Palliative and end-of-life care for military veterans: the forgotten few?

Mila Petrova; Nick Caddick; Michael Kevin Almond

doi:10.3399/bjgp21X714869

BACKGROUND

Military veterans are likely to have encountered death, pain, and suffering, and to have prepared for them like few other groups in society. This is also a group trained to follow highly ceremonial rituals around death, burials, and commemoration. Yet veterans are not seen as ‘different’ in palliative and end-of-life care (EoLC), including that provided by GP practices. Throughout military service, encounters with death and dying are frequently intense, highly personal, and potentially traumatic, in ways seldom seen or understood in civilian life. Furthermore, the nature of military occupation — resembling more a lifestyle than a job — entails cultural separation from civilian life, with perceptions, norms, and ideals around death and dying forming part of this culture. Embodied experiences in military life as well as psychological, social, and ethical constructs (for example, guiding beliefs, value systems, norms, rules, and expectations) are often markedly different from those of civilian society. We do not know enough about how this legacy impacts the dying process in veterans and what the health services implications are, including in the context of general practice.

VETERANS’ HEALTH AND END-OF-LIFE CARE IN GP PRACTICES — WORLDS APART?

There is a growing number of resources aiming to support GP practices in looking after their military veteran patients. Examples include the Royal College of General Practitioners’ (RCGP) ‘veteran-friendly GP practices’ initiative,¹ the Veterans’ Healthcare Toolkit, the Military Veterans e-learning course, and the Veterans Health Days of Health Education England. The provision of EoLC, in turn, apart from being a traditional role for GPs, has had its profile raised significantly via the Quality Improvement domain introduced in the 2019 GP contract. In Year 1 of the contract (2019/2020), practices could achieve 37 points by engaging in continuous quality improvement of their EoLC services.² Yet the intersection between the two types of population — veterans at the end of life …

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