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Brown CK, DiBiase J, Nathanson A, Cadet TJ. Trauma-Informed Care for Inpatient Palliative Care Social Work: Applying Existing Models at the Bedside. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:309-325. [PMID: 37698906 PMCID: PMC10840610 DOI: 10.1080/15524256.2023.2256479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Coexisting serious illness and posttraumatic stress place hospitalized individuals at risk for complex pain, anxiety, and retraumatization. Hospital palliative care social workers increasingly recognize the value of trauma-informed care (TIC) for reducing harm in the inpatient setting. Despite this recognition, there is limited operationalization of TIC principles for inpatient interventions. This paper integrates each TIC principle with inpatient psychosocial interventions to advance trauma-informed competencies among inpatient palliative care social workers and to provide a foundation for future TIC implementation research.
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Affiliation(s)
| | - Jennifer DiBiase
- Department of Geriatrics and Palliative Medicine, Mount Sinai Beth Israel
| | | | - Tamara J. Cadet
- School of Social Policy & Practice, University of Pennsylvania
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2
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Meyerson JL, O'Malley KA, Obas CE, Hinrichs KLM. Lived Experience: A Case-Based Review of Trauma-Informed Hospice and Palliative Care at a Veterans Affairs Medical Center. Am J Hosp Palliat Care 2023; 40:329-336. [PMID: 35848682 DOI: 10.1177/10499091221116098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Many individuals who present for hospice or palliative care might have experienced trauma during their lives, with some progressing to post-traumatic stress disorder. As these individuals face life-limiting illness, trauma might resurface. Consequently, physical and emotional health might suffer due to exacerbation of trauma-related symptoms, such as anxiety, irritability, or flashbacks. Providing trauma-informed care can help mitigate the effects of trauma for those facing life-limiting illness who might not be able to tolerate formal trauma treatment due to limited prognosis, fatigue, or lack of willingness to engage in treatment. The goal of this narrative review is to describe how aging and the end-of-life experience can lead to a re-engagement with previous traumatic experiences and, using case-based examples, provide recommendations for all members of the interprofessional hospice or palliative care team on how to elicit and respond to a history of trauma to minimize the potential negative impact of trauma at end-of-life.
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Affiliation(s)
- Jordana L Meyerson
- Medical Service, Section of Palliative Care, 20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kelly A O'Malley
- Mental Health Service, RinggoldID:20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christelle E Obas
- Department of Nursing, 20026Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Kate L M Hinrichs
- Mental Health Service, RinggoldID:20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Coffey M, Edwards D, Anstey S, Gill P, Mann M, Meudell A, Hannigan B. End-of-life care for people with severe mental illness: mixed methods systematic review and thematic synthesis of published case studies (the MENLOC study). BMJ Open 2022; 12:e053223. [PMID: 35193909 PMCID: PMC8867317 DOI: 10.1136/bmjopen-2021-053223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES People with severe mental illness (SMI) have significant comorbidities and reduced life expectancy. The objective of the review reported in this paper was to synthesise material from case studies relating to the organisation, provision and receipt of care for people with SMI who have an end-of-life (EoL) diagnosis. DESIGN Systematic review and thematic synthesis. DATA SOURCES MEDLINE, PsycINFO, EMBASE, HMIC, AMED, CINAHL, CENTRAL, ASSIA, DARE and Web of Science from inception to December 2019. Supplementary searching for additional material including grey literature along with 62 organisational websites. RESULTS Of the 11 904 citations retrieved, 42 papers reporting 51 case studies were identified and are reported here. Twenty-five of the forty-two case study papers met seven, or more quality criteria, with eight meeting half or less. Attributes of case study subjects included that just over half were men, had a mean age of 55 years, psychotic illnesses dominated and the EoL condition was in most cases a cancer. Analysis generated themes as follows diagnostic delay and overshadowing, decision capacity and dilemmas, medical futility, individuals and their networks, care provision. CONCLUSIONS In the absence of high-quality intervention studies, this evidence synthesis indicates that cross disciplinary care is supported within the context of established therapeutic relationships. Attention to potential delay and diagnostic overshadowing is required in care provision. The values and preferences of individuals with severe mental illness experiencing an end-of-life condition should be recognised. PROSPERO REGISTRATION NUMBER CRD42018108988.
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Affiliation(s)
- Michael Coffey
- School of Health and Social Care, Swansea University, Swansea, West Glamorgan, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sally Anstey
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Paul Gill
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Mala Mann
- University Library Services, Cardiff University, Cardiff, UK
| | | | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Riss T. A case report of posttraumatic stress disorder at the end of life. Wien Med Wochenschr 2021; 172:184-188. [PMID: 34727275 DOI: 10.1007/s10354-021-00892-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
A case of posttraumatic stress disorder (PTSD) in the last days of life is presented. It shows insufficient pharmacological therapy and PTSD that was not recognized early enough. We discuss the dilemma caused by the necessity of a long-term psychotherapy and the challenge of little time being left at the end of life. Additionally, a language barrier can be a main reason for misinterpreting symptoms of PTSD.
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Affiliation(s)
- Tabea Riss
- PBZ Berndorf/NÖ, Leobersdorferstraße 8, 2560, Berndorf, Austria.
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Ricks-Aherne ES, Wallace CL, Kusmaul N. Practice Considerations for Trauma-Informed Care at End of Life. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:313-329. [PMID: 32960739 DOI: 10.1080/15524256.2020.1819939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Trauma is widespread, and its symptoms can adversely impact wellbeing at end of life, a time when hospice seeks to maximize quality of life. This article reviews research on trauma at end of life, provides an overview of trauma-informed principles, and explores possibilities for applying trauma-informed care through an illustrative case study of a patient at end of life. The case discussion applies findings from the literature using Feldman's Stepwise Psychosocial Palliative Care model as a roadmap. As shown in the case study, trauma-related symptoms may complicate care, making it an important subject of clinical attention for interdisciplinary hospice team members. As part of this team, social workers are particularly well suited to provide more targeted interventions where indicated, though all members of the team should take a trauma-informed approach. Lastly, this article reflects on the need for organizations to take a systems-level approach when implementing trauma-informed care and suggests implications for practice through a universal approach to trauma and the need for trauma-specific assessments and interventions at end-of-life, along with areas for future research.
