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

Abstract: Context Exposure to dying patients can contribute to secondary traumatic stress among palliative care workers. Peritraumatic dissociation, 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 secondary traumatic stress is limited. Objective To compare the level of secondary traumatic stress among palliative workers with clinical levels of peritraumatic dissociation compared to those without clinical levels of peritraumatic dissociation. Methods A cross sectional, self-report survey. Setting/participants 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 144 participants returned completed questionnaires (response rate=35%). Sixty percent reported a non-clinical level of dissociation. Workers with a clinical level of dissociation had significantly higher levels of secondary traumatic stress compared to workers who did not. Awareness of an interaction effect between peritraumatic dissociation and fear of dying progression can advance our understanding of how the development of peritraumatic dissociation during exposure to dying can have an impact that is beyond the main effect on secondary traumatic stress. Conclusions The clinical level of peritraumatic dissociation correlates significantly with secondary traumatic stress. Further research is needed to understand whether secondary traumatic stress is related to the individual's own vulnerability, as reflected by their personal proneness to dissociation, during exposure to death and dying.