From the moment the patient is given a diagnosis or a prognosis shock in their minds is a response to the reality presented to them.
“Shock is the emotional trauma when we lose that which we hold dear to us” in this case “to continue to be” Daniel Miller, M.D.
Some patients, as a result, present avoidance of symptoms and distrust of authority figures which can lead to poor medical adherence and strained communication with the medical team. (Feldman and Periyakoil (2006))
While a terminal diagnosis undermines coping strategies, it can also mean that the patient’s response is in fact a cognitive way of liberating himself from anguish. Looking into discovering their meaning, “Who I am”, finding to live with new and more fulfilling intentions, and getting closer to those important in their lives are some of the coping mechanisms that help to go through this time despite the perspective of tragedy.
Trauma-informed orientation is important when working with patients struggling with terminal illness.
A trauma-informed approach to end-of-life care would include a solid foundation for all staff on the basics of trauma. It would also require those directly involved with counselling to gain additional training
Trauma related training is important whether the trauma is created by the shock of the news of a terminal illness, or the patient has past related trauma events that can be exacerbated by the news themselves.
Hospice professionals are usually not trained to assess for and intervene with patients who have PTSD or longstanding issues with traumatic stress; professionals who work with trauma survivors often do not have the background to understand the potential issues related to the end of life. Yet, when these respective areas overlap in patients’ lives, it can create intense challenges and concerns for which we need to be ready to respond effectively, and about which we need to be informed.
Click here for a related article on Trauma and Shock of a terminal diagnosis.