Treatment of posttraumatic stress disorder at the end-of-life: application of the Stepwise Psychosocial Palliative Care model.
OBJECTIVE
Feldman (2011) has proposed a new approach to the treatment of posttraumatic stress disorder (PTSD) in individuals at the end-of-life known as Stepwise Psychosocial Palliative Care (SPPC). This approach helps to compensate for the disadvantages of existing PTSD interventions with regard to treating patients with life-limiting and terminal illnesses by employing a palliative care philosophy. The model relies on cognitive and behavioral techniques drawn from evidence-based approaches to PTSD, deploying them in a stage-wise manner designed to allow for interventions to track with patents' needs and prognoses. Because this model is relatively new, we seek to explore issues related to its implementation in the complex settings in which providers encounter patients at the end-of-life. We also seek to provide concrete guidance to providers regarding the management of PTSD at the end-of-life in diverse palliative care settings.


METHODS
We examine three specific cases in which the SPPC model was utilized, highlighting particular treatment challenges and strategies. These case studies provide information regarding the SPPC model's application to patients in two distinct palliative care settings-a palliative care consult team and an inpatient palliative care unit.


RESULTS
The SPPC model's stage-wise approach allows for its flexible use given a variety of constraints related to setting and patient issues.


CONCLUSIONS
The SPPC model provides an alternative to existing psychosocial treatments for PTSD that may be more appropriate for patients at the end of life.
Santa Clara University,Santa Clara, California.
David B
DB
Feldman
University of Oklahoma Health Sciences Center,Oklahoma City VA Medical Center, Oklahoma City, Oklahoma.
Kristen H
KH
Sorocco
University of Oklahoma Health Sciences Center,Oklahoma City VA Medical Center, Oklahoma City, Oklahoma.
Kristi L
KL
Bratkovich
D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009369:Neoplasms / Q000523:psychology; D059408:Pain Management; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011379:Prognosis; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D019452:Terminally Ill / Q000523:psychology*; D014728:Veterans / Q000523:psychology