Hospice and palliative care clinicians’ perceptions of posttraumatic stress disorder at end-of-life in military veterans

In many ways, veterans face the end of life in a similar manner as civilians. In some ways, however, they experience death differently. Military experiences often change veterans in fundamental ways that shape, mold, destroy, and redeem the rest of their lives, including the ends of their lives. This chapter identifies some of these differences in the hopes that readers will understand the unique hospice and palliative care needs of veterans and their families. For example, the value of stoicism so earnestly and necessarily indoctrinated in young soldiers may interfere with a peaceful death for veterans depending on the degree to which stoicism has permeated their post-military lives. This chapter provides lessons that inform healthcare delivery for veterans and bereavement care for their families. It explains how posttraumatic stress disorder (PTSD) can become exacerbated at the end of life, complicating peaceful dying. An overlooked, unassessed wound, now identified as “soul injury” and distinguishable from moral injury, will also be addressed.

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Treatment of posttraumatic stress disorder at the end-of-life: Application of the stepwise psychosocial palliative care model

Palliative & Supportive Care ◽

10.1017/s1478951513000370 ◽

2013 ◽

Vol 12 (3) ◽

pp. 233-243 ◽

Cited By ~ 7

Author(s):

David B. Feldman ◽

Kristen H. Sorocco ◽

Kristi L. Bratkovich

Keyword(s):

Posttraumatic Stress Disorder ◽

Palliative Care ◽

Posttraumatic Stress ◽

End Of Life ◽

Stress Disorder ◽

Evidence Based ◽

Care Model ◽

New Approach ◽

Behavioral Techniques ◽

Complex Settings

AbstractObjectives:Feldman (2011) has proposed a new approach to the treatment of posttraumatic stress disorder (PTSD) in individuals at the end-of-life known as Stepwise Psychosocial Palliative Care (SPPC). This approach helps to compensate for the disadvantages of existing PTSD interventions with regard to treating patients with life-limiting and terminal illnesses by employing a palliative care philosophy. The model relies on cognitive and behavioral techniques drawn from evidence-based approaches to PTSD, deploying them in a stage-wise manner designed to allow for interventions to track with patents’ needs and prognoses. Because this model is relatively new, we seek to explore issues related to its implementation in the complex settings in which providers encounter patients at the end-of-life. We also seek to provide concrete guidance to providers regarding the management of PTSD at the end-of-life in diverse palliative care settings.Methods:We examine three specific cases in which the SPPC model was utilized, highlighting particular treatment challenges and strategies. These case studies provide information regarding the SPPC model's application to patients in two distinct palliative care settings—a palliative care consult team and an inpatient palliative care unit.Results:The SPPC model's stage-wise approach allows for its flexible use given a variety of constraints related to setting and patient issues.Significance of results:The SPPC model provides an alternative to existing psychosocial treatments for PTSD that may be more appropriate for patients at the end of life.

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