Health Psychology

Question 1

What are the critical time points in illness/cancer trajectory?

Answer 1

1. Before illness develops
2. The diagnosis
3. Treatment decision-making
4. Treatment
5. Between end of treatment and 5-year survivial
6. End of life issues
7. Survivorship

Question 2

For BEFORE ILLNESS DEVELOPS, what are the psychological responses and what strategies/interventions can address these?

Answer 2

Screening/genetics - communicating risk surrounding results, interpretation/decision-making about results

WORRYING to wait for results - anxiety and intrusive thoughts. Partners also worry.

DISTRESS among women without mutation and their partners. Half choose to have mastectomy anyway.

Behaviour change - managing risk with lifestyle - anti-smoking, sun damage, diet

Question 3

For THE DIAGNOSIS, what are the psychological responses and what strategies/interventions can address these?

Answer 3

No right or wrong way to react. Can range from denial/disbelief (I’m healthy, I’ve always taken care of myself) to relief (been through lots of testing and great to finally have an answer, and something we can work with; feel more in control)

Bargaining
Protest
Grief
Shock
Anxiety
Acute distress

The way health professionals communicate the diagnosis can influence impact and adjustment. Empathy is key. Having someone you care about by your side can also help.

Carers and the life changes they will go through should also be considered, especially with an emphasis now on home-based care.

Question 4

For TREATMENT DECISION MAKING, what are the psychological responses and what strategies/interventions can address these?

Answer 4

Shared decision making is preferred. Brings together doctors medical knowledge and patients expertise on their values, attitudes and preferences. Both are equally involved in the decision.

Decision-making tools can also help –> decision aids

Question 5

For TREATMENT, what are the psychological responses and what strategies/interventions can address these?

Answer 5

Surgery - high anxiety beforehand

Radiotherapy - perceived as more frightening than surgery. Side effects can lead to depression.

Chemotherapy - most feared treatment - nausea/vomiting

Education surrounding pre and post procedures are critical - including managing side effects.
Anxiety management may be necessary

Question 6

For BETWEEN END OF TREATMENT AND 5 YEAR SURVIVAL, what are the psychological responses and what strategies/interventions can address these?

Answer 6

Most return to normal

But some have heightened anxiety about cancer recurrence. During treatment they felt more secure and in control, but now they’re living in uncertainty and have no agency over what might happen.

Anxiety and depression are very common

Question 7

For END OF LIFE ISSUES, what are the psychological responses and what strategies/interventions can address these?

Answer 7

Most people don’t fear death, but the process of dying. Fear of pain/suffering.

Lots of important decisions to be made in this time.

Many fear palliative care as “giving up” but actually it’s there to improve QOL.

Question 8

For SURVIVORSHIP, what are the psychological responses and what strategies/interventions can address these?

Answer 8

Sometimes people feel they have a “new life” after cancer. Existential tension experienced - meaning of life - how do I want to live my life and what do I want from life?

Often leads to POST-TRAUMATIC GROWTH

Some anxiety surrounding aches/pains of the body - could think it’s more serious, etc

Important that psychological interventions VALIDATES and NORMALISES the experience

Positive attitudes can improve well-being but have no effect on survival. Feelings of sadness, fear, anger, etc post-diagnosis, however, are also normal.