A mixed methods pre-implementation study of a trauma-informed care intervention for hospitalized patients with serious illness

Nearly two-thirds of adults living with serious illness also experience posttraumatic stress symptoms (PTSS). PTSS and serious illness impacts older adults as a result of cumulative hardships across the lifespan. Particularly during acute hospital care, patients with comorbid serious illness and PTSS experience higher rates of pain and anxiety, and longer hospitalizations. Despite national palliative care guidelines that recognize the importance of addressing trauma during care delivery, there is little evidence regarding the effectiveness of current trauma- informed interventions that target reduced retraumatization during hospitalization for serious illness care. Lack of knowledge regarding intervention context, acceptability, and feasibility for this population limits the ability to effectively test and implement these interventions. There is a fundamental need to address this pre- implementation gap in knowledge so that later stages of intervention testing can advance the goal of reducing retraumatization during hospitalization for patients with serious illness and PTSS. The long-term goal for this Ruth L. Kirschstein Predoctoral Individual National Research Service Award (NRSA) is to support research and training that allows the applicant to become an independent investigator who advances the science of psychosocial care delivery for patients with serious illness. To achieve this goal, the overall objective of the research proposal is to conduct a convergent mixed methods study that will address existing pre-implementation knowledge gaps regarding the context, acceptability, and feasibility of a palliative care social worker-led (PCSW) trauma-informed intervention, the Stepwise Psychosocial Palliative Care Model (SPPC). The study aims are to: 1) identify key contextual factors of retraumatization in the hospital among patients with serious illness, and 2) evaluate stakeholder perceptions of the acceptability and feasibility of the SPPC intervention. The Training Plan includes four key goals: 1) expand theoretical and conceptual knowledge of trauma across the lifespan and the relationship between serious illness and PTSS; 2) strengthen training in quantitative, qualitative, and mixed methods design, data collection, and analysis; 3) expand implementation science knowledge and skills for intervention adaptation, testing, and implementation; and 4) increase writing, publishing, and dissemination skills in preparation for future stages of career research. This proposed study is aligned with the National Institute on Aging’s (NIA) Strategic Research Goal F: to elucidate psychological and social determinants of health related to processes and outcomes of aging with serious illness and will directly inform a future K23 application that proposes implementation mapping and a pilot feasibility study of the SPPC intervention among patients hospitalized with serious illness.