Editor Introduction.

Welcome to another issue! Each in a different way, the authors in this issue together present a focus on difficult medical/social situations that may cause distress in the individual or caregivers and thus lead toward a lessening of quality of life at the end of life. These articles show the value of taking into consideration that traumatic experiences happen in everyday lives While suicide among hospice recipients has received some attention in the literature, suicide and suicidal thoughts among hospice caregivers has not. Primary among the difficulties with focusing on this topic is the fact that most receive hospice care for a very short time. The first article, by Mirick and Wladkowski, takes us through a case study presenting a step-by-step recognition of the issues involved and recommendations for how social workers can best utilize prevention techniques and intervene as necessary. The first among these is universal screening for suicidality. Social workers may also engage in providing resources, safety planning, supportive contacts, including following death of the care recipient and continue their own training and awareness of suicidality. Cunningham et al. explored psychosocial distress as it related to cardiac distress in individuals with advanced heart failure and then further linked this to traumatic distress. Of course this is important as it has been well-established that psychosocial distress and traumatic distress can lead to negative health outcomes. Through a survey of individuals with advanced heart failure, multiple measures were utilized to understand distress on multiple levels and included measures of depression and anxiety. Explore the usefulness of the current measures in assessing distress in this population. They found that the number of exposures to potentially traumatic incidents, the higher the distress and then likely higher level of traumatic distress, but no predictors of it in this particular group of respondents. The authors suggest that further study is needed with this population and also examination of the usefulness of the measures for populations with advance heart disease. Next, Cagle and Brandon address the issue of social justice in palliative care. They conducted a survey of hospice and palliative care social workers’ perceptions on the meaning of social justice and how these social workers see the issue played out in their work. These social workers reported encountering many people who are disadvantaged in some way, economically, physically or intellectually, and non-English speaking as well as those who abuse substances or are homeless. All of these individuals may be at a higher risk to experience social injustices and in turn, traumatic experiences. The respondents’ defined social justice as access to basic needs, high-quality care, and education without regard to group membership. Also identified were ways to overcome barriers to access, some of which included the recognition that something active needs to be done, such as outreach, advocacy, increased funding and efforts to enhance the professional value of social work to other health professions so they have the sanction to address social injustices. Of course, this work will be ongoing and Cagle and Brandon should be applauded to have taken this first look at the issue for social workers in palliative and end-of-life care.