Secondary Traumatization and Proneness to Dissociation Among Palliative Care Workers: A Cross-Sectional Study

Context. Exposure to dying patients can contribute to secondary traumatic stress (STS) among palliative care workers. Peritraumatic dissociation (PETD), an individual's personal proneness to dissociation during exposure to a stressful event, is the strongest predictor of post-traumatic stress, but existing research on its relationship to STS is limited. Objective. To compare the level of STS among palliative workers with clinical levels of PETD compared with those without clinical levels of PETD. Methods. A cross-sectional self-report survey. Setting/Participants. These include about 420 physicians and nurses working in hospital-based and/or home-based palliative care units. Inclusion criteria: two years' experience with at least 10 hours/week of direct care for terminally ill patients. Results. About 144 participants returned completed questionnaires (response rate 35%). Sixty percent reported a nonclinical level of dissociation. Workers with a clinical level of dissociation had significantly higher levels of STS compared with workers who did not. Awareness of an interaction effect between PETD and fear of dying progression can advance our understanding of how the development of PETD during exposure to dying can have an impact that is beyond the main effect on STS. Conclusions. The clinical level of PETD correlates significantly with STS. Further research is needed to understand whether STS is related to the individual's own vulnerability, as reflected by their personal proneness to dissociation, during exposure to death and dying. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.