Lecture 25 - Health Psyc, adjustment to illness Flashcards
What are the critical time points of the illness/cancer trajectory?
- Before illness develops…
- The Diagnosis
- Treatment decision-making
- Between end of treatment and 5-year survival
- End-of-life issues
OR - Survivorship
What are the key issues and psychological responses characterising the time before an illness develops…
Screening for disease &/or genetic disposition to one…
- process can be worrying…
- high levels of anxiety & intrusive thoughts
- Elevated levels of distress even among women without the mutation (10%) and their partners (13%)
What are the key issues and psychological responses characterising the Diagnosis?
- common reactions include: shock, disbelief, bargaining, protest, grief, anger, anxiety, depression, acceptance etc.
- wide range of responses
- denial may continue
What are the key issues and psychological responses characterising treatment decision-making?
- lots of decisions to be made regarding re-tests, treatments, procedures, trials etc.
- great variability in the degree to which patients prefer to be informed and involved in decision-making:
- paternalistic
- shared (see SDM)
- informed/autonomous
- preparation and post-treatment support
What are the key issues and psychological responses characterising the time between the end of treatment and 5-year survival?
- For the majority, psychological adjustment returns to normal
- For some, cessation of treatment leads to heightened anxiety
12 months after treatment:
• ~ 20% of patients are clinically anxious
• ~ 16% of patients remain clinically depressed
• others have ongoing difficulties
What are the key issues and psychological responses characterising the end of a life?
- Uncertainty / fear of the process of dying
- Fear of pain and suffering, anticipatory grief
- Decision-making: advanced directives
- Carer: feelings of inadequacy
- Practical issues
What are the key issues and psychological responses characterising survivorship?
For many survivors life after cancer is as good as, and sometimes even better, than before the diagnosis
Yet, for many others there are CHALLENGES…
• A common assumption: survivors will return “back to normal” once their health returned (post-treatment)
• Continuing existential tension of the survivor: “compulsory philosophers”
• Identity disruption => finding a “new normal”
• The body becomes a ‘house of suspicion’
• Positive outcomes: post-traumatic growth
MENTAL HEALTH is the only direct impairment associated with being a cancer survivor
What are the common strategies/interventions designed to address psychological adjustment associated with
the time before an illness develops?
- Public health campaigns, such as anti smoking, sun safety, can lead to behavioural Changes
- During screening, important to communicate & manage risk
What are the common strategies/interventions designed to address psychological adjustment associated with the diagnosis?
- communicate well
- empathy is important
- involve family!
What are the common strategies/interventions designed to address psychological adjustment associated with treatment decision-making?
- Medical professionals must tailor communication; ensure understanding; facilitate involvement; avoid coercion.
- Clinicians: communication skills training
- Patients/family:
• coaching patients/family members to ask questions
• psycho-educational resources
• question prompt sheets
• decision aids
What are the common strategies/interventions designed to address psychological adjustment associated with the end of treatment and 5-year survival?
Adequate preparation and post-treatment support is critical:
- patient and staff attitudes to side effects/pain
- education (procedural and sensory information)
- anxiety management
- managing side-effects
- continuous support (nurse care coordinators)
- complementary therapy
What are the common strategies/interventions designed to address psychological adjustment associated with
End-of-life issues
- Hospice care
- start palliative care earlier, conjointly with life prolonging care
What are the common strategies/interventions designed to address psychological adjustment associated with survivorship?
A positive attitude is a useful coping technique => CAN improve quality of life
SURVIVORSHIP CARE PLANS : to address poorly coordinated follow-up care = formal, written documents that provide details of a person’s:
• cancer diagnosis and treatment,
• potential late/long-term effects arising from the cancer and its treatment,
• plans for medical follow up
• recommended management of current medical/psychosocial/practical issues;
• advice and coaching regarding healthy lifestyle
• discussion of potential future issues and a plan for management
Why is it important to communicate well?
What are some ways to improve health professional-patient-family communication?
Health professional-patient-family communication can influence the impact of the diagnosis & long term adjustment
=> Communication skills training, Audio-taping consultations etc.
Why is it important to consider/include the family in communication?
Because family are often the caregivers that:
• regularly attend medical consultations
• may have a considerable impact on the dynamics and outcomes of medical consultations
• roles: emotional, informational, decisional and logistical support, advocate, interpreter, memory aid in consultations
