![Page 1: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/1.jpg)
![Page 2: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/2.jpg)
Outline
• Introduction• 3 Cases
– Suffering– Trajectory– Prognosis – PTSD/OUD interventions
![Page 3: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/3.jpg)
Wha?
?Emergency MedicineEmergency Medicine
Palliative Medicine
![Page 4: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/4.jpg)
BURN OUT?? NO ‐ PTSD
• Trauma (literally)• Good death/bad death• Shut down
![Page 5: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/5.jpg)
DAD
![Page 6: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/6.jpg)
Trauma Informed
• How do we care for patients and families at the end of their lives WHILE caring for ourselves and each other
• Monitor yourself during this lecture
![Page 7: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/7.jpg)
![Page 8: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/8.jpg)
![Page 9: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/9.jpg)
Outdated model of care
Curative TreatmentCurative Treatment
Hospice Care
Hospice Care DeathDeath
“There is nothing more I can do”
![Page 10: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/10.jpg)
Curative Therapy
Palliative Therapy
Hospice/EOL Care
DeathPresentation
Non-curative Symptom Management
Palliative Care Continuum
![Page 11: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/11.jpg)
• “Palliative care is the medical subspecialty focused on providing relief from the symptoms, pain and stress of serious illness.
• The goal is to improve quality of life for both the patient and the family. It is appropriate at any age and at any stage of illness, and can be provided along with curative treatment.
Palliative Care
End of Life Care/Hospice
Center for the Advancement of Palliative Care, 2016
Definition of Palliative Medicine:
![Page 12: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/12.jpg)
Suffering
• “The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians’ failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself.”
‐Eric Cassell, MD
![Page 13: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/13.jpg)
Case 1 ‐ GC
• 54 yo woman presents with abdominal pain– No past medical history
• Admitted for mass in abdomen and intractable pain
• Biopsy shows colon cancer• Scans show metastatic disease throughout liver and bones
![Page 14: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/14.jpg)
Trajectory
![Page 15: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/15.jpg)
How do you want to die?
• Why?
• Reflect on experiences personal/professional
• What are you scared of?
• Ask patients!!!
![Page 16: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/16.jpg)
How we die
Deaths
Sudden Death 3%
Frailty 28%
Organ Failure 34%
Terminal Illness 30%
Other 5%
![Page 17: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/17.jpg)
Prognosis
• Least well‐studied and discussed area in medicine
• Evaluate indications for treatment
• Adjust expectations! Not take away hope
![Page 18: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/18.jpg)
STAGES OF ILLNESS
EARLY EARLY
MIDDLEMIDDLE
LATELATE
![Page 19: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/19.jpg)
Prognostication
Functional Status
Functional Status DiseaseDisease PROGNOSISPROGNOSIS
![Page 20: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/20.jpg)
Why is Prognosis Important
• Standard psychotheraputic interventions take weeks to months to years to complete.
• Symptoms often worsen before improving especially in trauma focused care
• Meds also take time to work
![Page 21: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/21.jpg)
Case Continued
• She needed escalating doses of dilaudid with no seeming relief of her pain
• Was only comfortable when she was unconscious
• Sources of suffering
![Page 22: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/22.jpg)
SUFFERING
• The manifestation and expression of a disease by a human is unique to that individual.
• The reasons people suffer with a specific disease is unique to them.
• A disease will never express itself in the same way in two different people.
• E. Cassell “The Nature of Suffering”
![Page 23: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/23.jpg)
Case continued
• LCSW support• Family support – significant other, daughter close by and son out of town
![Page 24: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/24.jpg)
Complications
• Suffering is trauma and vice versa• The life limiting illness is the traumatic event AND it reactivates old trauma
• Look through trauma lens• Interventions need to be trauma informed• Feeling out of control compounded
– Body – System
![Page 25: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/25.jpg)
Complicated Suffering/Grief
• PTSD• Young • Opiate use disorder• Old• Frail • Poor • Incarcerated • ICU
![Page 26: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/26.jpg)
Trauma
• Universal experience – 84%• PTSD – 8%
–With cancer 35%– Symptoms of PTSD 68% ‐ including curable– 84% with terminal cancer– After ICU 64%– Aging – Nursing home placement
![Page 27: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/27.jpg)
Trauma Interventions
• DIFFERENT for patients with limited prognosis• Standard therapy can WORSEN PTSD symptoms
• Need to work with MD/nursing to get clinical sense of prognosis
![Page 28: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/28.jpg)
Stepwise Psychosocial Palliative Care Approach
• Ordered to be time sensitive• Patient centered• Considers environmental and health related variables– Prognosis– Energy levels/symptom burden
– Feldman et al.
![Page 29: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/29.jpg)
Stepwise Approach
• Stage 1: Palliate immediate discomfort and provide social supports
• Stage 2: Provide psycho‐education and enhance coping skills
• Stage 3: Treat specific trauma issues
![Page 30: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/30.jpg)
Stage 1
• Active listening – empathy, validation• Reassurance • Direct assistance in solving practical problems• Educate team and family how to avoid PTSD triggers
• Mediate discussions with medical providers or family members
![Page 31: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/31.jpg)
Stage 1: Immediate discomfort/Social support
• Develop trust• Quick interventions, but results short lived• Make changes to patient’s immediate environment
• Advocacy for needs, desires and goals of client, caregiver and family
• Solve problems for them*
![Page 32: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/32.jpg)
Stage 1 cont
• If prognosis short, may stay here
• Need to answer immediate questions about dying, funeral arrangements
• Practical concerns
![Page 33: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/33.jpg)
Case continued
• Chemo tried• Patient clinically worsened• Actively dying
![Page 34: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/34.jpg)
• DYING IS A PROCESS ‐ as variable as the birthing process.
