People with Post-Traumatic Stress Disorder (PTSD) experience dying differently. What is known is that people with a diagnosis of PTSD have a high burden of medical co-morbidities, including chronic pain. What isn’t known is how these impact on death. 

Objectives 
The aim of this integrative review is to investigate the following: 1) Is previous trauma identified in people who are dying and if so, how? 2) How is previous trauma associated with the experience of death/dying in people with or without cognitive impairment? and 3) What palliative care interventions are available to people with previous trauma at end of life?

 Method

An integrated review was conducted. Electronic databases were searched using key search terms and pre-defined eligibility criterion. This integrative review has been reported according to PRIMSA statement guidelines. Data extraction included phenomena of interest, setting, context, participation characteristics, study findings and illustrations. Thematic analysis was used.  

Results
A total of n= 1399 abstracts were identified, n= 243 duplicates removed, and n=1 record identified from alerting service, n=1156 records screened, 11 studies met the inclusion criteria.  Three themes were identified. Theme 1. PTSD- and its related symptoms are difficult to identify at EOL. Theme 2. Experiencing PTSD-Related symptoms at EOL is complicated by lack of understanding and trust. Theme 3. High symptom burden and increased pain and suffering at end of life.  

Conclusion
There is little evidence to say that previous trauma is identified in people who are dying and only one trauma informed palliative care approach identified in this review called the Stepwise Psychosocial Palliative Care model (SPPC). This is despite PTSD and its related symptoms causing increased pain and suffering at end of life. Education needs to be developed to support palliative care clinicians so that they have the skills and knowledge to identify, manage and treat PTSD and related symptoms at end of life to reduce further trauma and increase the quality of life and death for this population.