Creating Safe Spaces: Why Trauma-Informed Care Matters for Patients and Teams

Trauma has no boundaries. It can affect anyone, and it’s more common than you may realize. In fact, there’s a good chance that it’s impacting many of your patients.

The National Council for Behavioral Health reports that 70% of adults in the U.S. have experienced at least one traumatic event in their lives. Trauma, as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA), is “an event, a series of events, or set of circumstances experienced by an individual as physically or emotionally harmful, or life-threatening, with lasting adverse effects.”

After experiencing trauma, some people develop post-traumatic stress disorder (PTSD). According to the National Center for PTSD, about 6% of the U.S. population will experience PTSD at some point, with women being more likely to develop it than men.

Given these statistics, it’s essential for clinicians to recognize trauma, understand trauma-informed care, and integrate it into their practice. It’s important to keep in mind that untreated trauma can exacerbate conditions of physical health and negatively impact future health outcomes. In this blog post, we cover the principles of trauma-informed care and how to implement trauma-informed care for people living with serious illness.

When providing trauma-informed care in palliative care settings, it’s helpful to remember that trauma-informed care honors three key tenets as outlined in CAPC’s Trauma-Informed Care toolkit:

• Many serious and psychological illnesses are affected or even perpetuated by a history of childhood or adult trauma
• Data show a striking association between trauma and illness
• Effective, evidence-based treatments that acknowledge trauma and provide trauma-specific treatment can help many people

It’s also important to understand the factors that can cause trauma. While adverse childhood experiences (ACES) are well-known contributors to mental illness, addiction, and other medical diseases, racism is another, often overlooked, source of trauma that can affect some of your patients. Some patients may not be aware that they have experienced trauma or recognize its impact on their lives.

For palliative care teams, trauma-informed care requires enhancing the team’s capacity to provide whole-person care. According to SAMHSA’s recommendations, we emphasize the following 6 principles: (1) safety, (2) trustworthiness, (3) peer support, (4) collaboration, (5) empowerment, and (6) cultural and historical awareness. These principles acknowledge resilience and strength of people who have survived trauma and create space for patient-centered coping strategies and preference for and against various treatment options.

Although there are some overlaps between trauma-informed care and palliative care, such as a focus on connection and compassion, clinicians should make sure their teams are equipped with best practices. Here’s how you can integrate trauma-informed care into your day-to-day practice.

It’s important that all clinicians understand trauma, including how it can present in their patients living with serious illness. CAPC’s Trauma-Informed Care toolkit includes many tools and resources to help organizations and clinicians do just this. Additionally, a growing number of health care organizations are providing in-person professional development opportunities for their staff, like Denver Health, which offers monthly trauma lectures and pediatric trauma grand rounds.

When speaking with patients, especially during the initial history and physical, use trauma-informed techniques in order to gather information without retraumatizing the patient. Also, ask your patient about their understanding of their current care plan, so you know how they’ve interpreted it. Having a complete picture of your patient’s lived experiences will enable you to provide culturally sensitive and responsive care.

Additionally, narrative medicine may empower patients to share their stories with members of the interdisciplinary team (like chaplains or social workers), fostering collaboration and trust.

Research suggests that people with trauma histories may perceive new information as threatening, causing them to react with distress. Being aware of this can help guide clinicians when they deliver news about changes in prognosis or treatment.

While you may be able to identify trauma in a patient, this doesn’t mean they want to talk about it. You can offer resources, including access to a counselor or social worker, but be mindful that they may decline. That is their choice, and we must respect that.

Trauma doesn’t just impact patients—many health care professionals may have faced it, particularly in the wake of the COVID-19 pandemic.

When providing trauma-informed care, clinicians with their own histories of trauma may experience a trauma response that can affect their well-being and ability to continue caring for a patient.

To support both staff and patients, health care organizations should foster a workplace culture that prioritizes psychological safety. SAMHSA recommends ensuring that both staff and patients feel physically and psychologically safe, which may include trauma-informed training and protected discussion spaces. Dr. Maiysha Clairborne, an expert and educator on trauma, recommends organizations teach and promote healthy conflict resolution, because conflict is a trigger for some people.

These are a number of possible strategies that can boost team morale and well-being, a top concern among palliative care clinicians, according to the results of CAPC’s 2024 Palliative Pulse survey.

Trauma affects many people, including patients and clinicians. Given its prevalence, all palliative care clinicians should understand trauma, recognize its effects, and use best practices to support both their patients and their teams.

For more information on trauma-informed care, we recommend the resources below.

• CAPC’s Trauma-Informed Care toolkit, which includes curated tools and resources to help organizations and health professionals apply trauma-informed principles in the care of people living with a serious illness.
• Trauma-Informed Care: Why It’s Important and How to Implement It into Practice, an on-demand webinar which fills a critical gap in trauma-informed care education and training, hosted by Drs. Karen Bullock and Sherika Newman.
• Register for CAPC National Seminar 2025, where Dr. Karen Bullock will host the breakout session, How to Implement Trauma-Informed Care Principles into Palliative Care Practice, on September 16.
• An Interview with Dr. Edward Machtinger: Lessons of Trauma-Informed Care, a blog that delves into trauma-informed care, the markers of trauma, and provides guidance on screening.

Edited by Melissa Baron. Clinical review by Andrew Esch, MD, MBA.