Stepwise Psychosocial Palliative Care: A New Approach to the Treatment of Posttraumatic Stress Disorder at the End of Life

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 National Hospice &; Palliative Care Organization (NHPCO). (2015). NHPCO Facts and figures: Hospice care in America. Retrieved from http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf. Google Scholar]), there is a potentially serious timing mismatch. Moreover, these treatments may temporarily increase trauma symptoms (Nishith, Resick, &; Griffin, 2002 Nishith, P., Resick, P. A., &; Griffin, M. G. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70, 880–886. doi:10.1037//0022-006x.70.4.880Crossref], PubMed], Web of Science ®] , Google Scholar]), 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 Gwyther, L. P., Altilio, T., Blacker, S., Christ, G., Csikai, E. L., Hooyman, N., … Howe, J. (2005). Social work competencies in palliative and end-of-life care. Journal of Social Work in End-of-Life &; Palliative Care, 1, 87–120. doi:10.1300/j457v01n01_06Taylor &; Francis Online] , Google Scholar]) and a case study is used to demonstrate its application.