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Editor's e-Note
Hospice is a time when people face a life-limiting illness or injury, and it involves a team-oriented approach to medical care, pain management, and emotional and spiritual support of the patient's needs and wishes.

It is only within recent years that trauma-informed care has become an important orientation in working with clients in general, and it has eventually been applied to hospice and palliative care as the end of life is a time that may mimic original trauma, exacerbating previously mild PTSD symptomatology and lead to significant distress. It is a time when key memories can be trauma related and the normal process of life review can lead to anxiety, sadness, guilt, or anger. Our E-News Exclusive describes how hospice professionals can practice trauma-informed care that recognizes the symptoms of patients who are experiencing trauma at the end of life.

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— Marianne Mallon, editor
e-News Exclusive
Trauma-Informed End of Life Care
By J. Scott Janssen, MSW, LCSW

In recent years there has been an increasing awareness about the prevalence and impact of traumatic stress reactions and PTSD in the general population. More than one-half of the adults in the United States experience at least one psychological trauma in their lifetime and approximately 25% of those who have will develop PTSD (Feldman, 2006). This has led many social workers to alter their practice in the interests of becoming trauma informed in order to better identify when clients are being triggered by situations that activate (often undisclosed) traumatic stress, and to respond in ways that help them stabilize and move toward healing.

Such a trauma-informed orientation is important when working with clients struggling with terminal illness. In one of the few studies to date exploring the intersection of terminal illness and unresolved PTSD, Feldman and Periyakoil (2006) argue that existing PTSD can complicate the dying process in a number of ways, including the following:

• The threat to life inherent in terminal illness may mimic the original trauma, exacerbating previously mild PTSD symptomatology and leading to significant distress.

• When key memories are trauma related, the normal process of life review can lead to intense anxiety, sadness, guilt, or anger.

• Avoidance symptoms and distrust of authority figures can lead to poor medical adherence and strained communication with the medical team.

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