• The exact time of death cannot be predicted, nor can the exact manner.
• People in advanced stages of a terminal illness experience similar symptoms as they approach the end of life, regardless of their illness.
Death
![Page 35: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/35.jpg)
• Increased restlessness, confusion, agitation, inability to stay content in one position and insisting on changing positions frequently
• Withdrawal from active participation in social activities
• Increased periods of sleep, lethargy• Decreased PO intake• Changes in breathing patterns
Signs and Symptoms of Dying
![Page 36: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/36.jpg)
• Sees persons who have already died• States that he or she is dying• Requests family visit to settle unfinished business
• Inability to heal or recover from wounds or infections
• Increased edema of either the extremities or the entire body
Dying cont
![Page 37: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/37.jpg)
• Extremities feel cold to touch or turn blue
• Complains that his or her legs/feet are numb
• Body is held in rigid unchanging position
• Jaw drop
Dying, cont.
![Page 38: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/38.jpg)
• Clinicians can best help families by expecting these questions, providing education and reassurance – Is my loved one in pain; how would we know?– Aren’t we just starving my loved one to death?– What should we expect; how will we know that time is short?
– Should I/we stay by the bedside?– Can my loved one hear what we are saying?– What do we do after death?
Common Family Concerns
![Page 39: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/39.jpg)
• I forgive you• Forgive me• Thank you• I love you• Good‐bye
5 things we need to hear/say
![Page 40: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/40.jpg)
TAKE HOME POINT
• Respect patients’ choices regarding how to spend their limited time remaining
• No such thing as a “good death”
![Page 41: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/41.jpg)
Take home points – Case 1
• Prognosis matters• Pain sources need to be identified• PTSD risk factor for complicated death/grief• People cannot be forced to confront trauma at end of life
![Page 42: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/42.jpg)
Case 2: RB
• 62 year old man presents with weakness, back pain, low appetite
• Pt is homeless and heroin addict• Lung mass found in ED, admitted for cancer work up
• Scans show metastatic cancer throughout organs
![Page 43: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/43.jpg)
Trajectory
![Page 44: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/44.jpg)
Prognostication
Functional Status
Functional Status DiseaseDisease PROGNOSISPROGNOSIS
![Page 45: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/45.jpg)
Case continued
• Pain management• Fear that relieving pain may hasten death
– IT DOES NOT
• All religions encourage relief of suffering• Doctrine of double effect• Intent • OUD need this especially
![Page 46: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/46.jpg)
• Oncology does not offer disease directed treatment as he is severely debilitated
• Not actively dying yet–We have some time
Case Continued
![Page 47: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/47.jpg)
Stage 2: Provide Psychoeducation/Coping skills
• Shift to offering tools to solve their own problems
• Do not discontinue stage 1• Provide information on care plans, options, meds, dying process
![Page 48: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/48.jpg)
Stage 2 cont
• Coping skills– Psycho‐education about PTSD symptoms– Relaxation training– Breathing retraining– Cognitive restructuring– Thought stopping–Mindfulness based skills– Assertiveness or communication skills training
![Page 49: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/49.jpg)
Case continued
• Brought ice cream, sweets• Over time, he opened up about his past• Intensive support from LCSW
– OUD and trauma
• Confession• Team distress about estranged family• Death
![Page 50: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/50.jpg)
Communication Skills
• Group exercise: Listener/Loser
• See handouts for more in depth study
![Page 51: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/51.jpg)
Stage 3:Treat Specific Trauma Issues
• Transition to trauma‐focused interventions– Only if stage 1 and 2 did not adequately address suffering
– Prognosis/energy levels allow – months to years– Patients MUST BE OPEN
• Long term resolution may be irrelevant• Do not want to trigger PTSD symptoms if you do not have time to treat
![Page 52: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/52.jpg)
Step 3 cont.
• Prolonged exposure• CPT• EMDR
![Page 53: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/53.jpg)
Case 3 Erin Laypan
• Interview with Lillian
![Page 54: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/54.jpg)
TAKE HOME POINTS
• Bear witness/Presence/Not fixing• Trauma treatment is different in the seriously ill/dying patient
• Trauma lens: everyone has it• Opportunities for our own growth• Dying is a process• Prognosis offers us a chance to plan
![Page 55: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/55.jpg)
Useful Links
• www.mypcnow.org• www.capc.org• www.vitaltalk.org
![Page 56: Clinical PM 3, Rm 101--ABERGER AND EASAW--Trauma Informed …€¦ · •Trauma (literally) •Good death/bad death •Shut down . DAD. Trauma Informed •How do we care for patients](https://reader034.vdocuments.us/reader034/viewer/2022043004/5f861ba9a1a5e15ff822ef8e/html5/thumbnails/56.jpg)
THANK YOU !!!!