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16. HaDSoc > 4. Chronic Illness; Health-Related Quality of Life > Flashcards

4. Chronic Illness; Health-Related Quality of Life Flashcards

1
Q

What is a chronic illness?

A

A condition that is long term and has a profound influence on the lives of sufferers.

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2
Q

What are the features of onset of chronic illness?

A

Symptoms can be striking, slow in onset, and have alternate explanations.

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3
Q

What are the features of diagnosing a chronic illness?

A

Prolonged period of uncertainty, ambivalent status, unpleasant process, can be shocking/threatening/relief.

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4
Q

What is a sociological concept that identifies chronic illness as a major disruptive experience?

A

Biographical disruption.

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5
Q

What is the illness narrative?

A

People’s narrative of their illness that offer a way of making sense of illness so it performs a certain function.

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6
Q

What is narrative reconstruction?

A

The process by which the shattered self is reconstructed in a way that explains the appearance of illness.

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7
Q

Where does narrative reconstruction come from?

A

A desire to create coherence, stability, and order in the aftermath of biographical disruption.

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8
Q

What is illness work?

A

Symptom management, dealing with the physical manifestations of the illness.

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9
Q

What is everyday life work?

A

Managing daily living, strategy to manage the condition and its impacts to try to keep pre-illness lifestyle and identity intact and to re-designate new life as ‘normal life’.

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10
Q

How is everyday life work managed?

A

By mobilising resources, balancing demand on others and remaining independent. Disguising or minimising symptoms.

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11
Q

What is emotional work?

A

Managing one’s own emotions and those of others. Protect the emotional well-being of others.

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12
Q

How does emotional work impact life?

A

Impacts social relationships, may disrupt friendships or cause withdrawal. Impacts role, may involve switch to dependency.

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13
Q

What is biographical work?

A

Loss and subsequent reconstruction of self.

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14
Q

What is identity work?

A

Work to maintain an acceptable identity.

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15
Q

What is stigma?

A

A negatively defined condition, attribute, trait, or behaviour conferring deviant status.

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16
Q

What is discreditable stigma?

A

The stigma is yet to be revealed.

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17
Q

What is discredited stigma?

A

Physically visible characteristic or well-known stigma that sets patient apart. Patient is discredited.

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18
Q

What are the effects of discredited stigma?

A

Patient is discredited which affects behaviour of patient and those around them.

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19
Q

What is enacted stigma?

A

Experience of prejudice, discrimination, and disadvantage.

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20
Q

What is felt stigma?

A

Fear of enacted stigma. Feelings of shame even though the discrimination has not actually occurred.

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21
Q

How does the medical model define disability?

A

Change from medical norms so disadvantages are a direct consequence of impairment and disabilities and medical intervention is needed to cure or help.

22
Q

How is the medical model of disability limited?

A

It lacks recognition of psychological and social factors. It uses stereotyping and stigmatising language.

23
Q

How does the social model define disability?

A

A form of social oppression so disadvantages are a product of environment and its failure to adjust and political action or social change are needed to help.

24
Q

How is the social model of disability limited?

A

It leaves out biological factors and fails to recognise bodily realities and the extent to which these are solvable socially.

25
Q

What is the purpose of international classification of impairments, disabilities, or handicaps (ICIDH)?

A

It attempts to classify the consequences of disease.

26
Q

What is impairment concerned with in the ICIDH?

A

Abnormalities in structure of the functioning body.

27
Q

What is disability concerned with in the ICIDH?

A

Performance of activities.

28
Q

What is handicap concerned with in ICIDH?

A

Broader social and psychological consequences of living with impairment and disability.

29
Q

What are some limitations of the ICIDH?

A

The term ‘handicap’ has been used negatively so now is avoided. The model implies problems are intrinsic or inevitable.

30
Q

What is the international classification of functions, disability, and health (ICF)?

A

The WHO’s framework for measuring health and disability at individual and population levels. It describes and measures health and disability and attempts to integrate medical and social models.

31
Q

What are the considerations of ICF?

A

The body structure and functions that impair activities undertaken by the individual and how that participates in life situations.

32
Q

Why does health need to be measured?

A

To indicate the needs of healthcare, target resources, assess effectiveness, evaluate quality, use evaluations of effectiveness to get better value for money, monitor patient’s progress.

33
Q

What do measures of health include?

A

Mortality, morbidity, and patient-based outcomes.

34
Q

What are the aims of patient-based outcomes?

A

Assess well-being from the patient’s perspective and compare before and after treatment scores over longer-periods.

35
Q

How can scores for before and after treatment be collected?

A

Health-related quality of life (HRQoL) and patient-reported outcomes measures (PROM).

36
Q

How can patient-based outcomes be used?

A

Clinically, to assess benefits in relation to cost, in clinical audit, to measure health status of populations, to compare interventions, as a measure of service quality.

37
Q

What is the NHS outcomes framework?

A

Identifies PROMs as a key source of information about outcomes of planned procedures.

38
Q

What are the key emphases of HRQoL?

A

Patient’s own views, functional efforts, therapy as well as illness.

39
Q

What are the dimensions of HRQoL?

A

Physical function, symptoms, global judgements of health, psychological well-being, social well-being, cognitive functioning, personal constructs, satisfaction with care.

40
Q

How can HRQoL be measured?

A

Qualitatively or quantitatively.

41
Q

Evaluate the use of qualitative methods to measure HRQoL?

A

It is good for initially assessing HRQoL. But is resource expensive and hard to evaluate.

42
Q

What are the important features of quantitative methods in measuring HRQoL?

A

Reliability of instruments (no change in health should mean no change in score) and validity of instruments (measures what it should measure).

43
Q

What are the principals in using generic instruments in measuring HRQoL?

A

Can be used with any population, covers perceptions of overall health, questions on social, emotional, and physical functioning, pain, and self care.

44
Q

What is a short-form 36-item questionnaire (SF-36)?

A

36 items that assess HRQoL over 8 dimensions with responses to questions scored for each dimension, adds to out of 100.

45
Q

Evaluate the use of SF-36.

A

The dimension scores aren’t added together which can make interpretation difficult. But it is acceptable to people and doesn’t take long, reliability is good and it is responsive to change.

46
Q

What does the EuroQoL (EQ-5D) look at?

A

5 dimensions of health with three levels for each (no problems, some/moderate problems, extreme problems).

47
Q

What are the 5 dimensions of health that EQ-5D considers?

A

Mobility, self-care, usual activities, pain/discomfort, anxiety/depression.

48
Q

What are the principals of specific instrument use in measuring HRQoL?

A

Disease specific, site specific, or dimension specific.

49
Q

What are the advantages of specific instruments in measuring HRQoL?

A

Relevant content, sensitive to change, acceptable to patients.

50
Q

What are the disadvantages of specific instruments in measuring HRQoL?

A

Can’t be used with people who don’t have the disease, comparison is limited and unexpected effects may not be detected.

51
Q

How can the suitability and value of HRQoL instruments be assessed?

A

Look at published work showing validity/reliability, published work showing successful use of instrument, suitable for area of interest, reflect patient concerns, acceptable to patients, sensitive to change, easy to administer and analyse.

16. HaDSoc (12 decks)

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