Coping with illness and treatment Flashcards
WHO Definition of Health:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
define:
impairment
disability
handicap
impairment refers to a problem with a structure or organ of the body
disability is a functional limitation with regard to a particular activity
handicap refers to a disadvantage in filling a role in life relative to a peer group, as a result of impairment and disability
What are the links between the terms handicap, disability and impairment
Disability strongly correlates with handicap.
BUT research shows a very low correlation (r=0.19) between impairment and disability in 763 CHD patients.
Suggesting other factors in addition to impairment (structural problem), influencedisability (functional limitations)…
Crisis Theory of Coping with Illness (Moos, 1977)
description
- Similar to homeostasis, we have a need for social and psychological equilibrium.
- Serious illness presents ‘a crisis’ and our usual, habitual ways of coping are inadequate.
- A state of disorganisation, feelings of fear, guilt, sadness etc .
- A crisis by definition is self-limited because we cannot remain in an extreme state of disequilibrium.
- Adaptive responses lead to personal growth and adjustment to the illness.
- Maladaptive responses lead to poor adjustment (psychological problems, low functioning etc).
Crisis theory of coping with illness
see diagram
Illness related factors
• Unexpected • Cause & Outcome/Prognosis • Disability • Stigma • Disfigurement • Prior experience
background/personal factors to do with understanding illness
• Age of onset • Gender • SES & occupation • Pre-existing illness beliefs • Pre-existing personality
how can the big 5 personality traits affect how one understands their illness
- Openness – no clear link to health
- Conscientiousness - +2 years life expectancy
- Extraversion – lower rates of CHD, protective respiratory disease
- Agreeableness – Hostility associated w/ CHD
- Neuroticism – higher use of alcohol and smoking; higher symptom reportin
The Impact of Agreeableness
Big Five Personality Traits: Different adaptation for high and low agreeableness ‘I see myself as someone who has a forgiving nature’ May be explained by more agreeable individuals… Having more social support & better quality of friendships More likely to follow self-care instructions & have positive, active coping strategies
Physical and Social Environment
• Hospitalisation • Accommodation and physical aids/adaptations • Societal attitudes • Social support & social role
impact of cardiac patients and socially isolation
The most socially isolated cardiac patients scored higher on a hostility measure, had lower incomes, and were more likely to be smokers…
• Although when these variables were adjusted for, social isolation remained robust predictor of cardiac mortality.
influence of social relationships on risk for mortality
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.
crisis theory of coping with serious illness
see diagram
define illness representations
“A patients own implicit, common sense beliefs about their illness”
5 factors of illness representations
about their illness” 1) Identity 2) Cause 3) Consequences 4) Time line 5) Curability/controllability
a picture of health
-what were they required to do?
74 patients after MI were asked to draw pictures of their heart (before discharge from hospital)
Recovery was assessed 3 months later, measuring work, exercise, distress about symptoms and perceptions of recovery
a picture of health: conclusions
Patients who drew damage to their heart perceived that their heart had recovered less at 3 months, that their heart condition would last longer and had lower perceived control over their heart condition Extent of damage drawn correlated to slower return to work Peak troponin-t not related to 3-month outcomes or return to work
“Drawings of damage predict recovery better than medical variables”
Maladaptive Coping Appraisals & Responses examples
“Stress caused my heart attack, smoking helps me reduce my stress levels, so I’m going to continue smoking”
“Now I’ve had a heart attack, my life is as good as over, I’ll never be able to enjoy myself again” => low mood => reduce activity levels, avoid seeing friends => depression
2 types of adaptive tasks
1) Tasks related to illness or treatment • Coping with symptoms or disability • Adjusting to hospital environment/medical procedures • Developing and maintaining good relationships with healthcare professionals
2) Tasks related to general psychosocial functioning • Controlling negative feelings and retaining a positive outlook • Maintaining a satisfactory self image and sense of competence • Preserving good relationships with family and friends • Preparing for an uncertain future
define coping
Coping: ‘Cognitive and behavioural efforts to master, reduce or tolerate external and internal demands and conflicts’ (Strauss, 1988).
