Kaiser Anica Pless, O'Malley Kelly, Moye Jennifer, Etchin Anna G, Korsun Lynn, Weiskittle Rachel, Bashian Hannah, Kemp Katherine, Sager Zachary S
VA National Center for PTSD, Boston, MA, USA.
VA Boston Healthcare System, Boston, MA, USA.
Prog Palliat Care. 2021 Oct 3;2021:1-7. doi: 10.1080/09699260.2021.1980649.
At the end of life, individuals may re-engage with earlier life trauma as they reflect on life experiences and confront their mortality. As such, posttraumatic stress disorder (PTSD) symptoms at the end of life may worsen the quality of death experience. This is a concern for military veterans, who tend to have more trauma exposures and higher rates of PTSD, and particularly for veterans receiving care in rural areas where access to PTSD specialty services is limited. To better understand this issue, we conducted 10 focus groups with clinicians serving veterans in rural communities across five U.S. states. The aims of this project were to evaluate: (1) do hospice and palliative care providers/staff observe PTSD symptoms in veterans at the end of life? (2) if so, how are symptoms similar to and different from existing DSM-5 criteria for PTSD? We used qualitative content analysis with mixed deductive and inductive approaches to code 151 anonymized statements. Analyses found descriptions of PTSD symptoms aligned broadly with existing diagnostic nomenclature, but descriptions revealed specific presentations relevant to the end of life setting such as resistance to care, agitation, restlessness, and effects of delirium. In addition, some veterans expressed pride in service and openness to discussing military experiences. Further, clinicians noted that PTSD symptoms were relevant to family dynamics. Future research should further characterize these symptom differences through direct patient assessment and develop resources to improve quality of death experience for veterans with PTSD symptoms.
在生命末期，个体在反思人生经历并直面死亡时，可能会重新面对早年的生活创伤。因此，生命末期的创伤后应激障碍（PTSD）症状可能会使死亡体验的质量恶化。这对于军事退伍军人来说是一个问题，他们往往有更多的创伤经历和更高的PTSD发生率，对于在农村地区接受护理的退伍军人来说尤其如此，因为在这些地区获得PTSD专科服务的机会有限。为了更好地理解这个问题，我们在美国五个州的农村社区对为退伍军人提供服务的临床医生进行了10次焦点小组访谈。该项目的目的是评估：（1）临终关怀和姑息治疗提供者/工作人员是否观察到生命末期退伍军人的PTSD症状？（2）如果观察到，这些症状与现有的PTSD DSM-5标准有哪些异同？我们采用定性内容分析，结合演绎和归纳方法，对151条匿名陈述进行编码。分析发现，PTSD症状的描述与现有的诊断术语大致相符，但描述揭示了与临终环境相关的特定表现，如抗拒护理、烦躁、不安和谵妄的影响。此外，一些退伍军人对服役表示自豪，并愿意谈论军事经历。此外，临床医生指出，PTSD症状与家庭动态有关。未来的研究应通过直接的患者评估进一步描述这些症状差异，并开发资源以改善有PTSD症状的退伍军人的死亡体验质量。
