Fast Fact And Concept #152: The Military History as a Vehicle for Exploring End of Life Care with Veterans

Authors: Lynn Hallarman, MD and Clare Kearns, MSW

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. VA Trainee Pocket Card: www.va.gov/oaa/pocketcard
2. www.va.gov; Search for “Veteran Fact Sheets”
3. VA Transforms End of Life Care: Monograph; Beresford, Larry. Department of Veterans Affairs. 2004.

Copyright/Referencing Information: Users are free to d ownload and distribute Fast Facts for educational purposes only. Citation for referencing: Hallerman L and Kearns C. Fast Facts and Concepts #152; The Military History as a vehicle... March 2006. End-of-Life/Palliative Education Resource Center www.eperc.mcw.edu.

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in 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.

Purpose: Self-Study Guide, Teaching

Audience(s)

ACGME Competencies: Medical Knowledge and Patient Care

Keyword(s): communication