12. Coping with illness and disability Flashcards
What is health?
- State of complete physical, mental and social well-being
* Not merely an absence of disease or infirmity
What proportion of people have a chronic illness in developed countries?
1/3
What are the 3 main consequences of disease and their causal links, that the WHO classification describes?
- Impairment - refers to a problem with a structure or organ of the body
- Disability - functional limitation with regard to a particular activity
- Handicap - interaction of the individual with the environment; usually a disadvantage as a result of impairment and disability
Is there a correlation between disability + handicap, and impairment + disability, and what does this suggest?
- High correlation between disability + handicap
- Low correlation between impairment + disability
- Suggests that something in addition to impairment (structural problem) influences disability (functional limitations)
How high is the human capacity for overcoming serious health problems (resilience)?
Very very high (apart from a minority who suffer from severe psychological problems)
What 3 parts is the coping process made up of and what 3 factors influence this (in the crisis theory)?
Factors
• Illness related
• Background and personal
• Physical and social environmental
Coping
1) Coping appraisal
2) Adaptive tasks
3) Coping skills
What are the 2 responses to a crisis?
- Adaptive - leads to personal growth and adjustment to illness
- Maladaptive - leads to poor adjustment (psychological problems, low functioning etc.)
What illness related factors can influence the coping process?
- Unexpected - harder to come to terms with
- Cause and prognosis - guilt
- Disability - level of it
- Stigma
- Prior experience
What background and personal factors can influence the coping process?
• Age of onset
• Gender
• Socio-economic background
- lower background makes it harder
• Occupation - if it requires good health
• Pre-existing illness beliefs e.g. cancer = death sentence
• Personality
What big 5 personality traits have been linked to health outcomes?
- Openness - no clear link
- Conscientiousness - +2 years to life expectancy
- Extraversion - lower rates of CHD, protective respiratory disease
- Agreeableness - hostility associated with CHD
- Neuroticism - higher use of alcohol and smoking, but higher symptom reporting (hyper-vigilant)
How does life satisfaction change after becoming disabled, and what personality trait affects this?
• Significantly negative impact on life satisfaction
• May be small improvement years on
• Life satisfaction is significantly moderated by agreeableness
• Agreeable people:
- tend to have good social support and better quality of friendships
- more likely to follow self-care instructions
- positive and active coping strategies
What physical and social environmental factors influence the coping process?
- Hospitalisation - negative effect
- Accommodation and physical aids
- Societal attitudes
- Social support and social role
What is an illness belief?
A patient’s own implicit, common sense beliefs about their illness
What 5 things are asked in an illness perception questionnaire?
- Identity - symptoms?
- Cause - e.g. pollution
- Timeline - likely to be acute or chronic?
- Consequences - expected effects
- Curability/control - expectations about recovery or control
What did a study where MI patient’s drew their hearts show?
- Patients who drew damage to their heart perceived that their heart had recovered less after 3 months, that it would last longer and that they had less control
- Extent of damage drawn was correlated with a slower return to work
- Peak troponin-t was not related to 3-month outcomes or return to work
Study concluded that drawings of damage predict better recovery than medical variables
What are the 2 types of adaptive tasks?
1) Tasks related to illness or treatment
• coping with symptoms
• adjusting to hospital environment and medical procedures
2) Tasks related to general psychosocial functioning
• controlling negative feelings and retaining a positive outlook
• maintaining a satisfactory self-image
• preserving relationships
What are the 2 types of coping skills?
1) Problem-focused coping - efforts directed at changing the environment or changing own actions or attitudes
• seeking relevant information
• learning specific procedures
2) Emotion-focused coping - efforts designed to manage the stress-related emotional responses in order to maintain own morale
• seeking reassurance and emotional support
• meditation and distraction
How helpful are emotion-focused coping strategies and what can be done about this?
- Associated with poorer adjustment and greater levels of depression
- May be due to avoidance
- However, those who are more distressed may need this (circular reasoning)
- Optimal coping strategy depends on individual’s preferred coping style and situation
- Flexibility is the most beneficial
Why is patient distress a bad thing?
- Related to longer-term psychological morbidity and poorer health outcomes
- Greater chance of patients not complying => poorer outcomes
Why is medical treatment stressful and how can we use this information to our benefit?
- Stress = perceived discrepancy between demands of the situation and the coping resources available
- Medical procedures => high perception of threat => coping resources perceived to be low
- Preparing patients with information can make the experience less stressful
- Studies have shown informing on post-operative pain has decreased post-operative hospital stay
What is procedural and sensory information, and which type is likely to reduce distress during a procedure?
- Procedural - information about the procedure to be undertaken
- Sensory - information about the sensations that may be experienced
Sensory info is more likely to reduce distress (but a combination is even better = dual process hypothesis)
Is it better to give general or specific information to a patient before a procedure?
Better to inform them with as much specificity as they want, in order to cause less distress
How does control affect distress during medical procedures and give examples of how this has been considered?
- Increased control = less distress
- e.g. buzzer for patient to halt an MRI procedure
- e.g. choice to watch the procedure during an angioplasty
What is the most effective coping strategy for younger children?
Distraction
modelling interventions can be helpful e.g. Film of “Jack has an operation”
What is the “tell, show, do” combined approach to preparing a child for a procedure?
1) Tell - use simple language to tell the child what will happen (avoiding negative language)
2) Show - demonstrate the procedure using an inanimate object or a member of staff
3) Do - procedure does not begin until the child understands what will be done
Does the presence of a parent in treatment help?
- Mixed findings
- Children’s distress during a routine immunisation was correlated with distress shown by parents, but not to parents’ subjective anxiety
What affect does a mother doing the following affect pain in children (girls and boys):
• pain promoting (empathy etc.)
• pain reducing (distraction etc.)
• control (no training)
- Pain promoting increased pain and pain reducing decreased pain below the control in girls
- No significant effect in boys
How should you act differently in a consultation with adolescents?
- Be aware of embarrassment when talking about sensitive health concerns
- Respond in a non-judgmental way
- Reassure patient about confidentiality
- May be helpful to ask parents to allow adolescent to have part of the consultation alone
