Top Ten Tips Palliative Care Clinicians Should Know About Trauma-Informed Care

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Abstract
Trauma is a personal stress response to experiences perceived as harmful or life-threatening, and has ongoing impacts on illness and health. Exposure to trauma is increasingly prevalent, and the risk of medical trauma or re-traumatization is heightened for people living with serious illness. Trauma not only impacts health outcomes, but can also interfere with decision-making and worsen symptom burden at the end of life. Thus, it is critical that palliative care clinicians in all professions be skilled at providing high-quality trauma-informed care (TIC). TIC seeks to provide more holistic and equitable care through better understanding of how a person’s life situation impacts behavior, reactions, behavior, responses, or relationships. A clinician using a trauma-informed lens asks, “What has happened to this person?” instead of, “What is wrong with this person?” A “universal precautions” approach is recommended, encouraging broad acknowledgment of possible trauma and recognition of signs of trauma responses, to better understand triggers for medical retraumatization among patients, caregivers, and even us as clinicians. TIC provides a framework that guides clinicians to acknowledge the widespread experience and consequences of trauma, recognize the symptoms of traumatic stress, mitigate mistrust and disempowerment, and advocate for culture change in health care systems to reduce the risk of further health care-based traumatization.

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