Vol. 41 No. 1 January 2011 267Schedule with Abstracts

of the surgeon and palliative care provider cancause stress, confusion, and distrust from the pa-tient and family. Keeping patient goals utmost inpriority and to reconcile the surgical and pallia-tive care perspectives in end-of-life care cases willbe presented by surgeons from different special-ties. These presentations will provide a forumfor palliative care practitioners to identify theunique surgical perspectives on palliative care.Complementing the case presentations will bea series of ‘‘cutting edge’’ questions and answersto further clarify the surgeons’ viewpoints. Usingthe knowledge from the cases and Q&A, the ses-sion participants will have insights into how toeffectively interact with surgeons to institute ap-propriate palliative care for dying patients with-out jeopardizing either the surgical or thepalliative perspective. These techniques will bebroadened so after the session the participantwill be able to identify and recruit local surgical‘‘champions’’ to assist in implementing appro-priate palliative care interventions in challeng-ing surgical cases.

DomainStructure and Processes of Care; Physical As-pects of Care

Palliative Care for Veterans withPTSD (524)Bettina Kehrle, MD, VA Greater Los AngelesHealthcare System, Los Angeles, CA. JillisaSteckart VA Greater Los Angeles Healthcare Sys-tem, Los Angeles, CA. Deborah Moran VAGreater Los Angeles Healthcare System, Los An-geles, CA.(All speakers for this session have disclosed norelevant financial relationships.)

Objectives1. Identify special considerations for veterans

with posttraumatic stress disorder (PTSD) atthe end of life.

2. Discuss appropriate andpractical pharmacolog-ical and psychological interventions and man-agement skills for veterans with PTSD at theendof life andhow touse them indaily practice.

Posttraumatic stress disorder (PTSD) is a condi-tion characterized by intrusions of traumaticmemories, symptoms of avoidance and numb-ing, and hyperarousal. It has been reportedthat more than 30% of veterans suffer fromPTSD and suggest that this is likely an

underestimate of actual prevalence. The volumeof veteran deaths is significant (25% of all Amer-ican deaths in 2006) with most veteran deathsoccurring in non-VA facilities or at home. Theserealities make it important for providers to un-derstand the unique needs of veterans, particu-larly those with PTSD. A single-site VA studyfound that 17% of patients reported PTSD-re-lated symptoms in the last month of life. Physicalill health was the most significant risk factor as-sociated with reactivation of PTSD symptoms inlate life. PTSD may be exacerbated at the endof life due to re-exposure, pain, and reactionto diagnosis of terminal illness. Often goals ofcare are constrained by the patient’s psychopa-thology and clinicians need to accept limitationson their ability to provide optimal medical treat-ment. Anxiety associated with PTSD may nega-tively influence the ability for patients todevelop a trusting relationship with their medi-cal provider and contribute to ill-feeling in theircaregivers or providers. Pharmacological inter-ventions must be considered carefully. IntensePTSD symptoms can mimic ‘‘terminal restless-ness’’; however, the antidepressants, anxiolytics,and antipsychotics used to treat terminal rest-lessness may have a paradoxical reaction in vet-erans experiencing PTSD agitation. Thissession will use literature review, case study,and vignette to identify special considerationsfor veterans with PTSD at the end of life; providean overview of appropriate and practical phar-macological and psychological interventions;and teach recognition and management skills.By the end of the session, participants will beable to identify/manage constellations of symp-toms common in PTSD that could affect qualityof end-of-life treatments.

DomainAll domains

Serving Two Masters: Should One Act asEthics Consultant and Palliative CareConsultant? (525)Ryan Nash, MD, University of Alabama at Bir-mingham, Birmingham, AL. Catherine Kelso,MD MS, McGuire VA Medical Center, Rich-mond, VA. Farr Curlin, MD, University of Chica-go, Chicago, IL.(All speakers for this session have disclosed norelevant financial relationships.)