settings felt more confident in handling the emotional and psychosocial challenges of EOL care (fieldwork exposure to EOL care).

Participants stressed the need for regular workshops, seminars and short-term courses on palliative and EOL care to keep social workers updated (continuous education programmes). Social workers working in palliative care settings often learn on the job, either through supervision or self-learning. Many participants expressed the need for structured orientation programmes and specialised training within healthcare institutions to bridge the gap between academic knowledge and real-world practice (job education training).

Good communication, listening, empathy and grief counselling were all felt to be critical for the social worker in palliative care. Attendees acknowledged that much of this expertise came over time; however, formal training in therapeutic interventions would make a significant difference in their skills to help patients and families with EOL challenges (development of basic clinical skills). The responses highlighted the strengths and gaps in their training, education and field experience, offering a comprehensive understanding of their readiness to provide psychosocial support in such sensitive environments.

From the template analysis of the curriculum, it was identified that out of the 487 universities registered with the UGC, 126 had dedicated social work departments. The participant profile is described in Table 2.

Descriptive summary of curriculum review

Nature of universities

In the case of technical education, there are 46 universities, but no social work department. Similarly, there are 32 healthcare/medical universities with only one hosting a social work department. Additionally, there are 12 veterinary universities and 40 agriculture universities. Among the 30 language universities, one university has social work department, and they have integrated palliative care into its curriculum. Furthermore, there are seven fisheries universities, seven sports universities, six skill development universities and four visual arts universities. Notably, one rehabilitation university hosts a social work department, although it does not include palliative care topics in its curriculum [Table 3] (UGC Annual Report 2022-23).[17]

Table 3: Postgraduate social work curriculum with palliative care education components
State Content Type of university
General Technology Health/Medical Veterinary Agri/Horti aw
L
Language Fisheries Sports skill visual arts Rehabilitation Marine science/Av i
o n
a t i
Assam Number of universities 11 1 1 1 1 1 1 1
Number of universities with SW departments 1
Palliative care training in curriculum 1
Bihar Number of universities 12 1 1 1 1 1 2
Number of universities with SW departments
Palliative care training in curriculum
Chhattisgarh Number of universities 9 2 1 1 2 1 1
Number of universities with SW departments 5
Palliative care training in curriculum 1
Chandigarh Number of universities 1
Number of universities with SW departments
Palliative care training in curriculum
Delhi Number of universities 3 4 1 1 1 1
Number of universities with SW departments
Palliative care training in curriculum
Goa Number of universities 1
Number of universities with SW departments 1
Palliative care training in curriculum
Gujarat Number of universities 15 3 3 5 1 1 1 1
Number of universities with SW departments 8
Palliative care training in curriculum
Haryana Number of universities 9 3 2 1 1 1 1 1 1
Number of universities with SW departments 5
Palliative care training in curriculum
Himachal Pradesh Number of universities 2 1 1 2 1
Number of universities with SW departments 1
Palliative care training in curriculum
Jammu & Kashmir Number of universities 6 1 2
Number of universities with SW departments 1
Palliative care training in curriculum
Jharkhand Number of universities 9 1 1 1
Number of universities with SW departments
Palliative care training in curriculum
Karnataka Number of universities 22 1 1 1 4 2 2 1
Number of universities with SW departments 18
Palliative care training in curriculum 3
Kerala Number of universities 5 3 1 1 1 1 2 1
Number of universities with SW departments 4 1
Palliative care training in curriculum 2 1
Ladak Number of universities 1
Number of universities with SW departments
Palliative care training in curriculum
Madhya Pradesh Number of universities 15 1 1 2 2 2 1
Number of universities with SW departments 10
Palliative care training in curriculum
Maharashtra Number of universities 13 2 1 4 3 1 1 1 1
Number of universities with SW departments 4
Palliative care training in curriculum
Manipur Number of universities 1 1 1
Number of universities with SW departments
Palliative care training in curriculum
Odisha Number of universities 12 2 1 3 1 1 1 1
Number of universities with SW departments 5
Palliative care training in curriculum
Pondichéry Number of universities 1
Number of universities with SW departments
Palliative care training in curriculum
Punjab Number of universities 5 2 2 1 1 2 1
Number of universities with SW departments 1
Palliative care training in curriculum
Rajasthan Number of universities 14 3 2 1 2 2 1 1
Number of universities with SW departments 4
Palliative care training in curriculum 1
Sikkim Number of universities 1 1
Number of universities with SW departments
Palliative care training in curriculum
Tamil Nadu Number of universities 12 2 1 1 1 2 1 1 1
Number of universities with SW departments 8
Palliative care training in curriculum 3
Telangana Number of universities 8 2 2 1 2 1 1
Number of universities with SW departments 5
Palliative care training in curriculum
Tripura Number of universities 1 1
Number of universities with SW departments
Palliative care training in curriculum
Uttar Pradesh Number of universities 22 3 4 1 1 2 1
Number of universities with SW departments 13 1
Palliative care training in curriculum
Utara Khand Number of universities 6 1 2 1 1
Number of universities with SW departments 3 1
Palliative care training in curriculum 1
West Bengal Number of universities 30 1 1 2 1 1 1
Number of universities with SW departments 4
Palliative care training in curriculum 1
Arunachal Pradesh Number of Universities 1
Number of universities with SW departments
Palliative care training in curriculum
Andhra Pradesh Number of Universities 16 4 2 1 2 1 1 1
Number of universities with SW departments 3
Palliative care training in curriculum
Central Universities Number of Universities 44 1 3 6 2
No of universities with SW departments 24 1
Palliative care training in curriculum 11

