Families' Perceptions of Veterans' Distress Due to Post-Traumatic Stress Disorder-Related Symptoms at the End of Life
Accepted 30 July 2009. published online 18 January 2010.
Abstract
Objectives
To define the frequency of post-traumatic stress disorder (PTSD)-related symptoms among veterans who are near the end of life and to describe the impact that these symptoms have on patients and their families.
Methods
Patients had received inpatient or outpatient care from a participating VA facility in the last month of life, and one family member per patient was selected using predefined eligibility criteria. Family members then completed a telephone survey, The Family Assessment of Treatment at End-of-Life, which assessed their perceptions of the quality of the care that the patients and they themselves received during the patients' last month of life.
Results
Seventeen percent of patients (89 of 524) were reported to have had PTSD-related symptoms in the last month of life. PTSD-related symptoms caused discomfort less often than pain did (mean frequency score 1.79 vs. 1.93; Wilcoxon sign rank test, P<0.001) but more often than dyspnea did (mean severity score 1.79 vs. 1.73; Wilcoxon sign rank test, P<0.001). Family members of patients with PTSD-related symptoms reported less satisfaction overall with the care the patient received (mean score 48 vs. 62; rank sum test, P<0.001). Patients who received a palliative care consult (n=49) had lower ratings of discomfort attributed to PTSD-related symptoms (mean 1.55 vs. 2.07; rank sum test, P=0.007).
Conclusion
PTSD-related symptoms may be common and severe among veterans near the end of life and may have a negative effect on families' perceptions of the quality of care that the veteran received.
aGeriatric Services Unit, Central Regional Hospital, Butner, North Carolina, USA
bPhiladelphia VA Center for Health Equity Research and Promotion, University of Pennsylvania, Philadelphia, Pennsylvania, USA
cDivision of Geriatric Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
dBirmingham VA Medical Center, Birmingham, Alabama, USA
eLebanon VA Medical Center, Lebanon, Pennsylvania, USA
fVA Greater Los Angeles Health Care System, Los Angeles, California, USA
Address correspondence to: Yesne Alici, MD, Geriatric Services Unit, Central Regional Hospital, Butner, NC 27509, USA.
This work was supported by a Health Services Research and Development Merit Award from the Department of Veterans Affairs (Dr. Casarett) and by a Presidential Early Career Award for Scientists and Engineers (Dr. Casarett). The views expressed here are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs or the Department of Health and Human Services.
ABSTRACT