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Psychology applied to health > Consultation Behaviours And Patient Adherence > Flashcards

Consultation Behaviours And Patient Adherence Flashcards

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1
Q

Outline the 5 step process from illness to recovery, in an ideal world.

A

Experience a problem -> see an expert -> receive a diagnosis -> follow medical advice -> get well

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2
Q

Name a few examples of problems that can get in the way of patients’ help seeking.

A

Symptom appraisal, feelings towards doctors, problems with getting an appointment and expectations about self.

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3
Q

Experiencing symptoms: initiating consultation is a _____________

A

Behavioural decision

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4
Q

Health psychology is largely about _________ and __________ behavioural decisions.

A

Understanding/modifying

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5
Q

The complicated nature of behavioural models (e.g. Ref?) show that ___________________.

A

(The integrated behaviour change model; hagger and chatzisarantis, 2014) lots of factors structure and impede behavioural decisions.

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6
Q

We know that intentions ___________ but do not ______________ behaviour.

A

Influence/guarantee.

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7
Q

Experiencing symptoms: what is the ‘clinical iceberg effect’?

A

While some people consult for minor ailments, others are more stoic and rarely consult - this leads to the clinical iceberg effect whereby there are lots of people who don’t see doctors.

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8
Q

Name some structural factors which influence consultation behaviours.

A

Inability to get an appointment, fastest finger first, postcode lottery.

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9
Q

Data from the ____________ showed that there was an _____ percent increase in A&E visits from 08/09 to 12/13 as a result of people not being able to get a gp appointment. (Ref?)

A

National patient survey
11% (6million)
Cowling et al., 2014

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10
Q

Name two diseases for which early consultation and diagnosis is important and give reasons.

A
  1. Dementia:
    Helping patients make sense of the condition and put their affairs in order while they still can.
    Avoidance of risks e.g. Road accidents
  2. Cancer:
    Early diagnosis can help to slow the progression and save lives.
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11
Q

Which 3 cancers does the NHS routinely screen for?

A

Bowel, Breast and Cervical

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12
Q

What % of new cancer diagnoses are made after and A&E visit?

A

25%

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13
Q

What % of people see their GP more than 5 times before receiving a cancer diagnoses?

A

10%

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14
Q

What are the 4 possible outcomes of cancer screening? and what might each of them lead to?

A
  1. True/positive - this is only useful if treatment is available and is likely to impact quality of life.
  2. True/neg - May lead to complacency
  3. False/pos - May cause distress or unnecessary risk from invasive procedures.
  4. False/neg - May lead false sense security and delayed help seeking
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15
Q

Who identified 3 thresholds which underpin perceptions of symptoms (ref)?

A

Ogden (2012)

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16
Q

What were the 3 threshold underpinning perception? identified by Ogden 2012

A
  1. Is it a real symptom (and is it norm/abnorm?)
  2. Do I need help?
  3. Could a doctor help me?
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17
Q

Is it a symptom?: In what way might personality factors affect symptom decisions? (ref)

A

Decisions may depend on a tendency to be internally or externally focused in terms of attention.
Internal focus inc. likelihood of sensitivity to symptoms but may lead to overestimation and slower perception of recovery.
Pennebaker (1983)

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18
Q

Is it a symptom?: In what way might social identity labels affect symptom decisions?

A

(St. Claire et al) If you consider yourself as someone who gets colds, you are more likely to perceive symptoms as indicative of a cold.

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19
Q

Is it a symptom?: Give a list of factors that affect symptom decisions.

A

Personality factors, social identity labels, demographics, mood/cognitions, social context and self categorisation.

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20
Q

Is it a symptom?: Who studied categorisation effects in perceptions of the common cold? (ref)

A

Levine & Reicher (1996)

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21
Q

Is it a symptom?: Describe Levine & Reicher’s (1996) study on categorisation effects in perceptions of the common cold.

A

Study looked at a P.E teacher/female identity and perceptions of facial scars, they presented pics of females with scars to female P.E teachers and manipulated the salience of gender/job role ‘study of women’s/P.E teachers attitudes’.

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22
Q

Is it a symptom?: Describe the results of Levine & Reicher’s (1996) study on categorisation effects in perceptions of the common cold.

