# 152 The Military History as a Vehicle for Exploring End-of-Life Care with Veterans

FAST FACT AND CONCEPT # 152 PDF


Author(s): Lynn Hallarman MD and Clare Kearns MSW

Background   54,000 American veterans die each month and account for one quarter of all US deaths. Inquiring about military service has both practical and therapeutic benefits. Hospice care is now a covered benefit for all enrolled veterans and the Veterans Administration will purchase hospice services from local communities it serves. Military service can be a core experience in defining the way veterans live and the way they die. Knowing the components of a military history can be a useful tool in bridging the silence that often surrounds the war experience and can act as a catalyst for discussions about end of life preferences. Establishing an environment of trust is critical when speaking with war veterans about end of life care. A polite inquiry about military service is a good way to create an atmosphere of respect, keeping in mind that not all veterans will want to speak with you about the details of their war experience. Because a discussion of combat experiences can reactivate deeply buried issues, it is important to make this known to the veteran and ask if he/she wishes to proceed.

Listed below are phrases to help you get started in taking a military history.

Starting Questions

  • Are you a veteran?
  • Tell me about your military experience?
  • What did you do in the military?
  • When and where did you serve?
  • What branch of the military were you in?
  • How has it affected you?

Detailed Questions

  • What was your highest rank?
  • Did you see combat or were you in a combat area? Did you see enemy fire or causalities?
  • Were you a prisoner of war?
  • Were you wounded or hospitalized?
  • Do you currently receive care at a VA?
  • Do you have a service-connected condition? If not, are you enrolled?

Deepening the Military History

  • Do you think you were changed as a result of being in the military? Please describe the changes.
  • Do you think your experiences in the military are affecting you today?
  • Is there anything about your experiences in the military that is still troubling you today?
  • Do you have nightmares about the war?
  • What was your homecoming like? Is there anything about your homecoming that is still troubling you today?
  • Do you think your experiences in the military and your homecoming affected your relationships with family and friends when you returned?
  • Do you keep in touch with your war buddies?
  • Do you think your military experiences are influencing the way you are now coping with your illness?

If the veteran experiences significant anxiety and needs psychological assistance, or if you would like guidance, you can contact your local VA Medical Center to access their mental health clinics, trauma recovery clinics, or Vet Centers.

References

  1. US Department of Veterans Affairs. Military Health History Pocket Card for Clinicians. Available at: www.va.gov/oaa/pocketcard.
  2. Beresford L. VA Transforms End of Life Care. (Monograph.) US Department of Veterans Affairs. 2004.
  3. Patient resources can be found at: http://www.va.gov. Search for “Veteran Fact Sheets.”

Fast Facts and Concepts are edited by Drew A Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu.

Version History: This Fast Fact was originally edited by David E Weissman MD and published in March 2006. Current version re-copy-edited in April 2009.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Hallarman L, Kearns C. The Military History as a Vehicle for Exploring End of Life Care With Veterans. Fast Facts and Concepts. March 2006; 152. Available at: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_152.htm.

Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Communication