Coping with illness and Treatment

Question 1

What is the WHO definition of health?

Answer 1

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Question 2

What are some of the consequences of disease stated by WHO?

Answer 2

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.

Question 3

What are some of the causal relationships between impairment, handicap and disability stated by WHO?

Answer 3

Disability strong correlation with handicap Low correlation between disability and impairment meaning that other factors in addition to impairment influence disability.

Question 4

Summarise the crisis theory of coping with illness

Answer 4

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).

Question 5

List illness related factors

Answer 5

• Unexpected
• Cause & Outcome/Prognosis
• Disability
• Stigma
• Disfigurement
• Prior experience

Question 6

List background and personal factors

Answer 6

• Age of onset
• Gender
• SES & occupation
• Pre-existing illness beliefs
• Pre-existing personality

Question 7

Give examples of how big 5 personality traits are linked to health

Answer 7

• 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

Question 8

Describe adaption to disability

Answer 8

Some adaptability by the 4th year in a prospective study

The more agreeable the more life satisfaction achieved with disability (PERSONALITY TRAIT STUFF)

Question 9

List physical and social environments

Answer 9

• Hospitalisation
• Accommodation and physical aids/adaptations
• Societal attitudes
• Social support & social role

Question 10

How did isolation affect cardiac patients?

Answer 10

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

Question 11

What are illness representations?

Answer 11

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”

Question 12

Explain the results of picture of health study with cardiac patients where they drew the amount of perceived damage to their hearts

Answer 12

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

Question 13

Give an example of a maladaptive coping practise

Answer 13

I believe stress caused MI

Im now SMOK to relieve my stress

Question 14

What are two adpative tasks (Moos 1982)?

Answer 14

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

Question 15

Give some examples of how adaptive coping of a patient be improved?

Answer 15

Educate symptoms

misconceptions of cause

explore beliefs about recovery

review action plan

Question 16

Define coping

Answer 16

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

Question 17

What are two types of coping?

Answer 17

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

Question 18

Define the Transactional definition of stress

Answer 18

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 19

Why is patient distress a bad thing?

Answer 19

1. 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.

Question 20

Is it helpful to prepare patients?

Answer 20

Prepared group reported less pain, used less analgesic medication and their post-operative stay in hospital was an average of 2.7 days shorter.

Question 21

Procedural vs sensory information

Answer 21

• 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.

Question 22

What is the dual process hypothesis?

Answer 22

• 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.

Question 23

How much information is enough? Auerbach (1983)

Answer 23

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

Question 24

Summarise the nursing home study

Langer & Rodin (1976)

Answer 24

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

Question 25

How can patient control be increased in medical situations?

Answer 25

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

Question 26

How can children be prepared for treatment?

Answer 26

• 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)

Question 27

How are children’s methods of coping different?

Answer 27

•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

Question 28

How did parent’s behaviour impact child’s distress?

Answer 28

Children’s distress during a routine immunization was correlated with the amount of distress shown by parents but not to subjective anxiety