A

Results -> Gender group rated scarring as more impactful on identity. This shows how self categorisation can influence symptom perception.

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23
Q

Is it a symptom?: Who studied self categorisation and performance in cognitive tests on old people? (ref).

A

Haslam et al (2012)

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24
Q

Is it a symptom?: Describe the design of Haslam et al’s 2012 study on self categorisation and performance in cognitive tests on old people.

A

N = 68, 60-70yr olds
All completed baseline cognitive tests
Half asked to draw comparisons between themselves and older people (self cat:younger)
Other half asked to draw comparisons between themselves and younger people (self cat:older)
Second manipulation: half given info that ageing is associated with specific memory decline.
Other half given info that ageing is associated with general cognitive decline.
Outcome measures = Memory test/general cognitive ability tests.

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25
Q

Is it a symptom?: What were the findings of Haslam et al’s 2012 study on self categorisation and performance in cognitive tests on old people?

A

People who self categorised as older performed worse overall = stereotype threat effect.
This effect interacted with expectations = those expecting general decline performed worse on cognitive tests (and met criteria for dementia).
Those expecting memory decline performed worse on memory tests.

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26
Q

Is it a symptom?: What is the significance of Haslam et al’s 2012 study on self categorisation and performance in cognitive tests on old people?

A

This study highlights the importance of social identity in symptom perception and role performance.
Has implications for diagnoses of dementia (doctors may influenced by own categorisation or patients OR patients behaviour may be influenced by GP behaviour based on these categorisations).

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27
Q

Is it a symptom?: Who performed qualitative interviews with old people r.e age related labelling by healthcare professionals?

A

Warmoth et al (2015)

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28
Q

Is it a symptom?: What are the findings and implications of Warmth et al’s (2015) qualitative interviews with old people?

A

Older people feel routinely treated as ‘old/frail’ and this underpins their performance in consultation settings in that they conform to this label. The implication of this is that they may not consult if they feel that their symptoms are ‘just because I’m old’.

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29
Q

Do I need help?: In any given 2 week period, between ___ and ____ percent of people report some ill health symptoms, but only _____ take consultation action. (ref?)

A

50 - 75%, 1/3 (Porter et al., 2004)

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30
Q

Do I need help?: Of those individuals who don’t consult, some self medicate or just live with it. ___________ are important to this decision.

A

Illness cognitions.

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31
Q

Do I need help?: What are illness cognitions?

A

Illness cognitions are what people think about the consequence of illness.

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32
Q

Do I need help?: Who identified 5 steps in illness cognitions?

A

Leventhal et al., 1997

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33
Q

Do I need help?: What are the 5 steps in illness cognitions, and what conclusions must be drawn for a person to decide they need help? (Leventhal et al., 1997)

A
  1. Identification/classification - Is it a symptom? (yes)
  2. How long will it last? (a significant period of time)
  3. What caused this? (a serious cause)
  4. How will this affect my life? (Large impact)
  5. Is this something I can control? (No - I need help to do this)
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34
Q

Do I need help?: What is the problem with the number of steps in illness cognitions?

A

They take time and many symptoms may pass before consultation takes place.

35
Q

Can a doctor help me?: Past experience of ___________ and _________ can reinforce inaction. This is because symptom experiencing is _________.

A

not seeking help/things getting better/normalised

36
Q

Can a doctor help me?: Patients must also analyse the _____ and ______ of seeking help (e.g.?)

A

Costs/benefits/e.g. money, procedures, medication side effects etc.

37
Q

Can a doctor help me?: Social pressures not to seek help can come from _________.

A

Public health campaigns

38
Q

Can a doctor help me?: Who wrote a summary of social stigma around mental health?

A

Vogel and Wade (2009)

39
Q

Can a doctor help me?: What did Vogel and Wade (2009) find re: stigma around help seeking?

A

They found that there is social stigma attached to help seeking, particularly in mental health - with consulting being seen as a ‘mark of disgrace, particularly in certain cultures.

40
Q

Can a doctor help me?: What proportion of people with depression never seek help? (ref?)

A

1/3 (Vogel and Wade, 2009)

41
Q

Can a doctor help me?: What is one proposed reason why a high proportion of people with depression never seek help? (ref?)

