Stepwise Psychosocial Palliative Care: A New Approach to the Treatment of Posttraumatic Stress Disorder at the End of Life

2017 ◽  
Vol 13 (2-3) ◽  
pp. 113-133 ◽  
Author(s):  
David B. Feldman
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Palliative Care ◽  
Posttraumatic Stress ◽  
End Of Life ◽  
Stress Disorder ◽  
New Approach

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

2013 ◽  
Vol 12 (3) ◽  
pp. 233-243 ◽  
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.

End-of-Life-Related Factors Associated with Posttraumatic Stress and Prolonged Grief in Parentally Bereaved Adolescents

2020 ◽  
pp. 003022282096376
Author(s):  
Megan Weber Falk ◽  
Anette Alvariza ◽  
Ulrika Kreicbergs ◽  
Josefin Sveen
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
End Of Life ◽  
Stress Disorder ◽  
Ptsd Symptoms ◽  
Related Factors ◽  
Prolonged Grief Disorder ◽  
Prolonged Grief ◽  
Parentally Bereaved ◽  
Significant Difference

Posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) are well-documented in parentally bereaved adolescents. Whether or not the parent’s death is perceived as traumatic may be influenced by several end-of-life-related factors. This study aimed to examine the associations between end-of-life-related factors, symptoms of posttraumatic stress disorder (PTSD), symptoms of prolonged grief disorder and PGD, and the association between PTSD and PGD. Mann-Whitney U tests and Spearman correlation were used to analyze the relationships between end-of-life-related factors, PTSD, and PGD. Regretting one’s decision to be present or not present at the time of death resulted in a significant difference in self-reported scores for PTSD, but not PGD.

Posttraumatic stress disorder at the end of life: Extant research and proposed psychosocial treatment approach

2011 ◽  
Vol 9 (4) ◽  
pp. 407-418 ◽  
Author(s):  
David B. Feldman
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
End Of Life ◽  
Stress Disorder ◽  
Treatment Approach ◽  
Traumatic Event ◽  
Healthcare Providers ◽  
Life Review ◽  
Psychosocial Treatment

AbstractAccording to some estimates, 84% of people experience a traumatic event during their lives (Vrana & Lauterbach, 1994), and 15% to 24% then develop posttraumatic stress disorder (PTSD). Many carry with them lasting effects of trauma as they age and enter the last phase of life. PTSD manifests in unique ways at the end of life, possibly disrupting factors associated with a positive dying process, including social support, medical communication, life review, and acceptance of death. Terminally ill people with PTSD may suffer more emotional distress, lower quality of life, and poorer medical prognosis than those without PTSD. Unfortunately, healthcare providers may not be trained to address this issue. This article reviews the literature concerning how PTSD may affect the end of life and proposes an intervention model based on a palliative care philosophy.

Posttraumatic Stress Disorder and End-of-Life Care

2018 ◽  
Author(s):  
Kristen H. Sorocco ◽  
Kristi L. Bratkovich ◽  
Whalen JoAnne ◽  
David B. Feldman
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
End Of Life ◽  
End Of Life Care ◽  
Stress Disorder ◽  
Life Care

Veterans

2019 ◽  
pp. 539-544
Author(s):  
Deborah Grassman
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Palliative Care ◽  
Posttraumatic Stress ◽  
End Of Life ◽  
Healthcare Delivery ◽  
Moral Injury ◽  
Care Needs ◽  
Hospice And Palliative Care ◽  
Bereavement Care ◽  
Palliative Care Needs

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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