Trial reportJournal of general internal medicine2020
The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis.
Trial report in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00234286 (Intervention to Improve Care at Life's End in VA Medical Centers), which is not on this map. Cited by 10 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Intervention to Improve Care at Life's End in VA Medical Centers
Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Psychiatric Comorbidities and Outcomes in Palliative and End-of-Life Care: A Systematic Review.Journal of pain and symptom management · 2023Pooled it
- Trauma-informed palliative care: A systematic scoping review of evidence sources describing concepts relevant to an emerging field of practice.Palliative medicine · 2026Article
- Interventions for behavioral health comorbidities in the hospice setting: a scoping review.Annals of palliative medicine · 2024Article
- "The great escape": how an incident of elopement gave rise to trauma informed palliative care for a patient experiencing multiple disadvantage.BMC palliative care · 2024Article
- Re-living trauma near death: an integrative review using Grounded Theory narrative analysis.Palliative care and social practice · 2024Review
- Trauma-informed palliative care is needed: A call for implementation and research.Palliative medicine · 2023Article
- Hospice and Palliative Medicine Fellowship Training in Mental Health: A Survey of Program Directors.Journal of pain and symptom management · 2023Article
- Factors Associated With Distress Related to Posttraumatic Stress Disorder at the End of Life Among U.S. Veterans.Journal of pain and symptom management · 2023Observational
- A study of post-traumatic stress disorder in schizophrenic patients 35 years after experiencing the Tangshan earthquake.Brain and behavior · 2023Article
- Hospice and palliative care clinicians' perceptions of posttraumatic stress disorder at end-of-life in military veterans.Progress in palliative care · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundPost-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death. PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep. Thus, increased symptoms may lead to increased end-of-life healthcare utilization.
objectivesTo determine if veterans with PTSD have increased end-of-life healthcare utilization or medication use and to examine predictors of medication administration.
designSecondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center. SUBJECTS: Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011. MAIN MEASURES: Emergency room (ER) visits, hospitalizations, and medication administration in the last 7 days of life. KEY
resultsOf 5341 veterans, 468 (8.76%) had PTSD. Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalizations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001). PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943). Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598, 95% CI 1.194-2.138).
conclusionsPTSD's association with increased end-of-life healthcare utilization and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD. Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients.
trial registrationNCT00234286.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.