End-of-life care is one of those practice areas that can feel emotionally heavy — and on the ASWB exam, it can feel conceptually murky too. Questions about hospice settings tend to blend several content areas at once: grief and loss, ethics, interdisciplinary collaboration, and client self-determination. If you're not thinking clearly about how those elements interact, you can talk yourself into the wrong answer pretty quickly.

Here's what shows up, why it matters, and how to think through it when you're under exam pressure.

What the Exam Is Actually Testing

When ASWB writes hospice-related questions, they're rarely just testing whether you know what hospice is. They're more interested in how you navigate the emotional and ethical complexity of the setting. That means you'll see scenarios involving conflicting family wishes, questions about a client's right to refuse treatment, grief that doesn't follow a tidy timeline, and the social worker's role within a team.

The hospice interdisciplinary team (IDT) is worth understanding clearly. Social workers in hospice settings work alongside nurses, chaplains, physicians, and home health aides — and on the exam, your role within that team is well-defined. You're not the medical decision-maker. You're the person addressing psychosocial needs, facilitating family communication, helping clients and families process anticipatory grief, and connecting people to practical resources. If a question gives you a medical finding or symptom and asks what you should do, the answer is almost never to handle it yourself — it's to bring it to the appropriate team member.

Anticipatory Grief and the Kübler-Ross Caveat

You'll want to know the concept of anticipatory grief — the grief that begins before a death actually occurs — because hospice social work is saturated with it. Clients may be grieving their own approaching death. Family members may be cycling through anger, guilt, and denial while their loved one is still alive. Both are normal, and both require your engagement.

Kübler-Ross's stages of grief will almost certainly appear somewhere in your exam content. But here's the thing the exam is increasingly testing: those stages are descriptive, not prescriptive. They're not a linear checklist, and clients don't have to move through them in order or experience all of them. When a question presents a family member who seems "stuck" in anger two weeks after a hospice admission, your job is not to push them toward acceptance — it's to meet them where they are. The exam rewards the non-directive, client-centered response more often than the psychoeducational one.

Self-Determination at the End of Life

This is where exam questions can get genuinely hard. A client with a terminal diagnosis has the right to make decisions about their own care — including decisions you or their family might disagree with. If a client tells you they don't want aggressive pain management because they want to remain alert, that's their right. If a client wants to pursue an alternative treatment that their oncologist thinks is futile, you're not in the position of overriding their choice.

Where it gets complicated is when family members want something different. The exam loves to put you in the middle of a family that wants "everything done" while the client has expressed clearly, verbally or through advance directives, that they want comfort care only. In those situations, the social worker's first obligation is to the client. Your role is to facilitate a conversation, help the family understand the client's wishes, and support everyone through a painful process — but you don't subordinate a competent adult's expressed wishes to family pressure.

Advance directives — including living wills and healthcare proxies — exist specifically to clarify these situations. When a client has one, it matters. If a question involves a conflict between a family's wishes and a client's documented advance directive, the advance directive generally governs, and your job is to support that process.

Pause here: if you saw an exam question where a client with a terminal diagnosis tells you they've changed their mind about hospice and wants to go back to curative treatment, what would you do? The answer isn't to explore their ambivalence or involve the team — it's to support that decision and facilitate the transition. Hospice is voluntary, and clients can disenroll at any time.

Ethical Considerations Around End of Life

The ASWB exam will not ask you about physician-assisted death in a way that requires you to take a position, but it may ask about your role when a client brings it up. In those scenarios, your job is to explore the underlying concerns — fear of pain, loss of control, burden on family — and ensure the client has access to appropriate palliative care and support. You're not in a position to facilitate or oppose a medical decision, but you're absolutely in a position to address the emotional drivers behind it.

Confidentiality still applies in hospice settings, even when family is deeply involved. The fact that a client is dying doesn't mean everyone has the right to their medical information. If a question involves a client who doesn't want certain family members to know the prognosis, you're bound by that preference unless there's a compelling ethical or legal reason to override it.

The Grief That Comes After

Hospice social work doesn't end at death. Bereavement follow-up is a standard component of hospice care under Medicare's hospice benefit, and the exam may reflect that. Survivors often need support processing the death, navigating guilt or complicated grief, and managing the practical and logistical changes that follow a loss.

Complicated grief — sometimes called prolonged grief disorder in more recent diagnostic language — is characterized by grief that is persistently intense, interferes with functioning, and doesn't follow the expected trajectory over time. It's more than being sad for a long time. The exam may ask you to distinguish between typical bereavement and a presentation that warrants a referral for more specialized mental health support.

A Sample Question to Try

A hospice social worker meets with an adult client who has been diagnosed with a terminal illness and has six months to live. The client's adult children tell the social worker they do not want their parent to be told the prognosis because they believe it will cause too much distress. The client has not indicated that they do not want this information. What should the social worker do FIRST?

A. Respect the family's request and withhold the prognosis from the client
B. Explain to the family that the client has a right to information about their own health
C. Consult with the hospice physician before speaking with the client
D. Assess the client's coping strengths before discussing the diagnosis

A competent adult has the right to information about their own medical situation, and you cannot withhold it based on family request alone. The family's concern is understandable and worth acknowledging, but it doesn't override the client's right to informed decision-making about their own care and end-of-life choices. Option D might seem reasonable — assessing coping first — but the more fundamental issue is that the family is asking you to participate in withholding information the client hasn't declined. The best answer is B. 

Bringing It Together

Hospice questions on the ASWB exam test your ability to hold complexity: grief that's messy and nonlinear, families in conflict, and clients whose autonomy matters even at the end of life. The social worker's role in these scenarios is consistently one of facilitation, advocacy for the client's expressed wishes, and emotional support for everyone involved — without overstepping into medical decision-making or imposing your own values on the process.

If you want to see how these concepts get tested in realistic exam scenarios, SWTP's practice tests include questions drawn from clinical settings like hospice care, where the ethical and relational stakes are high and the "obvious" answer often isn't the right one. Seeing how you respond under pressure is worth knowing before test day.




February 19, 2026
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