Lecture 11 - Management of Chronic Diseases

Question 1

explain The Scope of the Issue… -

Answer 1

=ì 58% of the population has some chronic condition
ì Accounts for 2/3 of Canada’s health spending
ì from mild to severe and life threatening

Estimates
ì 4 million people have arthritis
ì 145,000 new cases of cancer diagnosed each year
ì ~2 million people have diabetes
ì 500,000 people are living with the effects of a stroke
ì 5 million diagnosed with hypertension

Question 2

what were traditional view of chronic diseases quality of life -

Answer 2

=only looked at ì length of survival ì signs of disease

Question 3

explain Contemporary Views: What IS Quality of Life? -

Answer 3

=Degree to which a person is able to maximize
ì Physical, psychological, vocational, and social functioning;
ì Disease and treatment related symptoms

Indicator of recovery from or adjustment to chronic illness.

Question 4

what is the methods to Evaluating Quality of Life -

Answer 4

=Perceptions of own health ì Self-reports
Generic measures: ì SF-36
ì Health assessment questionnaire (HAQ)
Disease specific measures

Question 5

explain Generic measures: SF-36 -

Answer 5

=filling out a form; it yields an 8-scale profile of functional status and well-being.

Question 6

Why Study Quality of Life? -

Answer 6

=Makes it possible to
ì Determine what kinds of interventions may be needed
ì Determine what problems emerge for particular patients
ì Determine the impact of unpleasant treatments, reasons for poor adherence
ì Compare therapies
ì Inform decision-makers

Question 7

Is there a typical pattern of emotional adjustment to a chronic disease? -

Answer 7

=Not really, but heuristically helpful:

Question 8

explain the idea of the typical pattern of emotional adjustment to a chronic disease -

Answer 8

=ì State of crisis, denial, anxiety, depression
ì Evaluation, anxiety, depression
ì Rehabilitative attention

Question 9

explain denial -

Answer 9

=A defense mechanism involving the inability to recognize or deal with external threatening events
Immediately after diagnosis, can serve protective function
ì Patients are in a state of crisis where they find their habitual ways of coping do not work
ì Anxiety and depression take over

Question 10

is denial helpful -

Answer 10

=ì During the rehabilitative phase, denial may have adverse effects

Question 11

explain the stage of axiety -

Answer 11

=ì Anxiety may arise intermittently throughout the disease process
ì Anxiety may increase over time

Question 12

explain the state of depression -

Answer 12

=mood disorder marked especially by
ì sadness,
ì inactivity,
ì difficulty with thinking and
concentration,
ì a significant increase or decrease in appetite and time spent sleeping,
ì feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide

Question 13

what is depression related to -

Answer 13

=Related to long-term rehabilitation and recovery

Question 14

Emotional Responses to Chronic Illness: Are there CLEAR stages? -

Answer 14

=Efforts to delineate a set of stages have been unsuccessful
ì Denial is common early, but may appear intermittently
ì Depression usually occurs later, but some acutely-ill patients are depressed

thus, Does not appear to be a predetermined sequence

Question 15

what are the two main Personal Issues in Chronic Disease

Answer 15

• =self-concept and self-esteem

Question 16

explain Self-Concept as a Personal Issues in Chronic Disease -

Answer 16

=An integrated set of beliefs about one’s personal qualities and
attributes

Question 17

explain Self-esteen as a Personal Issues in Chronic Disease -

Answer 17

=A global evaluation of one’s qualities and attributes

Question 18

explain Personal Issues in Chronic Disease: The Physical Self -

Answer 18

=Body Image
ì Perception and evaluation of one’s body,
physical functioning, and appearance.
Negative body image can affect treatment adherence
Can be improved through interventions

Question 19

Personal Issues in Chronic Disease: The Achieving -

Answer 19

=Achieving Self:
ì Achievement is important to self-esteem and self-concept
ì Does the chronic illness threaten these? yes.

Question 20

explain Personal Issues in Chronic Disease: Social Self -

Answer 20

=Rebuilding the social self is an important part of readjustment
ì Interactions with family/friends provide
Fears about withdrawal of support

Question 21

explain Personal Issues in Chronic Disease: The Private Self -

Answer 21

=ì Illnesses create the need to be dependent on others

ì Illness can disrupt person’s identity or plans for the future

Question 22

what are the coping strategies -

Answer 22

=avoidant coping and active coping

Question 23

explain Avoidant coping -

Answer 23

=is associated with increased psychological distress

Question 24

explain Active coping -

Answer 24

=seem to be more consistently associated with good adjustment
ì MS, spinal cord injury
ì May depend on duration of illness ì May depend on social context

Question 25

explain Coping with Chronic Illness: Patients’ Beliefs -

Answer 25

=Patients need to adopt an appropriate model for their disorder
ì Acute models will not be effective

Question 26

explain Chronic Illness and Creative Non- Adherence -

Answer 26

=Recap: creative non-adherence = patients modify or supplement a prescribed treatment regimen

This is common among chronic illness patients
ì Often because they know their disease extremely well

However, this can lead to mistakes:
ì Using natural/non-prescription health products or complementary therapies (common among those with chronic illness) can produce problematic interactions with prescribed medications
ì Especially if their use is not disclosed to a health care professional

Question 27

what are the levels of Chronic Disease Management -

Answer 27

=level 1- lower level of chronic disease (70-80% of pop.) requiring self-managing support
level 2- high disease risk requiring disease/care management
level 3- high disease complexity requiring care co-cordination

Question 28

what is essential for rehab and chronic issues -

Answer 28

=physical rehab and aherence

Question 29

explain Physical Rehabilitation -

Answer 29

=ì helping patients use their bodies
more
ì make appropriate physical accommodations
ì learn new physical and management skills if necessary
ì pursue a treatment regimen
ì learn how to control expenditure of
energy

Question 30

explain Management: Vocational Issues -

Answer 30

=ì Patients may need to change/restrict work activities
ì Discrimination
ì Loss of insurance coverage
ì Some people may have to find ways to cope with working conditions that are not ideal but necessary to stay employed
ì Can create job strain for chronic illness patients
ì E.g., arthritis patients often have to endure unpleasant symptoms and working conditions, interpersonal difficulties, and emotional challenges at work

Question 31

explain Case Example: Epilepsy -

Answer 31

=ì Colin had spinal meningitis in infancy
ì Age 11: petit mal epileptic seizures (blackouts), soon
followed by grand mal seizures (convulsions)
ì Successful control through medication during his teens and twenties
ì Early 30s, Colin’s seizures returned and he is concerned about possible threat to his career as a bank manager.
ì What kind of job re-design/accommodations might be necessary?
how can chronic illness have Positive Changes - =ì Mostly negative emotions with chronic illness, but can also be positive
ì Up to 90% of cancer patients reported some benefit (Collins et al., 1990)
ì Finding benefits = better adjustment to illness