coping with illness and treatment

Question 1

what is health

Answer 1

a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Question 2

what is impairment

Answer 2

refers to a problem with a structure or organ of the body

Question 3

what is disability

Answer 3

a functional limitation with regard to a particular activity

Question 4

what is handicap

Answer 4

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

Question 5

what are the links between disability, handicap and impairment *

Answer 5

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

Question 6

describe the crisis theory of coping with disability *

Answer 6

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

Question 7

what are adaptive responses *

Answer 7

personal growth and adjustment to the illness

have a richer appreciation for life, reprioritise things

Question 8

what are maladaptive responses *

Answer 8

poor adjustment - psychological problems, low functioning etc

Question 9

what are the 3 factors that effect the way that we cope &

Answer 9

illness related factors

background and personal factors

physical and social environmental factors

Question 10

describe illness related factors *

Answer 10

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

Question 11

describe background/personal factors *

Answer 11

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

Question 12

effect of extraversion on health *

Answer 12

lower rates of CHD

protective against resp diseases

more likely to seek help and have a better support network

Question 13

effect of agreeableness on health *

Answer 13

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

Question 14

effect of neuroticism on health *

Answer 14

higher use of alcohol and smoking, higher symptom reporting

anxiety and depression

Question 15

describe the physical and social environment *

Answer 15

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

Question 16

describe coping appraisal *

Answer 16

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

Question 17

what is an illness representation *

Answer 17

A patients own implicit, common sense beliefs about their illness

Question 18

what are the 5 illness representations *

Answer 18

• 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

Question 19

describe the illness perceptions questionnaire *

Answer 19

clinical tool - give pts the opportunity to speak so you can investigate their specific beliefs and correct any misconceptions

Question 20

describe the picture of health study *

Answer 20

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

Question 21

examples of maladaptive coping strategies

Answer 21

“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

Question 22

describe adaptive tasks *

Answer 22

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

Question 23

describe effects of an adaptive coping intervention *

Answer 23

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

Question 24

what is coping *

Answer 24

‘Cognitive and behavioural efforts to master, reduce or tolerate external and internal demands and conflicts’

Question 25

what are the 2 types of coping *

Answer 25

problem focused coping

emotion focused coping

Question 26

describe problem focused coping *

Answer 26

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

Question 27

what is emotion focused coping *

Answer 27

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

Question 28

is emotional or problem focused coping more effective *

Answer 28

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

Question 29

what is stress

Answer 29

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.

Question 30

why is patient distress bad *

Answer 30

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.

Question 31

is it helpful to prepare patients for the distress *

Answer 31

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

Question 32

what is procedual and sensory info *

Answer 32

• 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

Question 33

is pt distress lower with procedural or sensory information *

Answer 33

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.

Question 34

how much information is enough to reduce distress *

Answer 34

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

Question 35

what is the role of communication in reducing stress *

Answer 35

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

Question 36

what is the effect of having control in medical situations *

Answer 36

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

Question 37

how should you prepare children for treatment *

Answer 37

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

Question 38

how do children cope *

Answer 38

• 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.

Question 39

describe the combined show tell approach *

Answer 39

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

Question 40

what is the impact of parent’s behaviour on children coping? *

Answer 40

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

Question 41

what is the effect of mothers being trained to interact with child in different ways *

Answer 41

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