Coping with illness and Treatment Flashcards
What is the 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.”
What are some of the consequences of disease stated by WHO?
Impairment - problem with structure or organ of the body Disability - functional limitation with regard to a particular activity Handicap - Disadvantage in filling a role in life relative to peer group as a result of impairment or disability.
What are some of the causal relationships between impairment, handicap and disability stated by WHO?
Disability strong correlation with handicap Low correlation between disability and impairment meaning that other factors in addition to impairment influence disability.
Summarise the crisis theory of coping with illness
We have a need for normal pyschological/social equilibrium
A crisis means that 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 personal growth and adjustment to the illness.
- Maladaptive responses poor adjustment (psychological problems, low functioning etc).
List illness related factors
- Unexpected
- Cause & Outcome/Prognosis
- Disability
- Stigma
- Disfigurement
- Prior experience
List background and personal factors
- Age of onset
- Gender
- SES & occupation
- Pre-existing illness beliefs
- Pre-existing personality
Give examples of how big 5 personality traits are linked to health
- 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 reporting
Describe adaption to disability
Some adaptability by the 4th year in a prospective study
The more agreeable the more life satisfaction achieved with disability (PERSONALITY TRAIT STUFF)
List physical and social environments
- Hospitalisation
- Accommodation and physical aids/adaptations
- Societal attitudes
- Social support & social role
How did isolation affect cardiac patients?
Higher scores on hostility measure
Lower incomes
More likely to be smokers
Social isolation is a robust predictor of cardiac mortality when these things were adjusted for. Social relationships were as valid as well established risk factors for mortality
What are illness representations?
Patient’s own implicit common sense beliefs about their illness
- Identity: the label of the illness and symptoms - E.g. “I have a cold, with a sore throat and runny nose”
- Cause: what may have caused the problem, such as genetics, circumstances, trauma, etc. - E.g. “My cold was caused by being stressed and run down”
- Consequences: expected effects from the illness and views about the outcome - E.g. “My cold will prevent me from going out tonight”
- Time-line: how long the problem will last and whether it is seen as acute, chronic or episodic - E.g. “My cold will be gone in a few days”
- Cure/control: expectations about recovery or control of the illness - E.g. “If I rest my cold will resolve quickly”
Explain the results of picture of health study with cardiac patients where they drew the amount of perceived damage to their hearts
Those who drew damaged perceived that they had recovered less, that their condition would last longer, less perceived control.
Extent of damage drawn correlated to how quickly they returned to work
Give an example of a maladaptive coping practise
I believe stress caused MI
Im now SMOK to relieve my stress
What are two adpative tasks (Moos 1982)?
Tasks related to illness/treatment - coping with symptoms/disability, adjusting to hospital environment
Tasks related to general psychosocial functioning - controlling negative feelings and keeping a positive outlook, satisfactory self image, good relationships
Give some examples of how adaptive coping of a patient be improved?
Educate symptoms
misconceptions of cause
explore beliefs about recovery
review action plan
Define coping
‘Cognitive and behavioural efforts to master, reduce or tolerate external and internal demands and conflicts’
What are two types of coping?
problem focused - Efforts directed at changing the environment in some way or changing one’s own actions or attitudes. E.G. seek relevant info about disease, illness related procedues, behaviour
emotion focused - Efforts designed to manage the stress-related emotional responses in order to maintain one’s own morale and allow one to function. E.G. meditation, relaxation strats, seek emotional support
Define the 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.
- 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?
Prepared group reported less pain, used less analgesic medication and their post-operative stay in hospital was an average of 2.7 days shorter.
Procedural vs sensory information
- Procedural information – Information about the procedures to be undertaken
- Sensory information – Information about the sensations that may be experienced.
- Results showed that the participants given sensory information reported significantly less distress during the procedure.
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.
How much information is enough? Auerbach (1983)
40 patients undergoing dental surgery were given either general or detailed pre-op info.
o Patients with a high desire for information experienced less distress when given specific information
o Patients with a low desire for information experienced less distress when given general information
Summarise the nursing home study
Langer & Rodin (1976)
o Study on the effect of perceived control on health
o There were 2 floors in a nursing home
o The residents on one floor were given more choice and independence than the other
o The floor given more choice reported greater engagement in activities, had a better general wellbeing and lower 18 month mortality rate
How can patient control be increased 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
How can children be prepared 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 are children’s methods of coping different?
•Distraction is the most effective coping strategy for younger children.
Children use same types of coping as adults but problem based develops with age.
Older children try match it with their preferred strategy
Show –Tell – Do Approach
How did parent’s behaviour impact child’s distress?
Children’s distress during a routine immunization was correlated with the amount of distress shown by parents but not to subjective anxiety
