Study characteristic

A comprehensive literature search identified 3,429 articles. After screening titles and abstracts, 127 full-text articles were retrieved. A detailed review excluded 108 articles that didn't meet inclusion criteria, leaving 19 left. These studies, published from 2001–2024, came from the US (10), China (4), UK (2), Israel, Spain, Korea (1 each). According to MMAT criteria, 19 articles meet the quality standards. There were 9 qualitative, 9 quantitative descriptive, and 1 mixed-methods study.

Through thematic synthesis, five core competencies emerged, forming the E-CARE framework: Ethics, Coordination, Assessment, Resource Allocation, and Education. The E-CARE framework outlines five core competency standards for palliative social workers, which might serve as benchmarks for high-quality, patient-centered care. These standards reflect the ideal integration of knowledge, skills, and values, acknowledging that actual practice may vary across contexts.

Ethics

In palliative care, social workers operationalize an integrated ethical-operational framework, balancing patient autonomy, cultural humility, and systemic advocacy. They operationalize these principles by prioritizing patients'best interests over institutional demands [29, 31], advocating for marginalized populations through structural barrier deconstruction [24,25,26,27, 34,35,36], and maintaining non-judgmental therapeutic alliances to uphold patient autonomy [24,25,26,27, 34,35,36], Their practice integrates cultural, spiritual, and ethnic belief systems into care plans through adaptive navigation of belief systems [24, 25, 31], while systematically implementing empathy principles and privacy protection mechanisms to foster trust [34, 36]. Ethically, they construct welfare-prioritizing decision frameworks [25, 28, 31, 34] that balance advocacy efforts with moral distress mitigation [24,25,26, 31, 34], resolving dilemmas through abuse identification protocols [27, 40] and legal safeguard mastery [26, 27, 31, 40]. Concurrently, they enhance service quality via intentional humanistic practices and collegial support systems addressing workplace discrimination [26, 27, 31]. This value paradigm is sustained through self-care strategies preventing professional burnout while enabling rights preservation across healthcare hierarchies [24, 25, 29, 31]. Collectively, these interconnected competencies—spanning justice-oriented advocacy [24, 27, 31, 34, 36], cultural mediation [24, 25, 31, 34], and dual protective systems [26, 27, 31, 40] —position social workers as catalysts for systemic change and dignity-preserving care in palliative ecosystems.

CoordinationInterdisciplinary team coordinator

Social workers demonstrate essential interdisciplinary competencies that are crucial for optimizing team functioning in palliative care settings. Their specialized skill set enables them to facilitate effective interprofessional collaboration while making distinctive contributions to team dynamics [25, 28, 29, 31, 34]. Specifically, they exhibit advanced competencies in emotional regulation, conflict mediation, and moral distress management, which they utilize to support both team cohesion and individual well-being among hospice professionals [24, 25, 34, 36]. A key competency lies in their ability to maintain team stability through enhanced communication protocols and information-sharing systems. Their professional sensitivity enables them to identify and address psychological pain that might otherwise be overlooked due to disciplinary differences in perception and approach. Furthermore, they demonstrate strategic competencies in clarifying role differentiation and optimizing operational workflows, thereby preventing inefficiencies in service delivery. Through the effective application of these competencies, social workers synergize diverse professional strengths, transforming multidisciplinary groups into cohesive, high-functioning care teams [25, 31]. Their unique skill set in team coordination and system optimization ultimately enhances the quality of palliative care delivery while supporting both patients and fellow healthcare professionals.

Communication facilitator between patients(families) and healthcare professionals

Social workers possess specialized competencies in mediation and information synthesis, which enable them to effectively bridge communication gaps between patients, families, and multidisciplinary healthcare teams. They apply advanced communication skills to cultivate an environment conducive to open-ended dialogue, which is essential for understanding the unique needs and preferences of patients and their families. Through their expertise in data integration, social workers systematically collect and synthesize information from diverse sources, including medical records, psychosocial assessments, and family histories. By leveraging these analytical and integrative skills, they provide the healthcare team with comprehensive and accurate data, empowering informed clinical decision-making and the development of personalized care plans [24, 27, 31, 38].Additionally, social workers demonstrate exceptional competencies in knowledge dissemination and team coordination [23, 27,28,29, 31, 32]. ensuring the seamless flow of critical information among all stakeholders. This coordination skill set not only maintains team alignment but also enhances the delivery of optimized, patient-centered care.

Communication facilitator between patients and their families

During periods of uncertainty and distress, social workers intervene to assist patients and their families in grappling with complex decisions. They offer emotional counseling and psychological support during family meetings, creating opportunities for family members to progress and reach consensus in decision-making [22, 23, 29, 31,32,33, 38]. Confronted with the reality of death, social workers collaborate with families to help patients reflect on their lives, plan for the remaining time with the dying individual, and kindle realistic hope. As facilitators of communication between patients and their families, social workers mobilize and integrate essential resources to ensure the best-possible services for patients [22, 23, 25, 26, 32].

AssessmentPatient assessment

The competencies to assess the needs of patients and their families is characterized by multi-dimensionality, real-time adaptability, dynamism, and methodological diversity. Social workers evaluate multiple dimensions of a patient's life, with a focus on aspects such as safety, illness perception, decision-making capacity, quality of life, psychosocial well-being, and social support networks. They gather insights through various means, including basic information collection, assessment of problem severity, quality-of-life evaluation, analysis of support networks, pain scale measurement, and assessment of suicidal intentions [23, 26, 28, 35, 40]. This process involves understanding the patient's primary current needs and expectations, coping mechanisms, understanding of illness perceptions, and healthcare planning [24, 26, 28, 29, 31, 40]. It is worth noting that the focus of social workers'assessments varies depending on the disease and age group [34]. For instance, during the treatment of Parkinson's disease, social workers concentrate on assessing mobility and drug-induced hallucinations [23, 35, 38].

Family assessment

Drawing on family system theory, social workers acknowledge the interdependence among family members and the significant impact of a member's terminal illness on the entire family system. They assess family's knowledge and skills of caregiving, communication patterns, and coping strategies, and then provide psychosocial support and interventions [28, 29, 31, 33,