Social Work’s Daniel Gardner Explores Ways to Improve End-of-Life Care

By Barbara Jester

No one can deny that America is graying. As baby boomers age and their parents live longer, the demographic switch to an older America is creating a critical need for geriatric health care professionals, including social workers, trained to enhance the health and well-being of older adults and their families.

Daniel Gardner, assistant professor in the School of Social Work and a 2006 Hartford Faculty Scholar in Geriatric Social Work, is facing the challenges presented by an older America as he explores ways to improve end-of-life care. His recent research focused on what happens with older couples when one of the partners has terminal cancer.

“The health care system tends to focus on the individual patient. But, as we know, people experience illness and make decisions about their care in the context of families and sometimes friends,” said Gardner. “I wanted to explore the relational aspects of advanced and progressive illness between older couples.”

Gardner crafted a study, partially supported by the John A. Hartford Foundation and the American Cancer Society, which surveyed 35 patient/caregiver dyads in an effort to understand how the partner relationship affected cancer patients and their partner caregivers. All but two of the couples were married, and the mean number of years together was 35. Patients were between 56 and 81 years old; 29 patients were white; four were African-American; and two were Latino.

As he interviewed these couples, Gardner discovered the phenomenon of “the 36-hour-day,” the unremitting stress placed upon both the caregiver and the cancer patient. He also discovered the amazing accommodations the couples made to living with advanced illness. For example: a 62-year-old engineer is married to a 60-year-old hairdresser who has terminal breast cancer. She has lost 55 pounds. The engineer, who has been a “traditional” husband, takes leave from his job and teaches himself how to cook. He becomes responsible for his wife’s nutrition and nurses her. She is so happy that he is doing this and feels assured of his love. He is proud that he can take care of her, even in the little things such as making her food that she likes.

Gardner’s study paid particular attention to how couples communicate: what they did and did not discuss about the patient’s illness and medical care. He discovered that couples negotiated the emotional impacts of illness primarily through non-verbal communication, saving overt conversation for medical decision-making and solving concrete concerns such as getting financial affairs in order. He also noted how the dyad changed along with changes in physical intimacy and changes in roles and the structure of the household. “The illness becomes the shared profession of the caregiver and the patient, and almost all were willing to take this burden on,” said Gardner.

Based on his findings in this study, Gardner developed a model of adaptive tasks for older couples facing chronic and terminal illness and made recommendations for social work practice and research with older families at the end of life.

As a Hartford Faculty Scholar, Gardner is launching a new phase of his research. In collaboration with an inpatient palliative care program, he will be developing and piloting a program that will work with terminal cancer patients and their family caregivers in order to enhance family emotional and social support, teach skills of family communication and problem-solving, and increase knowledge about patient care and advance care planning.