ASBHDS - Session 2

Question 1

What is “coping”?

Answer 1

The sum of COGNITIVE and BEHAVIOURAL efforts (which are constantly changing) to HANDLE PARTICULAR DEMANDS (whether internal or external) that are viewed as TAXING/DEMANDING.

Question 2

Describe the transactional model of stress.

Answer 2

Potential stressor -> primary appraisal (is this a threat?) -> secondary appraisal (do I have the skills to cope?) -> stress

Question 3

What are the two factors that must be considered in coping with the social and psychological impact of illness?

Answer 3

Adjustment to new identity and socioeconomic impact of illness.

Question 4

What is the difference between emotion and problem focussed coping?

Answer 4

Emotion focussed coping seeks to change the emotion behind the issue through behavioural or cognitive approaches, while problem focussed coping seeks to change the problem itself, eg by reducing demands of situation or finding resources to deal with it.

Question 5

Give three ways to aid coping.

Answer 5

• help patients increase social support
• increase personal control (eg. Pain management, involve patients more)
• prepare patients for stressful events by reducing ambiguity and uncertainty

Question 6

Give some outcomes of successful coping.

Answer 6

Tolerating/adjusting to negative events/realities, maintaining positive self image and emotional equilibrium, continuing satisfying relationships with others, reducing threats from future

Question 7

Which two things are people who are diagnosed with a chronic/life-threatening illness more likely to suffer from?

Answer 7

Depression and anxiety

Question 8

What is an anxiety disorder?

Answer 8

A normal reaction to stress which has become excessive, experienced as intense dread or uneasiness. Likely to occur at various stages during illness.

Question 9

Give some symptoms of depression due to another medical condition.

Answer 9

Depressed mood and irritable, decreased interest in activities, weight change, sleep change, activity change, fatigue, guilt, indecisiveness, suicidality

Question 10

True or false - co-morbid depression does not affect risk of mortality?

Answer 10

False - it does. It also adversely affects other illness outcomes.

Question 11

Give some barriers to recognising psychological problems in patients.

Answer 11

Symptoms may be inadvertently missed, patients my not disclose symptoms, HCPs may avoid asking.

Question 12

Is it important to be aware of the possibility of psychological problems?

Answer 12

Yes (shocker)

Question 13

Give three commonly used measures of health.

Answer 13

Mortality, morbidity and patient-based outcomes.

Question 14

What do patient based outcomes do?

Answer 14

Attempt to assess well-being from patient’s point of view by comparing scores before and after treatment or over longer periods.

Question 15

Give some reasons for using patient-based outcomes.

Answer 15

Increase in conditions where aim is managing rather than curing, need to focus on patient’s concerns, need to pay attention to iatrogenic effects of care.

Question 16

What can patient-based outcomes be used for?

Answer 16

They can be used clinically, to assess cost-benefits, in clinical audit, to measure health of populations, to compare interventions in a clinical trial, as a measure of service quality.

Question 17

What are two reasons often given in favour of introducing PROMs?

Answer 17

Improves clinical management of patients, allows comparison of hospitals.

Question 18

What are the challenges of PROMs?

Answer 18

Minimising the time and cost of collection/analysis/presentation, achieving high rates of patient participation, providing different output to diffferent audiences, avoiding misuse.

Question 19

What is “health-related quality of life”?

Answer 19

The functional effect of an illness and its consequent therapy on a patient, as perceived by the patient.

Question 20

What are the two basic groupings of “instruments” that can be used to measure health related QoL?

Answer 20

GENERIC (can be used with any population, cover general perception of overall health, can cover emotional health too), SPECIFIC (evaluates a series of health dimensions specific to a disease)

Question 21

Give some advantages of generic instruments.

Answer 21

Can be used for much broader range (or if no disease specific instrument), enables comparison across treatment groups, can detect unexpected effects, can assess health of populations.

Question 22

Give some disadvantages of generic instruments.

Answer 22

Less detailed, loss of relevance, less sensitive to changes, may be less acceptable to patients.

Question 23

What type of instrument are the SF-36 and the EuroQoI EQ-5D?

Answer 23

Generic

Question 24

What is the difference between the SF-36 and the EuroQoI EQ-5D?

Answer 24

SF-36 contains 36 items in 8 dimensions, generates score from 1-100 for each dimension which cannot be added up. EuroQoI generates single value from 1 (healthy) to 0 (death). 5 dimensions with 3 levels for each.

Question 25

What are the three types of specific instruments?

Answer 25

Disease specific, site specific, dimension specific.

Question 26

Give some advantages of specific instruments.

Answer 26

Very relevant content, sensitive to change, acceptable to patients.

Question 27

Give some disadvantages of specific instruments.

Answer 27

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

Question 28

What are long-term conditions?

Answer 28

An illness that can be controlled but not cured, where the manifestation varies greatly day to day.

Question 29

What is rheumatoid arthritis?

Answer 29

Chronic autoimmune disease. Symptoms include joint tenderness and swelling, anaemia, pain, fatigue, muscle atrophy and osteoporosis. Usually between ages of 40 and 60.

Question 30

What are “illness narratives”?

Answer 30

The story-telling and accounting practices that occur in the face of illness.

Question 31

What is “stigma”?

Answer 31

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

Question 32

What is the difference between discreditable and discredited stigma?

Answer 32

Discreditable stigma is where the illness is not seen but may cause issues if found out, eg HIV.
Discredited stigma has a physically visible characteristic or well known stigma which sets them apart, eg. Physical disability.

Question 33

What is the difference between felt and enacted stigma?

Answer 33

Enacted is a real experience of prejudice/discrimination/disadvantage. Felt stigma is a fear of enacted stigma, which also encompasses a feeling of shame.

Question 34

What is meant by the “work” of long term conditions?

Answer 34

• Illness work (symptom management, treatment)
• Everyday life work (managing daily living)
• Emotional work (managing one’s own emotions and
  those of others)
• Biographical and narrative work (reconstruction of self)
• Identity work (work to maintain an acceptable identity)