define problem focussed coping
Problem Focussed coping: Efforts directed at changing the environment in some way or changing one’s own actions or attitudes.
define emotion focussed coping
Efforts designed to manage the stress-related emotional responses in order to maintain one’s own morale and allow one to function.
examples of problem focused coping
•Seeking relevant information about an illness •Learning specific illness related procedures eg pacing activities •Changing behaviour eg diet
examples of emotion focussed coping
•Seeking reassurance and emotional support •Learning relaxation strategies •Meditation
Emotion vs Problem
focussed coping
•Many studies have found that use of emotion focussed coping strategies associated with poorer adjustment and greater levels of depression.
•However, circular reasoning (i.e. those who are more distressed may need to engage in more emotionfocussed coping).
•Optimal coping depends on the individual and the situation- flexibility is the most beneficial
Why is medical treatment stressful?
refers to
Transactional definition of stress: :
• Stress is a condition that results when the person / environment transactions lead the individual to perceive a discrepancy between the demands of the situation and the coping resources available.
Why is patient distress a bad thing?
- Moral/ethical responsibility to minimize suffering if possible. 2. Distress during treatment related to longer term psychological morbidity. 3. Distress during treatment related to wide variety of treatment outcomes, eg, patients not complying.
Is it helpful to prepare patients? (Egbert, 1964)
Prepared group reported less pain, used less analgesic medication and their post-operative stay in hospital was an average of 2.7 days shorter.
what is the difference between Procedural vs sensory information
- Procedural information – Information about the procedures to be undertaken
- Sensory information – Information about the sensations that may be experienced
which is more beneficial sensory or procedural information?
Results showed that the participants given sensory information reported significantly less distress during the procedure.
combined is better tho
what is the Dual process hypothesis
- Proposes that procedural and sensory information are both helpful because they work in different ways.
- Procedural information works by allowing patients to match ongoing events with their expectations in a nonemotional manner.
- Sensory information works by “mapping” a nonthreatening interpretation on to these expectations.
Effective communication is key
-what are the key points
• Prepare patients with information – not all patients like/know to ask questions • Try to gage patient preference for level of information and involvement • Check patient’s understanding – anxiety can block information being heard. • Try to avoid medical jargon • Provide written information as an well as verbal
Nursing Home Study: Results
On behavioural measures floor 1 residents (enhanced control group) showed greater engagement in activities.
- Self report and nurse’s ratings showed Floor 1 residents had better general well being (psychological & physical measures).
- 18 Months later – 15% of Floor 1 residents had died compared to 30% of Floor 2 residents.
how can you increase control in medical situations
Examples: • A device for patient to signal their pain/discomfort during dental treatment can reduce distress • Patient can squeeze a buzzer during an MRI to halt the procedure • Control over treatment options for fertility procedures related to greater well-being
preparing children for treatment
Preparatory information should be specific and include procedural & sensory information.
•Older children (> 7yrs) benefit most from information presented about a week before a procedure, younger children closer to the procedure.
•Modelling and coping skills interventions can be helpful •eg. Film ‘Ethan has an operation’ depicting a child in hospital using positive coping strategies reduced anxiety in children undergoing operations (Melamed & Siegal, 1975)
how do children cope?
- Children use the same types of coping as adults, but preference for problem-solving increases with age, whilst avoidant coping declines.
- Distraction is the most effective coping strategy for younger children.
- For older children (>9yrs) matching coping strategy to child’s preferred coping strategy is more effective.
describe the combined show-tell-do approach
1) Tell: Using simple language and a matter-of-fact style, the child is told what is going to happen before each procedure (comparisons the child understands are used and negative, emotive words avoided).
2) Show: The procedure is demonstrated using an inanimate object (eg a doll), a member of staff or the clinician.
3) Do: The procedure does not begin until the child understands what will be done.
The impact of parents’ behaviour
Children’s distress during a routine immunization was correlated with the amount of distress shown by parents but not to subjective anxiety (Frank et al, 1995)