A

People with depression often spend a long time denying that their symptoms are indicative of depression before they consult (Vogel and Wade, 2009).

42
Q

Can a doctor help me?: If symptoms could pose a threat to one’s ‘healthy’ identity, this can lead to __________ (ref?)

A

Denial of symptoms (Farmer et al., 2012)

43
Q

Can a doctor help me?: Concerns about confidentiality are an important factor in the role of anticipated stigma in inhibiting mental health help seeking (ref?).

A

Clement et al. (2015) (systematic review)

44
Q

Can a doctor help me?: We tend to consult when symptoms are at their _______ and may be in _______.

A

peak, decline

45
Q

Can a doctor help me?: Spontaneous recovery is ______ in ________________.

A

Common/commonly experienced conditions

46
Q

Can a doctor help me?: There are two possible consequences of late consultation, when symptoms are in decline, what are they?

A
  1. Doctors may be over confident about their abilities

2. It can reinforce the medical model (discredits the BPS model)

47
Q

Adherence: What is adherence?

A

Following medical advice. Once a diagnosis is given (assuming it is correct) adherence/compliance is important for successful treatment.

48
Q

Adherence: How obedient to authority are we? Describe Milgram’s (1963) obedience study.

A
  • Teacher and learner

- No participant said they would administer a fatal shock, 65% did

49
Q

Adherence: Do doctors have an authoritative influence? Whose study suggests not?

A

Krakow and Blass (1995) found that nurses said they would not obey doctors orders to administer unsafe medicine.

50
Q

Adherence: Do doctors have authoritative influence? Whose study suggests they do?

A

Hofling et al. (1996) 21/22 nurses complied with a telephone order to administer an excessive dose of medication.

51
Q

Adherence: _________ prescriptions are given per day but one meta analysis found that adherence rates were _______- percent, and a more recent one found that they were only ______ percent for chronic illnesses. (refs?)

A

2.5 million/45-50%/25%/ Ley (1997)/ Van Dulmen (2007)

52
Q

Adherence: Who looked at adherence in patients with poorly controlled diabetes/CHD and depression?

A

Lin et al. (2012)

53
Q

Adherence: What did Lin et al (2012) do/find?

A

They conducted an RCT of 214 primary care patients with poorly controlled diabetes/CHD and depression. They looked at patient and physician behaviours and found that frequent and timely adjustments, as well as increased patient self monitoring led to increased adherence.

54
Q

Adherence: There are around _______ identified reasons for non adherence, including _______, _______, ___________, _________ and _________.

A

200, demographics, number of symptoms, treatment duration, dose frequency and patient factors (Memory; Ley, 1997)

55
Q

Adherence: Adherence is also influenced by _______ of and _________ with consultation: this is linked to perceived empathy (ref?)

A

Understanding of and Satisfaction with (Griffith, 2003).

56
Q

Adherence: None of the identified factors influencing adherence are consistent predictors, this suggests that obedience is far more complicated than __________’s work might suggest.

A

Milgram (1963)

57
Q

Adherence and social identity: How does the context dependent nature of social identity potentially impact on adherence?

A

Advice given whilst under the ‘patient’ identity may be harder to follow outside of the consultation room, when this identity is less salient.

58
Q

Adherence and social identity: Some groups value health less (ref?)

A

Oysterman et al. (2007)

59
Q

Adherence and social identity: Groups who value health less/see it as an outgrip thing are less likely to follow prescriptions (ref?).

A

(Tarrant and Butler, 2010)

60
Q

Adherence and social identity: SI may affect ______, ______ and _______ of consultation.

A

Understanding, satisfaction with and recall of.

61
Q

Adherence and social identity: Clinical consultation is an __________ context.

A

Intergroup

62
Q

Adherence and social identity: The intergroup context of clinical consultations influences….

A
  1. How doctors interpret patient behaviours
  2. How doctors treat patients
  3. How patients respond.
63
Q

Adherence: Who did a 2 year longitudinal study of 186 physicians?

A

Dimatteo et al. (1993)

64
Q

Adherence: What did Dimatteo et al. (1986) find?

A

In a 2 year longitudinal study of 186 physicians, they found that adherence was linked to physician work-satisfaction.