SW: Social work

Number of social work colleges

Of the 521 general universities surveyed, 132 have social work departments, with only 25 incorporating palliative care into their social work syllabi, amongst which 11 institutions are under central universities and 14 institutions are under state universities.

Details of the curriculum

Twenty-five universities, including state and central institutions, have included palliative care in their curriculum out of the 132 universities with the department of social work registered under the UGC. This accounts for approximately 18.94% of universities in India, which is a relatively small percentage. These data suggest that central universities place more importance on palliative care education for social work students than state universities [Supplementary file].

Supplementary data

Semester details

The majority of the universities have included palliative care in their 2nd-year curriculum, 15 universities included it in the third semester, and 10 universities included it in the fourth semester. Only two universities have included it in the first semester itself.

Number of hours

Specifically, the number of hours has not been mentioned by any of the universities.

Credit score for the topic

Bankura University has assigned the highest credit points at 6. The majority of universities (12) have allocated 4 credit points, while five universities have assigned 3 credit points. In addition, two universities have also given 3 credit points.

Heading of the topic

  • Two universities have included palliative care in their medical and psychiatric social work specialisation papers

  • Eight universities have incorporated palliative care into their medical social work specialisation papers

  • Seven universities have included palliative care in community healthcare and social work papers

  • Six universities have added palliative care to their social work with the elderly or senior citizens papers.

Only one university has included palliative care in the Counselling Theory and Practice Group Counselling paper. The inclusion of palliative care in the curriculum varies across different areas of social work.

Fieldwork details and reference details

None of the universities has referred to the supervised practicum on palliative care social work in their curriculum.

DISCUSSION

India has a diverse higher education ecosystem. The system includes central, state, deemed and private institutions. In this study, the researcher undertook an inclusive analysis of all state and central universities nationwide. It was observed that certain universities specialise in specific fields such as technical, health/medical, veterinary, agriculture/horticulture, law, language, fisheries, sports, rehabilitation, skill development, visual arts and other general disciplines. The present analysis shows that the university curriculum for social work in India does not give substantial importance to palliative care. Despite the crucial role social workers play in providing psychosocial care as core members of interdisciplinary teams, there is a shortage of trained social work professionals to meet the needs of hospice, long-term care, community-based programmes and expanding hospital-based palliative care (Stein, 2018).[5] Similarly, in one of the studies conducted in Canada, insufficient educational preparation has been noted as a barrier to ethical and effective practice in EOL care. They suggested that these competencies can be utilised to produce relevant course materials for professional development and training programmes, as well as Bachelor of Social Work (BSW) and Master of Social Work (MSW) programmes.[8]

