HaDSoc Session 5 Flashcards
What is illness work?
Active effort a chronic illness pt makes including getting a diagnosis, managing symptoms and self management
What is the sociological theory on chronic illness?
Use illness narratives to focus on how illness impacts on social interaction and role performance and investigates how people manage and negotiate chronic illness in everyday life
Why might getting a diagnosis be an unpleasant process in chronic illness?
Investigations, uncertainty and ambivalence of some diagnoses
What do bodily changes lead to when managing symptoms of a chronic illness?
Self-conception changes
What are the advantages of the expert pt programme?
Gives coping and condition management skills, aims to reduce hospital admissions, pt centred
What are the disadvantages of the expert pt programme?
Puts responsibility for came on very ill pts and there is little evidence of efficiency savings
Why is optimum self-management difficult to achieve in chronic conditions?
Poor adherence, low QoL, poor psychological wellbeing
What are the components of everyday life work in chronic illness?
Coping, strategy and normalisation
What happens in normalisation when coping with chronic illness?
Maintaining pre-illness lifestyle and identity or redesignating new life as ‘normal’ life
What is emotional work in chronic illness?
Work done to protect emotional well-being of others and process impact of illness on role
What actions might pts take to complete emotional work?
Maintain normal activities, strategically restrict social terrain, down play symptoms, present ‘cheery self’
What happens in biographical work in chronic illness?
Work to maintain positive definitions of self and lead valued life following disruption to former self-image without simultaneous development of a new one
What are the 3 stages in biographical disruption in chronic illness?
1: disruption of assumptions and behaviour. 2: fundamental re-thinking of biography and self-concept. 3: mobilisation of resources
What is discreditable stigma?
No stigma experienced if no visible illness but diagnosis revealed the stigma seen (e.g. HIV)
What is discredited stigma?
Where a physically visible characteristic sets apart individual irrespective of disclosure
What is enacted stigma?
Real experience of prejudice, discrimination and disadvantage
What is felt stigma?
Fear of enacted stigma and feeling of shame
What is identity work?
Work done to present in a socially valued way
What is the medical model of disability?
Deviation from medical norms, disadvantages direct consequence of impairment and disabilities, requires medical intervention
What are the arguments against the medical model of disability?
Lacks recognition of social and psychological factors and uses stereotyping and stigmatising language
What is the social model of disability?
Problems product of the environment and its failure to adjust, is a form of social oppression and a function of society failing to take account of impairments
What does the social model of disability say in regard to ‘special needs’?
Only special in a particular context
What are the criticisms of the social model of disability?
Body left out, overly drawn view of society, fails to recognise bodily realities and extent they can be solvable socially
What is the international classification of impairments, disabilities/handicaps (ICDH)?
Classification of disease consequences by impairment, disability and social and psychological consequences of living with impairment and disability
What are the criticisms of the ICDH?
Suggests disease –> impairment –> disability –> handicap but this is not inevitable
What does the international classification of functions, disability and health consider?
How impairment, limitation and restriction interplay due to body function, activities, participation, personal and environmental factors
Why does health need to be measured?
Give indication for need for healthcare, target resources, assess effectiveness of interventions, evaluate quality of services, get better value for money and monitor pt progress
How is health commonly measured?
Mortality, morbidity and pt-based outcomes
What are the advantages of using mortality to measure health?
Easily defined
What are the disadvantages of using mortality to measure health?
Not always accurately recorded, not good for outcomes and quality of care measurements
What is the advantage of using morbidity to measure health?
Routinely collected
What are the disadvantages of using morbidity to measure health?
Not always reliable/accurate, not pt experience and not always easily evaluated
How are pt-based outcomes assessed?
HRQoL, health status, functional ability, PROMs
What are the challenges to pt-based outcomes?
Optimising data collection, achieving high rates of participation, providing appropriate output, avoiding misuse of PROMs, expansion to other areas
What is QoL?
Individual’s sense of social, emotional and physical well-Bing that influences the extent to which they can achieve personal satisfaction with life circumstances
What is HRQoL?
QoL in clinical medicine represents the functional effect of an illness and its consequent therapy upon a to as perceived by them
What dimensions does HRQoL consider?
Physical function, symptoms, global judgements of health, psychological well-being, social well-being, cognitive functioning, personal constructs and satisfaction with care
What is considered in the personal constructs domain of HRQoL?
Satisfaction with bodily appearance, stigma, life satisfaction and spirituality
When are qualitative methods of HRQoL measurement useful?
Initial look at dimensions to inform development of quantitative instruments
Why are qualitative methods not used in HRQoL beyond initial assessment?
V. Resource hungry and not easy to use in evaluation
What do quantitative methods examine HRQoL rely on?
Instruments or scales that must be reliable and valid
What are generic methods of measuring HRQoL?
Used for any population to cover general perceptions of overall health, social, emotional and physical functions, pain and self-care
What are specific quantitative methods of HRQoL measurement?
Evaluation of a series of health dimensions specific to a disease, site or dimension
What are the advantages of specific quantitative methods o P for HRQoL assessment?
Very relevant content, sensitive to change and acceptable to pts
What are the disadvantages of using specific quantitative methods to assess HRQoL?
Pts must have disease, limited comparison, may not detect unexpected effects
What are the disadvantages of using generic quantitative methods to assess HRQoL?
Inherently less detail, loss of relevance by being too general, less sensitive to changes due to intervention, may be less acceptable to pts
What are the advantages of using generic quantitative methods to assess HRQoL?
Covers broad range of health problems, can be used if there is no disease-specific instrument, allows comparison across Tx groups, detects unexpected effects of an intervention and assesses health of the population
