Masculinity and Military Culture in VA Hospice and Palliative Care: A Narrative Review With Clinical Recommendations

Abstract

This article examines the intersection between masculinity, military culture, and hospice and palliative care (HPC). The authors conducted a narrative literature review, supplemented with clinical annotations, to identify the impact of masculinity and military culture on the following topics salient to end-of-life care with older male veterans: pain management, mental health, coping, communication, autonomy and respect, and family roles. Findings suggest that traits associated with masculinity and military culture have an influence on the end-of-life process and HPC for older male veterans. Specifically, results suggest that older male veterans may deny or minimize physical pain, decline mental health treatment, utilize maladaptive coping strategies, avoid emotional conversations, struggle to manage perceived shifts in autonomy, and experience challenges negotiating changing family roles. The authors provide clinical recommendations for providers across various disciplines to address the aforementioned concerns with older male veterans in HPC. Overall, information presented in this article may be an important contribution to the literature for building cultural competencies with older male veterans and has the potential to improve the delivery of HPC for veterans and their families.

Care-seeking and delay of care during COPD exacerbations

“…A limitation of this study was that most participants were male veterans, and these findings may not generalize to the greater population of individuals with COPD. Older male veterans represent a cultural group that includes traits associated with masculinity and military culture such as stoicism, concealing vulnerability and non-help-seeking behaviors 39,40 . While similar traits of stoicism and self-reliance have been noted among nonveterans with COPD 27,41 , differences in care-seeking attitudes may exist.…”

Military Veterans' End of Life

“…Proactively include family members so they can help navigate and support their Veteran (Butler et al, 2015). Be aware of fluctuating family relationships that could include limited support and decreased interactions because of various moves, deployments, injuries, occupational responsibilities, and civilian reintegration (Elliott, 2017; Plys et al, 2020). Other factors could include:…”

Stories of the Heart: Illness Narratives of Veterans Living With Heart Failure

“…This overlaps with social messages on military culture, including self-reliance, toughness, persistence in the face of adversity, limited expression of emotions, and the recognition of power and respect. 23 People who internalize these social messages on masculinity may be less likely to access mental health treatment. 23 This stigmatizing barrier to mental health treatment could impact how positive narratives are constructed around the experience of chronic illness for narrators who identify as masculine.…”

“…23 People who internalize these social messages on masculinity may be less likely to access mental health treatment. 23 This stigmatizing barrier to mental health treatment could impact how positive narratives are constructed around the experience of chronic illness for narrators who identify as masculine. Military and masculine identity could exclude or constrain stories about a veteran who did not "solider on" or who had to rely on others in a team to get things done.…”