PTSD at End of life: A Qualitative Examination of Providers’ Experiences

Hannah Bashian, M.Ed.

VA Boston Healthcare System
PTSD at End of life: A Qualitative Examination of Providers’ Experiences

Scientific Abstract

Background: Veterans across the lifespan are at a high risk of experiencing traumatic events that may lead to Posttraumatic Stress Disorder (PTSD). At end of life (EOL), Veterans may have new or re-emergent PTSD symptoms due to increased thoughts around mortality and morbidity.

These symptoms can vary depending on the individual but often present as angry outbursts, intrusive memories, or negative emotions, and may worsen quality of death. Little is known regarding how providers manage PTSD symptoms at EOL and what support they may need when working with this population. Thus, in the current evaluation, 11 focus groups were conducted to examine PTSD symptoms most commonly reported at end of life and what extra resources providers may want or need.

Methods: Using inductive thematic analysis, 11 focus groups (N=92) were conducted virtually and in person with rural hospice providers across several states (FL, KY, VT/NH, MI, MN). Providers included social workers, nurses, and physicians.

Results: Results from the focus group demonstrated that PTSD at EOL is similar, but not identical, to PTSD throughout the lifespan. Seven themes were identified: four were consistent with PTSD symptom clusters (i.e., re-experiencing, avoidance, negative alterations of cognition and mood, and hyperarousal); and three were distinct: approach (i.e., a desire to talk about memories rather than avoid them), war cohort issues (e.g., differing experiences in Vietnam and older cohorts of veterans), and family support issues.  In addition, providers reported interest in learning more about assessing PTSD symptoms and how best to respond when Veterans experience PTSD symptoms at EOL.

Conclusions: PTSD at EOL is a dynamic experience that is similar to, but distinctly different from, PTSD across the lifespan. Further, based on the focus group responses, providers need more support and information around supporting Veterans with PTSD at EOL. We translated these results into three informational videos for providers supporting Veterans at EOL. Additionally, we are developing informational handouts for hospice and palliative care providers based on based on focus group responses.

Live Zoom Session – April 21st

research Areas


Hannah Bashian, M.Ed., Anica Pless Kaiser, Ph.D., Zachary S. Sager, M.D., Kelly A. O’Malley, Ph.D., Lynn Korsun, B.A., Anna Etchin, Ph.D., RN, Jennifer Moye , Ph.D.

Principal Investigator

Emily Kline, PhD, and Matcheri Keshavan, MD