Health Psychology

Question 1

What are the stages of the cancer trajectory?

Answer 1

• Screening
• Diagnosis
• Treatment decision making
• Treatment
• Between end of treatment and 5 year survival
• End of life issues
• Survivorship

Question 2

What are the psychological responses at the screening stage?

Answer 2

Before illness develops, screen for

• genetic risk (BRCA1, BRCA2 genes for breast and ovarian cancer)
• early detection of disease or symptoms (lumps, cervical abnormalities), behavioural risks (smoking, sedentary lifestyle, sun protection).
• The tests can make women worry about negative consequences and their partners can feel anxious.
• Women who do not carry the mutation feel distress and over half choose to undergo double mastectomy.

Question 3

What are the psychological responses at the diagnosis stage and the strategies to address adjustment?

Answer 3

The diagnosis:

• reactions may vary, some in denial, shock, feel angry, depressed, gradual adjustment, then acceptance.
• Doctors need to communicate with empathy and be genuinely interested in their wellbeing. Give the patient realistic hope.
• They can record the consultations so the patient can listen to it at home.
• Family members should attend medical consultations with the patient to provide emotional support and help guide decision making.

Question 4

What are the psychological responses at the treatment decision making stage and the strategies to address adjustment?

Answer 4

Treatment decision making:

• Advances in treatment mean that patients are given more than one treatment option, therefore they need to make the best decision for themselves.
• Shared decision making (SDM) combines the experiences of the clinician and patient to make an informed decision.
• They share information, deliberate on options, agree on treatment.
• Improves quality of life, satisfaction with medical care, improves treatment adherence, knowledge.
• Communication is key.
• Patient can use question prompt sheets that provide useful questions to ask their doctor. Psychoeducational resources, decision aids.

Question 5

What are the psychological responses at the treatment stage and strategies to address adjustment?

Answer 5

Treatment:

• Patients feel anxious before surgery, are afraid of radiotherapy and chemotherapy which have adverse side effects.
• Must provide education so that patient is aware of effects, help them manage side effects
• Support from nurses
• Manage their anxiety
• Use complementary therapy to enhance quality of life e.g. acupuncture, massage, aromatherapy, meditation.

Question 6

What are the psychological responses between end of treatment and 5 year survival?

Answer 6

Between end of treatment and 5 year survival:
- 2 years after treatment, some patients anxious or depressed, worry about the cancer coming back as they are not in treatment

Question 7

What are the psychological responses at the end of life stage and strategies to address adjustment?

Answer 7

End of life issues:

• Fear of pain and suffering, grieving begins
• Palliative care - ease suffering, improve quality of life

Question 8

What are the psychological responses at the survivorship stage and strategies to address adjustment?

Answer 8

Survivorship:

• Life after diagnosis and treatment may be very different
• Values, identity change, discovering who they are again
• Disconnected from body as it does not feel the same, have to adjust
• They may learn and grow from the experience
• Some have mental health issues
• Having a positive attitude helps them cope, be mindful of negative feelings
• Survivorship care plans are formal documents that provide details of cancer diagnosis, treatment, effects, plans for follow up, strategies to manage medical, psychosocial and practical issues, coaching for a healthy lifestyle, discuss potential future issues.
• Most cope well with illness diagnosis and are satisfied with medical care.