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Affiliation(s)
- Elizabeth S Ricks-Aherne
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Cara L Wallace
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA
| | - Nancy Kusmaul
- School of Social Work, University of Maryland Baltimore County, Baltimore, Maryland, USA
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Sable-Smith A, Hiroto K, Periyakoil VS. Assessment and Treatment of Post-Traumatic Stress Disorder at the End of Life #398. J Palliat Med 2020; 23:1270-1272. [PMID: 32877281 PMCID: PMC9836664 DOI: 10.1089/jpm.2020.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Alex Sable-Smith
- Address correspondence to: Alex Sable-Smith, MD, MPH, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
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Park T, Hegadoren K, Workun B. Working at the Intersection of Palliative End-of-Life and Mental Health Care: Provider Perspectives. J Palliat Care 2020; 37:183-189. [PMID: 32808560 DOI: 10.1177/0825859720951360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort-particularly those with a comorbid, chronic and persistent mental illness (CPMI)-are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients. METHOD Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis. RESULTS The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not. SIGNIFICANCE OF RESULTS Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers.
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Affiliation(s)
- Tanya Park
- Faculty of Nursing, 3158University of Alberta, Edmonton, Canada
| | - Kathy Hegadoren
- Faculty of Nursing, 3158University of Alberta, Edmonton, Canada
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Feldman DB. Stepwise Psychosocial Palliative Care: A New Approach to the Treatment of Posttraumatic Stress Disorder at the End of Life. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2017; 13:113-133. [PMID: 28753122 DOI: 10.1080/15524256.2017.1346543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although evidence-based therapies for Posttraumatic Stress Disorder (PTSD) exist for physically healthy populations, these often do not adequately address PTSD in dying patients. Particularly because these interventions require 8-16 weekly sessions, and the median stay in U.S. hospices is 17.5 days (National Hospice and Palliative Care Organization [NHPCO], 2015 ), there is a potentially serious timing mismatch. Moreover, these treatments may temporarily increase trauma symptoms (Nishith, Resick, & Griffin, 2002 ), resulting in some patients dying in greater distress than had they not received care. The Stepwise Psychosocial Palliative Care (SPPC) model presented in this article compensates for these difficulties by embracing a palliative care approach to PTSD. Although it utilizes techniques drawn from existing PTSD interventions, these are re-ordered and utilized in a time-responsive, patient-centered manner that takes into account prognosis, fatigue, and logistical concerns. The SPPC approach is further considered with respect to existing social work palliative care competencies (Gwyther et al., 2005 ) and a case study is used to demonstrate its application.
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Affiliation(s)
- David B Feldman
- a Department of Counseling Psychology , Santa Clara University , Santa Clara , California , USA
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Ganzel BL. Trauma-Informed Hospice and Palliative Care. THE GERONTOLOGIST 2016; 58:409-419. [DOI: 10.1093/geront/gnw146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 07/07/2016] [Indexed: 12/12/2022] Open
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Krause-Parello CA, Levy C, Holman E, Kolassa JE. Effects of VA Facility Dog on Hospitalized Veterans Seen by a Palliative Care Psychologist: An Innovative Approach to Impacting Stress Indicators. Am J Hosp Palliat Care 2016; 35:5-14. [PMID: 27895150 DOI: 10.1177/1049909116675571] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The United States is home to 23 million veterans. In many instances, veterans with serious illness who seek healthcare at the VA receive care from a palliative care service. Animal-assisted intervention (AAI) is gaining attention as a therapeutic stress reducing modality; however, its effects have not been well studied in veterans receiving palliative care in an acute care setting. A crossover repeated-measures study was conducted to examine the effects of an animal-assisted intervention (AAI) in the form of a therapy dog on stress indicators in 25 veterans on the palliative care service at the VA Eastern Colorado Healthcare System in Denver, CO. Veterans had a visit from a therapy dog and the dog's handler, a clinical psychologist (experimental condition) and an unstructured visit with the clinical psychologist alone (control condition). Blood pressure, heart rate, and the salivary biomarkers cortisol, alpha-amylase, and immunoglobulin A were collected before, after, and 30-minutes after both the experimental and control conditions. Significant decreases in cortisol were found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.007) and control condition ( p = 0.036). A significant decrease in HR was also found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.0046) and control ( p = 0.0119) condition. Results of this study supported that a VA facility dog paired with a palliative care psychologist had a measurable impact on salivary cortisol levels and HR in veterans.
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Affiliation(s)
- Cheryl A Krause-Parello
- 1 Canines Providing Assistance to Wounded Warriors (C-P.A.W.W.), Health Research Initiative for Veterans, College of Nursing, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Cari Levy
- 2 Department of Medicine, Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Elizabeth Holman
- 3 Palliative care psychologist and handler of facility dog Waffle, Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - John E Kolassa
- 4 Department of Statistics and Biostatistics, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
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Holland JM, Currier JM, Kirkendall A, Keene JR, Luna N. Sadness, Anxiety, and Experiences with Emotional Support among Veteran and Nonveteran Patients and their Families at the End of Life. J Palliat Med 2014; 17:708-11. [DOI: 10.1089/jpm.2013.0485] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Nora Luna
- Nathan Adelson Hospice, Las Vegas, Nevada
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