Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life

Overview

Journal Am J Hosp Palliat Care

Publisher Sage Publications

Specialties Critical Care
Nursing

Date 2018 Feb 22

PMID 29463090

Citations 11

Authors

Debra M Glick

Joan M Cook

Jennifer Moye

Anica Pless Kaiser

Affiliations

Soon will be listed here.

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 literature 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.

Citing Articles

The prevalence of lifetime trauma and association with physical and psychosocial health among adults at the end of life.

Duchowny K, Smith A, Cenzer I, Brown C, Noppert G, Yaffe K J Am Geriatr Soc. 2024; 73(1):123-135.

PMID: 39353852 PMC: 11735274. DOI: 10.1111/jgs.19209.

Re-living trauma near death: an integrative review using Grounded Theory narrative analysis.

Johnston N, Chapman M, Gibson J, Paterson C, Turner M, Strickland K Palliat Care Soc Pract. 2024; 18:26323524241277851.

PMID: 39346008 PMC: 11439169. DOI: 10.1177/26323524241277851.

Mental Health Integration and Delivery in the Hospice and Palliative Medicine Setting: A National Survey of Clinicians.

Shalev D, Robbins-Welty G, Ekwebelem M, Moxley J, Riffin C, Reid M J Pain Symptom Manage. 2023; 67(1):77-87.

PMID: 37788757 PMC: 10841817. DOI: 10.1016/j.jpainsymman.2023.09.025.

Trauma-Informed Care for Inpatient Palliative Care Social Work: Applying Existing Models at the Bedside.

Brown C, DiBiase J, Nathanson A, Cadet T J Soc Work End Life Palliat Care. 2023; 19(4):309-325.

PMID: 37698906 PMC: 10840610. DOI: 10.1080/15524256.2023.2256479.

Hospice and Palliative Medicine Fellowship Training in Mental Health: A Survey of Program Directors.

Shalev D, Ekwebelem M, Brody L, Callahan M, Singh N, Reid M J Pain Symptom Manage. 2023; 66(4):310-319.

PMID: 37442531 PMC: 10528591. DOI: 10.1016/j.jpainsymman.2023.06.015.

References

Chochinov H, Kristjanson L, Breitbart W, McClement S, Hack T, Hassard T . Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncol. 2011; 12(8):753-62. PMC: 3185066. DOI: 10.1016/S1470-2045(11)70153-X. View

Chang B, Stein N, Trevino K, Stewart M, Hendricks A, Skarf L . End-of-life spiritual care at a VA medical center: chaplains' perspectives. Palliat Support Care. 2012; 10(4):273-8. DOI: 10.1017/S1478951511001003. View

Cook J, Elhai J, Cassidy E, Ruzek J, Ram G, Sheikh J . Assessment of trauma exposure and post-traumatic stress in long-term care veterans: preliminary data on psychometrics and post-traumatic stress disorder prevalence. Mil Med. 2006; 170(10):862-6. DOI: 10.7205/milmed.170.10.862. View

Chopra M, Zhang H, Pless Kaiser A, Moye J, Llorente M, Oslin D . PTSD is a chronic, fluctuating disorder affecting the mental quality of life in older adults. Am J Geriatr Psychiatry. 2013; 22(1):86-97. DOI: 10.1016/j.jagp.2013.01.064. View

Brewin C . Systematic review of screening instruments for adults at risk of PTSD. J Trauma Stress. 2005; 18(1):53-62. DOI: 10.1002/jts.20007. View

Feldman D, Periyakoil V . Posttraumatic stress disorder at the end of life. J Palliat Med. 2006; 9(1):213-8. DOI: 10.1089/jpm.2006.9.213. View

Stagg E, Lazenby M . Best practices for the nonpharmacological treatment of depression at the end of life. Am J Hosp Palliat Care. 2011; 29(3):183-94. DOI: 10.1177/1049909111413889. View

Gutermann J, Schreiber F, Matulis S, Schwartzkopff L, Deppe J, Steil R . Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children, Adolescents, and Young Adults: A Meta-Analysis. Clin Child Fam Psychol Rev. 2016; 19(2):77-93. DOI: 10.1007/s10567-016-0202-5. View

Maercker A, Bachem R . Life-review interventions as psychotherapeutic techniques in psychotraumatology. Eur J Psychotraumatol. 2013; 4. PMC: 3660622. DOI: 10.3402/ejpt.v4i0.19720. View

10.

Gilpin H, Keyes A, Stahl D, Greig R, McCracken L . Predictors of Treatment Outcome in Contextual Cognitive and Behavioral Therapies for Chronic Pain: A Systematic Review. J Pain. 2017; 18(10):1153-1164. DOI: 10.1016/j.jpain.2017.04.003. View

11.

Rosenfeld B, Saracino R, Tobias K, Masterson M, Pessin H, Applebaum A . Adapting Meaning-Centered Psychotherapy for the palliative care setting: Results of a pilot study. Palliat Med. 2016; 31(2):140-146. PMC: 5473503. DOI: 10.1177/0269216316651570. View

12.

Dinnen S, Simiola V, Cook J . Post-traumatic stress disorder in older adults: a systematic review of the psychotherapy treatment literature. Aging Ment Health. 2014; 19(2):144-50. DOI: 10.1080/13607863.2014.920299. View

13.

Cook J, McCarthy E, Thorp S . Older Adults with PTSD: Brief State of Research and Evidence-Based Psychotherapy Case Illustration. Am J Geriatr Psychiatry. 2017; 25(5):522-530. DOI: 10.1016/j.jagp.2016.12.016. View

14.

Savel R, Munro C . The importance of spirituality in patient-centered care. Am J Crit Care. 2014; 23(4):276-8. DOI: 10.4037/ajcc2014328. View

15.

Weathers F, Bovin M, Lee D, Sloan D, Schnurr P, Kaloupek D . The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2017; 30(3):383-395. PMC: 5805662. DOI: 10.1037/pas0000486. View

16.

Ganzel B . Trauma-Informed Hospice and Palliative Care. Gerontologist. 2016; 58(3):409-419. DOI: 10.1093/geront/gnw146. View

17.

Russo S, Hersen M, Van Hasselt V . Treatment of reactivated post-traumatic stress disorder. Imaginal exposure in an older adult with multiple traumas. Behav Modif. 2001; 25(1):94-115. DOI: 10.1177/0145445501251006. View

18.

Bush S, Leonard M, Agar M, Spiller J, Hosie A, Wright D . End-of-life delirium: issues regarding recognition, optimal management, and the role of sedation in the dying phase. J Pain Symptom Manage. 2014; 48(2):215-30. DOI: 10.1016/j.jpainsymman.2014.05.009. View

19.

Wang T, Wei H, Liou Y, Su T, Bai Y, Tsai S . Risk for developing dementia among patients with posttraumatic stress disorder: A nationwide longitudinal study. J Affect Disord. 2016; 205:306-310. DOI: 10.1016/j.jad.2016.08.013. View

20.

Beng T, Chin L, Guan N, Yee A, Wu C, Jane L . Mindfulness-based supportive therapy (MBST): proposing a palliative psychotherapy from a conceptual perspective to address suffering in palliative care. Am J Hosp Palliat Care. 2013; 32(2):144-60. DOI: 10.1177/1049909113508640. View