Being diagnosed with a terminal illness is definitely a traumatic situation to experience.  It is important for those working in hospice and palliative care to have trauma-informed knowledge.  This will help them adjust their practices to better identify clients who are being triggered by situations that activate prior trauma and respond in ways that help them stabilize and move toward healing.

If the patient has previous trauma history, that can complicate the dying process.  The terminal diagnosis is an obvious threat to life and may mimic the original trauma and lead to significant distress.  Life review (which is generally a part of hospice services) may involve memories which are related to the individual’s trauma.  This can lead to a host of difficult feelings such as guilt, anger, anxiety, and sadness.

The diagnosis of a terminal illness will interrupt routines, undermine coping, cause intense emotions, and raise the fear of death.  The patient may experience physical pain, altered mental states, increased vulnerability, shifting roles, loss of privacy and loss of independence.

“Though patients may have suppressed or silently coped with the persistent impact of unhealed trauma, when faced with an incurable diagnosis, indications of traumatic stress reactions, including PTSD, may emerge in the form of fight, flight, or freeze responses. These can include, among other things, intense emotional reactions, such as fear, anger, or helplessness, that seem disproportionate to the situation, avoidance behaviors, hypervigilance, anxiety, intrusive memories, dissociation, panic, nightmares, emotional numbing, withdrawal, or becoming easily overwhelmed.

Other signs may be less obvious and are often attributed to organic or psychological conditions. Symptoms such as impaired memory, difficulty concentrating, hypo- or hypersensitivity to physical sensations, distrust, loss of motivation, and physical pain or somatic complaints for which no organic cause can be found. “   (www.socialworktoday.com/news/enews_0616_1.shtml)

We encourage hospice professionals as well as family and friends of those in hospice to consider the impact of prior trauma as they support people in this difficult time of life.