The traumas many vets experience during service often resurface at the end of their lives. Thus, researchers from Northwestern University Feinberg School of Medicine and the University of Alabama at Birmingham have developed one of the first palliative care education programs tailored to vets’ special needs.
The program, which began its rollout in October, will be introduced in 170 Veterans Administration (VA) Medical Centers around the country during the next 12 months. The first group of VA doctors, nurses, psychologists, social workers, chaplains and physician assistants were trained in the new program during a three-day conference at Northwestern’s Feinberg School in Chicago.
“Because these war memories come up more frequently near the end of life, palliative care providers need to be alert for these issues,” said Joshua Hauser, M.D., a co-chair of the project and assistant professor of medicine and of palliative care at Feinberg.
In addition to battle experiences, problems may arise from veterans’ sexual trauma or substance abuse during service. The particular war in which a veteran served also affects his or her emotional and physical care.
“Many veterans, at the end of their lives, struggle with issues related to a traumatic event they had during their time in service,” said project co-chair Amos Bailey, M.D., associate professor of internal medicine at the University of Alabama at Birmingham and director of the safe harbor palliative care program at the Birmingham VA Medical Center. “They may have had a physical or emotional disability related to their time in service.“ He noted the age at which a person enters the military – usually 18 or 19 – is a formative time, so experiences can have a particularly powerful impact.
The new program, called Education on Palliative and End-of-Life Care for Veterans Project, deals with pain treatment, patient-doctor communication and decision making about end-of-life treatment. It also addresses four psychosocial issues that have a higher prevalence among vets than in the general population. They include post-traumatic stress syndrome, homelessness, substance abuse disorder and military sexual trauma.
An estimated 20 percent of female veterans and 1 percent of male veterans have been victims of sexual violence during their service time.
“That has implications for the type of very intimate care that can happen near the end of life,” said Hauser, who also is assistant director of Northwestern’s Buehler Center for Aging, Health & Society. “That care may trigger some of those memories for veterans.”
In addition, many of the medications used in palliative care are closely related to drugs, such as heroin, that may have been abused by vets. Benzodiazepine, another medication used, is closely related to alcohol.
“Veterans may have concerns about becoming addicted to these medications,” Hauser said. “If a vet went through a 12-step program and was told never to touch a drug or alcohol again, he or she may be fearful of that.”
The war in which a veteran served also affects his or her palliative care. Soldiers who served in Vietnam, for example, may have more distrust and disappointment with the military and government as well as mixed feelings about their current medical dependence on the VA. They also are less likely to want to discuss their experiences than World War II veterans.
“A palliative care worker may say to them, ‘I realize you may have some distrust of this system. I want to try to do a better job,’“ Hauser explained. “We want to show health care professionals how someone’s individual war memories come up and how those can be talked about.”
On the physical front, soldiers in the Korean War were exposed to extreme cold, suffered frostbite and are more likely to experience greater pain near the end of their lives. These soldiers also tend to feel that their service was not recognized.
“We need to be aware of and sensitive to all veterans’ needs,“ Bailey said. The VA has made strides in palliative care, he said, noting plans to open 50 new patient palliative care and hospice units in VA facilities over the next five years. “Then every VA in the country will have designated hospice and palliative care beds,” Bailey said. “We want our VAs to provide excellent end-of-life care.”