Chapter 9: Chronic & Terminal Illness Flashcards
Chronic Conditions - Stats
- most of us likely to develop at least 1 chronic condition that may lead to our death
- 2/3 of canada health spending is on chronic conditions
- more common among lower income, women, seniors
Crisis Theory
factors that influence how ppl adjust/cope after first learning they have a chronic illness (illness-related factors, personal, physical/social)
Adaptive tasks in coping
- tasks related to the illness or treatment (adjusting to hospital environment, etc.)
- tasks related to general psychosocial functioning (control negative feelings, positive outlook, etc.)
Coping with Cancer - patient strategies
- social support
- distancing
- cognitive escape
- behavioural escape
maladaptive coping
- rumination
-interpersonal withdrawal - avoidant coping (denial)
Informal Caregiving
The provision of physical/emotional care to a family member or friend at home
caregiving as a chronic stressor
The stress of caregivers is generally higher than non-caregivers and for that reason caregiving is considered a chronic stressor
Factors in caregiving stress
- not having te time to care for oneself
- engaging in unhealthy behaviours due to lack of time
disrupted or insufficient sleep - poor stress management and stress prevention
- degrading social relationships and social support
caregivers are also m ore likely to believe that stress is having a negative impact on their physical health
Economic burden of caregiving
- extra expenses
- postponed education
- declined promotion
- missed days of work
- reduced hours of work
Health Costs of Caregiving
Higher levels of depression and physical health problems in caregivers when compared with non-caregivers
- abnormalities in measures of endocrine (cortisol) and immune system function
- spouse caregivers are at risk of premature death
Benefits of caregiving
- majority of caregivers consider it a positive experience
- providing the best care possible
- staying connected or becoming closer
- rewarding sense of accomplishment, giving back to someone who has cared for them
- sense of meaning and purpose
- passing on a tradition of care in family
- learning new skills
Future of Caregiving
based on stats Canada:
- there will be approx 120% more older adults using home care support
- there will be approx 30% fewer close family members avail to provide unpaid care
- family members will need to increase their efforts by 40% to keep up with care needs
Managing Terminal Illness
mortality is the main issue of concern to patients in the first few months of being diagnosed with a seriously life-threatening illness
High mortality illness
a high mortality disease does not typically mean a person will die in a few weeks or months
- however, families must adapt to this uncertainty (a source of stress in terminal illness)
denial in terminal illness
Denial is common in terminal illness - in some cases can be extreme and persistent
- many patients also hope they will be cured or hope for a miraculous recovery
denial and acceptance
denial is more common early on and acceptance is more common closer to death
acceptance in terminal illness
acceptance is important for both patients and their loved ones
Initial Response to pain
Sense of control is lowered; secondary appraisal is common
- engage in more emotion-focused coping early on
Crisis theory
Describes factors that influence how ppl adjust/cope after first learning they have a chronic illness
Adaptive Tasks in Coping
- Tasks related to the illness or treatment
- coping with the symptoms or disability of illness
- adjusting to hospital environment, procedures, treatments
- developing good relationships with practitioner - Tasks related to general psychosocial functioning
- controlling negative feelings
- having positive outlook
- maintaining satisfactory self-image, sense of competence
- preserving good relationships with family/friends
- preparing for uncertain future
Coping strategies cancer patients found most useful
- social support
- distancing
- positive focus
- cognitive escape/avoidance
- behavioural escape/avoidance
Maladaptive Coping
- rumination
- interpersonal withdrawal
- avoidant coping
Rumination
associated with exacerbation of symptoms
interpersonal withdrawal
associated with loneliness and low relationship satisfaction
avoidant coping
associated with increased psychological distress and can exacerbate the disease process - leads to poor adjustment to illness
denial in cancer patients
- denial of diagnosis
- denial of impact
- denial of emotions
Impact on physical and social functioning were inconsistent; the impact on psychological functioning depended on the form of denial
Distractive strategies were found reduce distress, whereas passive escape mechanisms turned out to decrease psychological well-being
Depression in cancer patients
may be delayed as patients try to understand implications of condition
- physically debilitating
- direct impact on symptoms
- history of depression is associated with poorer adjustment to cancer and other chronic illnesses
Can depression impact cancer survivability
increasing depression = decreasing months of survival!
cancer stigma
cancer stigma depends on the extent to which a person’s identity and sense of self are affected by the diagnosis
- perceived controllability and visibility of cancer, and whether it interferes with daily functioning are also main factors in cancer stigma
effects of cancer stigma
stigma is associated with more problematic outcomes (ex. depression)
- cancer stigma is correlated with reduced cancer screening for cervical, breast, and colorectal cancer
adaptation
making changes in order to adjust constructively to life’s circumstances
Successful adjustment to chronic conditions involves several major adaptive tasks that continue indefinitely
Cancer survivor
Long-term cancer survivor have higher rates of emotional distress, especially those of lower SES and those who are single and disabled
Social relationships are impacted, especially for couples
most cancer patients display a remarkable amount of resilience
Quality of Life
The degree of excellence people appraise their lives to contain
Based on physical, psychological, vocational, and social functioning; includes disease or treatment related symptoms
Emphasis is placed on daily living
an important indicator of recovery from
Evaluating quality of life
the most important aspect of quality of life is a person’s perceptions of their own health (Self reported or subjective health)
is subjective health consistent with objective health
Yes! Self reported health is associated with prevalance of all diseases, onset if all diseases, and labratory parameters of health
Is subjective health predictive of mortality?
Self reported health significantly predicts mortality in longitudinal research often more than objective indices of physical health
Is life satisfaction predictive of morbidity
YES - there is also a significant association between life satisfaction and onset of many chronic diseases
Is life satisfaction predictive of mortality
YES - life satisfaction scores predict mortality (although less consistently than self-reported health)
What psychological interventions are used to manage chronic illness and disease
- Psychopharmacological
- patient and family education
- individual or family therapy
- stress management/relaxation
- support groups
psychological benefits of
Cancer Support Groups
there is a significant survival benefit from support groups at one-year, but not 4 years
- improved mood
reduced uncertainty
-improved self-esteem
- enhanced coping skills
- improved quality of life
Factors in caregiver stress
- not having time to care for oneself; feeling overwhelmed
- engaging in unhealthy behaviours due to lack of time
- disrupted or insufficient sleep
- poor stress management
- degrading social relationships and poor support
caregivers are also more likely to believe that stress is having a negative impact on their physical health
Health costs of caregiving
higher lvls of depression and physical health problems
abnormalities in measures of endocrine (cortisol) and immune system functioning
premature death
benefits of caregiving
overwhelming majority of caregivers consider it to be a positive experience
- providing the best care possible
- staying connected or becoming closer
- rewarding sense of accomplishment, giving back to someone who has cared for them
- sense of meaning and purpose
- passing on a tradition of care in family
- learning new skills
Future of caregiving
- there will be approx 120% more older adults using home care
- approx 30% fewer close family members who will be avail to provide unpaid care
- family members will need to increase their efforts by 40% to keep up with care needs
Denial in terminal illness
enial is common in terminal illness yet it can pose significant challenges for the person and their family
Many patients also hope they will be cured or hope for a miraculous recovery. This can lead patients to choose aggressive care, even if it is futile
Denial/Acceptance
There is evidence that denial is more common early on and acceptance is more common closer to death
Acceptance in Terminal Illness
Acceptance is important for Both patients and their loved ones. But acceptance means different things to different people
