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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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DiBiase J. Social Workers as Leaders for Facilitating Trauma-Informed Palliative Care in the Outpatient Palliative Care Clinic. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:296-308. [PMID: 37768197 DOI: 10.1080/15524256.2023.2262157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Palliative care social workers are trained to identify how trauma manifests over the course of serious and chronic illness. This expertise can guide patients and team members to ensure a trauma-informed experience of care. This paper identifies the growth of outpatient palliative care clinics as an opportunity for palliative care social workers to emphasize this clinical skill set and assume a leadership role in the implementation of trauma-informed practices early in the trajectory of serious illness.
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Affiliation(s)
- Jennifer DiBiase
- Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai Beth Israel Hospital, New York, New York, USA
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Freud JS. The Vital Role of Palliative Care Social Workers in Providing Trauma-Informed Palliative Care. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2023; 19:277-280. [PMID: 36826444 DOI: 10.1080/15524256.2023.2183147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Jennifer S Freud
- Palliative Care Service, Valley Health Winchester Medical Center, Winchester, Virginia, 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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Yu ES. How to Deal with the Past Memories of Patients in Palliative Care: A Suggested New Approach. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2021; 24:69-73. [PMID: 37675237 PMCID: PMC10180050 DOI: 10.14475/jhpc.2021.24.2.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 09/08/2023]
Abstract
Dealing with existential concerns experienced by patients is an important part of palliative care. Interventions that use the life review method to encourage patients to reminisce about their lives can help them find new positive meanings, promote ego integrity, and reduce emotional suffering. Not everyone has positive memories when they look back on the past, however. This poses a limit on the effectiveness of the life review method for healthcare providers working in palliative care contexts. In this study, we discuss the limits of life review and suggest imagery rescripting as a new modality constituting a psychotherapeutic approach to deal with negative memories safely and effectively.
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Affiliation(s)
- Eun-Seung Yu
- Department of Counseling Psychology, The Cyber University of Korea, Seoul, Korea
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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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Brown C, Peck S, Humphreys J, Schoenherr L, Saks NT, Sumser B, Elia G. COVID-19 Lessons: The Alignment of Palliative Medicine and Trauma-Informed Care. J Pain Symptom Manage 2020; 60:e26-e30. [PMID: 32439516 PMCID: PMC7234954 DOI: 10.1016/j.jpainsymman.2020.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/29/2022]
Abstract
As the COVID-19 pandemic wears on, its psychological, emotional, and existential toll continues to grow and indeed may now rival the physical suffering caused by the illness. Patients, caregivers, and health-care workers are particularly at risk for trauma responses and would be well served by trauma-informed care practices to minimize both immediate and long-term psychological distress. Given the significant overlap between the core tenets of trauma-informed care and accepted guidelines for the provision of quality palliative care (PC), PC teams are particularly well poised to both incorporate such practices into routine care and to argue for their integration across health systems. We outline this intersection to highlight the uniquely powerful role PC teams can play to reduce the long-term psychological impact of the COVID-19 pandemic.
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Affiliation(s)
- Chelsea Brown
- Division of Palliative Medicine , Department of Social Work, University of California, San Francisco (UCSF), San Francisco, California, USA.
| | - Sarah Peck
- Division of Palliative Medicine , Department of Social Work, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Jessi Humphreys
- Division of Palliative Medicine , Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Laura Schoenherr
- Division of Palliative Medicine , Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Naomi Tzril Saks
- Division of Palliative Medicine , Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Bridget Sumser
- Division of Palliative Medicine , Department of Social Work, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Giovanni Elia
- Division of Palliative Medicine , Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
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Affiliation(s)
- Eve Makoff
- Torrance Memorial Health System, Torrance, California
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A scoping review of palliative care for persons with severe persistent mental illness. Palliat Support Care 2019; 17:479-487. [DOI: 10.1017/s1478951519000087] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePeople with severe persistent mental illness (SPMI) experience a greater burden and severity of chronic disease, late diagnosis, and premature death compared with the general population. Those with SPMI also receive fewer medical treatments, poor quality of care, and are less likely to receive palliative care. A systematic scoping review was undertaken to determine the extent, range, and nature of research activity about people with SPMI requiring palliative care, and to identify gaps and opportunities for future research.MethodA systematic scoping review was undertaken in September 2017 and updated in May 2018 to map literature on this topic, determine the extent and range of what has been published, and report the findings. This five-stage framework was conducted by (1) identifying the research question; (2) identifying relevant studies; (3) determining study selection; (4) charting the data; and 5) collating, summarizing, and reporting the results. A narrative approach to analysis was used to synthesize and interpret findings. A search of multidisciplinary healthcare databases resulted in 46 included articles.ResultFour major themes were identified from the included studies: complexity of care; limited access to care (both through systems and healthcare providers); competence and autonomy; and the potential for relationships between mental health and palliative care.Significance of resultsThis review reveals a highly vulnerable population with complex needs that are not reliably being met by the healthcare system and providers. Research in this area must continue to develop using rigorous qualitative and quantitative study designs, and interventions should be developed and tested based on existing knowledge to inform care. The voices of people with SPMI in need of palliative care must be represented in future studies to address gaps. To expand a body of literature addressing mainly individuals, system perspectives and sociocultural analysis can bring much to contextualizing the experience of living with SPMI in the palliative phase of care. Adoption of a palliative approach, which promotes the principles of palliative care across nonspecialized care settings provided by nonspecialist palliative providers, has the potential to increase access to high-quality palliative treatment for people with SPMI.
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Glick DM, Cook JM, Moye J, Kaiser AP. Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life. Am J Hosp Palliat Care 2018; 35:1133-1139. [PMID: 29463090 PMCID: PMC6546161 DOI: 10.1177/1049909118756656] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at end of life often lack the physical and mental stamina to participate in traditional psychotherapy. This article reviews the clinical and empirical literature on PTSD at end of life, as well as discusses assessment and psychotherapy treatment issues with this neglected population. In addition, it expands on the current reviews of this literature1-3 by extrapolating results from nontraditional treatment approaches with other patient populations. Elements of these approaches with patients sharing similar characteristics and/or comorbidities with patients with PTSD at end of life may provide additional benefits for the latter population. Clinical implications and suggestions for interdisciplinary care providers are provided.
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Affiliation(s)
- Debra M. Glick
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Joan M. Cook
- National Center for PTSD, VA Connecticut Healthcare System and Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer Moye
- VA Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
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