Therefore, it is essential to provide proper training in palliative care during the MSW course by incorporating comprehensive palliative care content into the social work curriculum in all universities. The course must integrate both theoretical and practical dimensions of palliative care if we want students to be ready to meet the intricate needs of patients and their families. The classroom part must explore the palliative care principles: Effective pain and symptom management, skilful, compassionate communication, examination of ethical and legal considerations and thorough attention to the psychosocial dimensions of EOL care. Mastering these principles will arm learners with the foundational knowledge they need to assist seriously ill patients and their families in facing the emotional, social and spiritual hurdles that arise as the disease progresses. Beyond classroom teaching, palliative care centres must serve as the fieldwork laboratories. Such placements are non-negotiable, as setting allows students to transpose classroom knowledge into lived experience. Guided by seasoned palliative care practitioners, the learners engage directly with patients and families. They attend and, when ready, contribute to interdisciplinary team discussions, assist in crafting care plans and extend psychosocial support. Placing students in the centre of the care team reinforces their ability and self-assurance, ensuring that the competencies they develop precede entry into practice.

Fieldwork in palliative care settings allows students to witness the day-to-day operations of members and appreciate the importance of collaborative, patient-centred care. It also exposes students to the emotional and ethical complexities of working with individuals at the EOL, preparing them to handle such situations with sensitivity and professionalism. This experience will be valuable as students transition to professional roles in palliative care organisations after graduation. By having practical experience in palliative care during their education, graduates will be better equipped to meet the demands of their roles, provide high-quality palliative care services, comprehend the duties and responsibilities of various team members and make valuable contributions to interdisciplinary teams.

They will be prepared to address patients’ and their families’ physical, emotional, social and spiritual needs, thereby improving the quality of life for those facing serious illnesses. Moreover, this approach can help address the current shortage of trained social work professionals in palliative care settings. By ensuring that all social work graduates have basic competence in palliative care, universities can help meet the growing demand for skilled professionals in hospice, long-term care, community-based programmes and hospital-based palliative care services. This will enhance the overall capacity of the healthcare system to provide comprehensive and compassionate care to patients at the EOL. In addition to educating social workers to have specialised palliative care expertise, social workers in various healthcare and other settings must have basic palliative care competence (Berkman and Stein, 2018).

In the qualitative part of the study, the interviews revealed that the curriculum of professional education in social work, such as MSW and BSW courses, does not adequately cover EOL care. Therefore, social workers at large are clueless about how to communicate with patients who are terminally ill, how to address their psychological and social issues and above all, how to professionally manage persons with terminal illness. The existing modality of teaching and training in social work in most countries, especially in India, covers orientation about medical and psychiatric illness and associated symptoms. However, such teaching and training curricula fail to enable and empower social workers for clinical management of psychosocial problems associated with terminal illness. Similarly, in another study done in US social work curricula review, they suggested that it is important that students should be made to face their own anxieties about EOL issues and learn better communication skills before becoming practising clinicians.[18]

The curriculum of a postgraduate programme for social work should foster professional inter-professional learning opportunities for social workers who have demonstrated interest in or would like to engage in working with patients who have chronic or life-limiting illnesses, patients who are nearing their EOL, patients who are in the active dying phase and their families around EOL planning, medical decision making, grief and bereavement.[19] Training should demonstrate the continuum of palliative care and hospice agencies and prepare social workers for work in various positions in these settings.

Limitations

Some universities did not have their curriculum readily available on their websites, which limited access to information regarding whether palliative care was included in their social work curriculum. In addition, most universities did not specify their sources or references for including palliative care in their curriculum. Furthermore, information regarding whether universities provided palliative care exposure during field visits was often unclear or not explicitly stated.

CONCLUSION

Palliative care, which includes physical, psychological and spiritual support, is essential for improving the quality of life for patients and their families dealing with life-threatening illnesses (WHO, 2002). Social workers play a crucial role in this multidisciplinary approach by providing crucial direction and assistance both during and after the course of the illness (Institute of Medicine, 2014). Effective palliative care is in high need in India, a country with a wide range of healthcare resources and access issues. Palliative care instruction in MSW programmes nationwide is still uneven, despite its significance. Significant differences between state and central universities’ approaches to including palliative care into MSW courses have been brought to light by this study.

Data availability statement

The datasets generated and/or analysed during the current study are publicly available on the UGC website.

Ethical approval:

The research/study was approved by the Institutional Review Board at National Institute of Mental Health and Neurosciences, approval number NIMHANS/28th IEC (BS and NS DIV)/2021, dated 23rd June 2021.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.

Financial support and sponsorship: Nil.

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