“The Great Escape”: how an incident of elopement gave rise to trauma informed palliative care for a patient experiencing multiple disadvantage

Quinn, S., Ferguson, L., Read, D. and Richards, N. (2024) “The Great Escape”: how an incident of elopement gave rise to trauma informed palliative care for a patient experiencing multiple disadvantage. BMC Palliative Care, 23(1), 61. (doi: 10.1186/s12904-024-01374-x) (PMID:38419002) (PMCID:PMC10900545)

Abstract

Background: This case report from Scotland, UK illustrates how unresolved traumatic experiences across the life course can affect a patient’s engagement with palliative care and offers insights into the flexibility and adaptations necessary for taking a trauma informed approach to care for an individual experiencing multiple disadvantage. Trauma informed care is a cornerstone in the pursuit of equitable palliative care, particularly for those facing multiple disadvantage, as it acknowledges the impact of past traumas on current healthcare experiences, and fosters an environment of understanding, acceptance, and tailored support to alleviate suffering in the final stages of life. Case presentation: “M” was a veteran with a history of homelessness, living with end stage anal cancer and symptoms consistent with post-traumatic stress disorder, although he never received a formal diagnosis. M exhibited complex behaviours perceived to be related to his history of trauma, including his decision to elope from the hospice, reluctance to accept personal care from nurses, and unpredictability. These behaviours posed a significant challenge to his palliative care team, both in the hospice and at home. An individualised and flexible approach to care delivery was eventually adopted, which included a ‘safety-netting’ approach and care delivery outside of the hospice. M was ultimately supported to remain at home until a week before he died. Conclusion: M’s case underscores the necessity of adopting a trauma informed approach to palliative care, particularly for patients with a history of trauma and multiple disadvantage. The case highlights the importance of understanding and respecting a patient’s past traumas, promoting safety and autonomy, and ensuring flexibility in care delivery.

• Item Type: Articles
• Additional Information: This project was funded by the Economic and Social Research Council (UKRI). Ref: ES/S014373/1.
• Keywords: Palliative care, trauma informed care, post-traumatic stress disorder, poverty, homelessness, veteran, elopement, patient autonomy, flexibility in care, end of life care.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Richards, Dr Naomi and Quinn, Dr Samuel
• Authors: Quinn, S., Ferguson, L., Read, D., and Richards, N.
• College/School: College of Social Sciences > School of Social & Environmental Sustainability
• Journal Name: BMC Palliative Care
• Publisher: BioMed Central
• ISSN: 1472-684X
• ISSN (Online): 1472-684X
• Copyright Holders: Copyright © The Author(s) 2024
• First Published: First published in BMC Palliative Care 23(1):61
• Publisher Policy: Reproduced under a Creative Commons licence

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
304429		Dying at the Margins: uncovering the reasons for unequal access to home dying for the socio-economically deprived	Naomi Richards	Economic and Social Research Council (ESRC)	ES/S014373/1	SSES - Interdisciplinary Studies