65
Q

Improving adherence: What are adherence contracts?

A

Verbal or written commitments to specified behaviours which contribute to adherence.

66
Q

Improving adherence: Who conducted a review of whether adherence contracts increase adherence across a range of conditions including weightloss and depression?

A

Bosch-Capblanch et al. (2007)

67
Q

Improving adherence: What were the findings from a review of whether adherence contracts increase adherence across a range of conditions including weightloss and depression? (ref?)

A

30 RCTs, N = 4,691
- Adherence contracts increase adherence across a range of conditions
- AC’s lead to significantly better outcomes at mid/end point of treatment and at 3 month follow up
- In general, evidence quality in this area is poor so strong inferences are not feasible.
Bosch-Capblanch et al. (2007)

68
Q

Improving adherence: Who conducted a systematic review of the effects of text messaging on adherence?

A

Ershad-Sarabi et al. (2016)

69
Q

Improving adherence: What were the findings of a systematic review of the effects of text messaging on adherence? (ref?)

A

Across 34 studies, 99.2% reported the effectiveness of SMS in increasing adherence, however the most common outcome measure was self report (41.2%).
Ershad-Sarabi et al. (2016)

70
Q

Improving adherence: Who conducted a review of 182 RCTs to try and unpick the best way to ensure adherence?

A

Nieuwlaat et al. (2014)

71
Q

Improving adherence: What were the findings of Nieuwlaat’s (2014) review of 182 RCTs?

A

Complex interventions with multiple components (support, education, inducing social support) were the best at maximising adherence.
Adherence is a complex problem which requires a complex solution.

72
Q

Improving adherence: ________ patients is critical.

A

Engaging

73
Q

Improving adherence: Engaging patients involves _______ preferences and _______ actions collaboratively.

A

Exploring, agreeing

74
Q

Getting well: Though there is a ____ - ____ percent misdiagnosis rate among GPs, physicians fail to anticipate this due to ________ (ref?)

A

10-15%, overconfidence, Berner & Graber (2008)

75
Q

Overconfidence: Doctors underestimate the rate of incorrect diagnoses because of _______ and systematically _______ factors including overconfidence. (ref?)

A

intrinsic, reinforced, Berner & Graber (2008)

76
Q

Overconfidence: Because of overconfidence, GPs are less likely to refer people for further testing, which has implications for the way patients are treated, listened to and respond (ref?)

A

Meyer et al. (2013)

77
Q

________ surgeons are the safest, because ______ surgeons have the least _____ and ________ surgeons are _______.

A

Mid career, early career, experience, later career, overconfidence.

78
Q

Who conducted a study on heuristic errors in clinical reasoning?

A

Rylander (2016)

79
Q

Describe Rylander’s (2016) study on heuristic errors in clinical reasoning.

A

150 clinical educators were surveyed about common types of heuristic errors in third year medical students and first year residents. Anchoring and premature closure were the most common in both.

80
Q

What is anchoring and what might it be related to in clinical practice?

A

Anchoring is reliance on initial information and may be a result of overconfidence or lack of attentional resources in clinical practice.

81
Q

What is premature closure and what might it be related to in clinical practice?

A

Premature closure is prematurely ending the decision making process and may be a result of overconfidence or lack of attentional resources in clinical practice.

82
Q

Cognitive bias can be avoided through procedural change, increase knowledge of diagnoses and metacognition (ref?).

A

(Vasquez-costa, 2012)

83
Q

Threat to healthy identity can cause patients to deny their symptoms: Describe Farmer et al’s (2012) study.

A

They conducted semi-structured interviews with 20 currently or previously clinically depressed patients, who either had or had not sought professional help. Thematic analysis revealed that the onset of symptoms had caused identity conflict for the individuals, participants used avoidance of help seeking as a strategy to reduce the threat to identity posed by depressive symptoms.

84
Q

Overconfidence means doctors are less likely to refer people for further testing: Describe Meyer et al’s (2013) study.

A

118 physicians correctly diagnosed 55.3% of easier and 5.8% of harder vignettes. But rated their confidence in hard vs easy diagnoses as 6.4/10 and 7.2/10. Higher confidence was related to decreased requests for additional diagnostic tests.

Psychology applied to health (6 decks)

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