HAP 😜 Flashcards
What questions to ask/answer with shared decision making (SDM)
What will happen if you wait and watch
What are the test or treatment options
What are the benefits and harms of these options
How do these pros and cons weigh up for you/how likely are they
Do you have enough info to make a choice
‘Living with cancer” means considering
Diagnosis delivery
Treatment
Patient issues
Family/supports
Patient acceptance (cancer) - coping strategies
Denial
Acceptance
Deepening religiosity
Reinforcement of family ties
Creation of social networks
Constructing a new identity after physical change to body
Smoking, etoh, non-compliance (maladaptive coping)
Patient experience
Consider:
Body image
Speech loss and cancer (to eat or speak? Which is more valuable?)
Diet modification (change in mouth structure, muscle strength, reduced saliva, mouth sores etc)
Airway mgmt
Divorce and cancer- higher risk of divorce/separation due to emotional and financial burdens
QOL
Financial burden - decreased QOL by four times reported
Fear or recurrence - one of top concerns
Patient and family experience with cancer
Support network important
Support network needed for family and carers (need respite, get sick themselves etc)
What is a placebo effect?
Patient knows they have been given a treatment
Patient believes treatment is effective
Patients expectation that the treatment will work influences their intrinsic capacity to self-cure (eg influences immune system)
Patients shows improvement in clinical symptoms
What are the two types of placebo
Pure - sugar pills, saline injections - no active pharmacological ingredients
Impure - eg treatments shown to be ineffective for the conditions/application - eg antibiotics to treat viral infection
Positive vs neutral placebos :
Positive - given with optimistic message about effectiveness
Treatment can be provided with drug company advertising or clinician recommendation
Nocebo effect
Expectation of negative health outcome from medical treatment
Measurement experience of illness symptoms
Somatisation (aka psychosomatic illness)
Conscious expectation of negative health outcome for any reason
Measurable or no measurable experience of illness symptoms
Perception effects: subconscious or conscious
Change in environment with likely health consequences is perceived
Measurable immune system response to changed environment
Perception effects consists of 1 and somatostion includes 2
- Placebo and somatisation
2. Nocebo
Does inducing pain count as nocebo or somatisation
Somatisation because it’s not considered a medical treatment
What are kosh’s postulates?
- Microorganism must be observed in every case of the disease
- It must be isolated and grown in pure culture
- The pure culture when inoculated in animals must reproduce the disease
- Microorganism must be recovered from the diseased animal
