coping with illness and treatment Flashcards
what is health
a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
what is impairment
refers to a problem with a structure or organ of the body
what is disability
a functional limitation with regard to a particular activity
what is handicap
a disadvantage in filling a role in life relative to a peer group, as a result of impairment and disabilit
eg accessing sports centres or experiencing prejudice
what are the links between disability, handicap and impairment *
disability strongly correlates with handicap
low correlation between impairment and disability -suggesting other factors influence disability - these are the individual differences ie coping strategies, personality, social and environment
describe the crisis theory of coping with disability *
we need social and psychological equilibrium
serious illness presents a crisis - our normal ways of coping are not good enough
leads to a state of disorganisation, feelings of fear, guilt, sadness etc .
A crisis is self-limited because we cannot remain in an extreme state of disequilibrium.
there are 2 possible responses to the disequilibrium - adaptive and maladaptive
what are adaptive responses *
personal growth and adjustment to the illness
have a richer appreciation for life, reprioritise things
what are maladaptive responses *
poor adjustment - psychological problems, low functioning etc
what are the 3 factors that effect the way that we cope &
illness related factors
background and personal factors
physical and social environmental factors
describe illness related factors *
if it is unexpected - difficult to come to terms with
cause and outcome/prognosis - people blame self if it is related to healthstyle - lead to depression, if poor or unknown prognosis it is hard to deal with
disability caused
stigma
disfigurment
prior experience - family/someone in public eye
describe background/personal factors *
age of onset - teenages struggle more with dm than younger children because they have more responsibility
gender - women struggle more/perhaps are more ready to search for help
socioeconomic status and occupation - low status worse
pre-existing health beliefs
pre-existing personality - some helpful, some inaccurate
effect of extraversion on health *
lower rates of CHD
protective against resp diseases
more likely to seek help and have a better support network
effect of agreeableness on health *
hostility related to CHD
more aggreeable people adapt better to illness - perhaps because they have more social support and better quality friendships, and are more likely to follow self care instructions and have positive active coping strategies
if hostile get angry instead and are less engaged
effect of neuroticism on health *
higher use of alcohol and smoking, higher symptom reporting
anxiety and depression
describe the physical and social environment *
hospitalisation - stressful
accomodation and physical aids/adaptions may need to be made to home
societal attitudes - if symptoms less obvious others might have doubts so it can be harder to access help
social support and social role - men feel demasculinated by heart disease
small social network increases risk of cardiac death in pts with coronary artery disease
most socially isolated people scored higher on hostility, had lower incomes, and were more likely to be smokers - when these adjusted for social isolation was still a predictor of cardiac mortality - comparable to risks like smoking
describe coping appraisal *
belief about the illness and the coping strategy you need to employ
cognitive representation about how to cope
effects the coping skills they need to employ and so what adaptive tasks are needed
what is an illness representation *
A patients own implicit, common sense beliefs about their illness
what are the 5 illness representations *
• Identity: the label of the illness and symptoms
Cause: what may have caused the problem, such as genetics, circumstances, trauma, etc.
Consequences: expected effects from the illness and views about the outcome
Time-line: how long the problem will last and whether it is seen as acute, chronic or episodic
Cure/control: expectations about recovery or control of the illness
describe the illness perceptions questionnaire *
clinical tool - give pts the opportunity to speak so you can investigate their specific beliefs and correct any misconceptions
describe the picture of health study *
pts after MI were asked to draw pictures of heart
pts who draw damage to heart had recovered less at 3 months, condition would last longer and had less percieved control
extent of damage drawn = slower return to work
peak troponin-t levels were not related to 3 month outcomes or return to work
drawings of damage predict recovery better than medical variables
examples of maladaptive coping strategies
“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
describe adaptive tasks *
tasks related to illness/treatment
- coping with symptoms/disability
- adjusting to hospital environment/medical procedures
- developing and maintaining good relationships with healthcare professionals
tasks related to general psychosocial functioning
- controlling negative feelings and retaining a positive outlook - not done immediately, initially have negative feelings
- maintain a satisfactory self image and sense of competence - eg self admin meds
- preserve good relationships with family and friends - pt keep communication open
- prepare for an uncertain future
describe effects of an adaptive coping intervention *
intervention aimed at modifying illness cognitions - educated about condition and adress any incorrect beliefs, explored beliefs about recovery and make explicit recovery plans, action plan reviewed and concerns about medication and symptoms were adressed
pts with these interventions had more positive views of MI in terms of belief of consequences, time line, control, cure, and symptom distress
they returned to work quicker, had less angina symptoms and had higher attendance at rehab classes
what is coping *
‘Cognitive and behavioural efforts to master, reduce or tolerate external and internal demands and conflicts’
what are the 2 types of coping *
problem focused coping
emotion focused coping
describe problem focused coping *
Efforts directed at changing the environment in some way or changing one’s own actions or attitudes.
Seeking relevant information about an illness
Learning specific illness related procedures eg pacing activities
Changing behaviour eg diet
what is emotion focused coping *
Efforts designed to manage the stress-related emotional responses in order to maintain one’s own morale and allow one to function
Seeking reassurance and emotional support
Learning relaxation strategies
Meditation
is emotional or problem focused coping more effective *
use of emotion coping associated with worse health outcomes - because closely associated with avoidance coping - going into denial
however there is circular reasoning - those that are more prone to anxiety need to engage in emotion coping
optimal coping depends on the individual and situation - need to be flexible
what is 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 bad *
we have a moral/ethical responsibility to minimize suffering if possible
Distress during treatment related to longer term psychological morbidity
Distress during treatment related to wide variety of treatment outcomes, eg, patients not complying.
is it helpful to prepare patients for the distress *
pts randomly allocated to recieve preparation (detailed info about pain) and normal care (no info)
prepared gp reported less pain, used less analgesic and post op stay in hospital was shorter
what is procedual and sensory info *
- Procedural information – Information about the procedures to be undertaken - how long it will last, what will happen etc
- Sensory information – Information about the sensations that may be experienced - numbness, hot flush
is pt distress lower with procedural or sensory information *
pts recieving sensory information reported less distress during the procedure
combined is most effective - procedural and sensory 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.
how much information is enough to reduce distress *
depends on the desire for information
those who want less info get more distressed if they recieve specific rather than general info and vice versa
what is the role of communication in reducing stress *
prepare pts with info - not all patients like/know how to ask qns
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
what is the effect of having control in medical situations *
when people in nursing home were given control eg were allowed to pick their film and had to look after their plant (as opposed to being given a timetable and everything done for them) they were more engaged in activities and had better physical wellbeing and survival
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
how should you prepare children for treatment *
prep info should be specific and include procedural and sensory
older children, >7, benefit from info a week before, younger should get the info closer to the procedure
modeling coping skills and interventions can be helpful - normalise the feeling of anxiety and demonstrate how to cope with it
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 approach *
tell - use simple language and matter of fact style to explain what will happen, use comparisons that the child will understand and avoid negative/emotive words
show - procedure demonstrated using inanimate object/staff
do - do when the child understands what will happen
what is the impact of parent’s behaviour on children coping? *
Children’s distress during a routine immunization was correlated with the amount of distress shown by parents but not to subjective anxiety - child pick up on anxiety even if the parent says they are not anxious
what is the effect of mothers being trained to interact with child in different ways *
if pain promoting (reassureance and empathy - child picks up that something is wrong when mum is overly supportive) the pain intensity is higher
pain reducing (distraction and humour) - pain intensity is less
this is true in girls, not boys - perhaps girls could be more sensitive to pain because all pain ratings were higher for girls, or more sensitive to the interactive style from the mother
