case 4 - bss Flashcards
what is patient centred care
patients and their priorities have central importance
Responsive to patients’ preferences, needs and values - use these to guide clinical decisions
Holistic care similar
Care for patient as a whole
Considers all aspects of a patients life
Includes physical, psychological, social and spiritual affects of illness
why does patient centred care matter
aid understanding of clinical problems
Improve relationship between healthcare professionals and patients
Increase concordance
Increase satisfaction from patients and from healthcare providers
Increasingly patient experience is used to develop services and measure outcomes
Increased job satisfaction
what is the biographical disruption
long term conditions can disrupt normality and individuals begin to re examine their expectations of self, daily life and future
what is the definition of palliative care
an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
what does palliative care involve
careful and continual assessment of symptoms
concept of total pain
the family as the unit of care
active total care
listening
questioning
what is the essence of palliative care
‘ You matter to the last moment of your life and we will do all that we can, not only to help you die peacefully, but to live until you die’
who should get palliative care
traditionally aimed at patients with incurable cancer
although more recently, patients with any life limiting diagnosis
what is the definition of consent
permission for something to happen or agreement to do something
what has to happen for consent to be valid
it must be voluntary and informed, and the person consenting must have the capacity to make the decision
what is the definition of voluntary
Voluntary: the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure for medical staff, friends or family. ‘Freely given’ is a common term here.
what is the definition of informed
Informed: the person must be given all the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn’t go ahead.
what is the definition of capacity
Capacity: the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision.
why is consent important
out of respect for autonomy
Without it you are likely to commit an offence:
Information disclosure - data protection, GDPR
Bodily contact - battery, manslaughter etc
f you gain it inadequately, just like any there facet of medial practice, you may be found to have acted negligently
what kind of actions might require consent
anything a person may rightfully require you to otherwise refrain from
what form may consent take
implicit, explicit, verbal or written
what information is needed for informed consent
this is the part of the law continuously evolving
Highly indicative of a shift in society’s relationship with its doctors
This evolution has not yet finished
what is the interpretation of the law we now use
law as laid out by ‘Montgomery vs Lanarkshire’
what does the Montgomery framework do
puts the reasonable patient as the standard
as per GMC guidance, what does this framework mean for us
take time to ask your patients what they need to know
Answer truthfully and to the extent of their wishes
Add on anything else they need to know
Remember to cover alternatives, including doing nothing. You aren’t a salesperson - you are a guide
what happens if you fail to get informed consent
You/your trust may get sued. Failure to meet the (evolving) standard will lead you open to a charge of negligence
Professional censure. You may also have to answer to the GMC they feel your incompetence makes you unfit to practice.
what is the health and illness continuum
illness onset –> illness adaption -> illness outcomes
what is included in illness onset
beliefs and behaviours
what is included in illness adaption
help seeking, coping, social support
what is included in illness outcomes
quality of life and behaviours
what is an example of the susceptibility health belief
i may have cancer
what is an example of the cost health belief
i need to be at home to look after my partner
what is an example of the benefits health beliefs
i might not feel as tired and have more energy
what is an example of the cue to action health belief
physical symptoms
what are the psychological consequences of ill health
lowered mood
increased anxiety
feelings of hopelessness
what are the potential behaviour changes
reducing alcohol
taking medicines
what do life stressors and behaviour change relate to
these two relate to adaption which is:
difficulty coping and adaption
what is the outcome part of the health belief
quality of life
disease free interval
prognosis
what is a stressor
something in our external environment
what is the stress
the response to the stressor
what is distress
stress that is harmful and damaging
what is eustress
stress that is positive and beneficial
what is the primary appraisal in Lazarus and Folkman’s model of coping
how stressful is the situation
what is the secondary appraisal in Lazurus and Folkman’s model of coping
how capable am i of coping with this thing
what is stress the imbalance between
demands and resources
what happens when stress activates the sympathetic nervous system
adrenaline and noradrenaline are released
what happens when adrenaline and noradrenaline are released
changes in blood pressure, heart rate, sweating, pupil dilation, immune function
what is the activation of adrenaline and noradrenaline more likely to be involved in
acute stress
what is released in HPA activation
cortisol is release
what does this cortisol release lead to
changes in management of carbohydrate stores, inflammation, immune function
what does this cortisol release involve in
chronic stress
what are stress behavioural changes
smoking
Drinking alcohol
Eating
Exercise
Accidents
what is the direct pathway between stress and illness
physiology
what is the indirect pathway between stress and illness
behaviour
what are the physiological moderators of stress-illness
stress reactivity, stress recovery, allostatic load, stress resistance
what are the psychological moderators of stress illness
health behaviours, coping strategies, social support, personality, actual or perceived control
what are the psychosocial risk factors for cancer
demographic
health behaviours
what are the psychological responses to cancer
anxiety
Depression
Body image
Coping strategies
Problem focused
Avoidant strategies
what is authenticity
understand what is important in their life
what is autonomy
perceived freedom to live life in line with values
what is acceptance
peaceful and joyful experiences and greater connection to others
what is the cognitive adaptive theory for the process of searching for meaning
searching for causality and to understand the implications. improved self knowledge, self change, process of reprioritisation
what is the cognitive adaptive theory for the process of searching for mastery
the sense of mastery is achieved by thinking the illness is controllable. mastery is achieved through psychological techniques or behavioural techniques
what is the cognitive adaptive theory for the process of self enhancement
comparing yourself to others to improve self esteem - ‘at least ive only had cancer once’, it could have been worse etc
what are the psychological interventions
cognitive behaviour therapy - CBT
Acceptance and commitment therapy - ACT
Mindfullness
