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Block 3 > Living With Chronic Illness > Flashcards

Living With Chronic Illness Flashcards

1
Q

What is chronic illness?

A

The experience of a long-term condition for which there is currently no cure and which is managed with drugs and other treatment

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2
Q

List some examples of chronic conditions.

A 
Diabetes
COPD
Arthritis
HPN
Some mental health conditions
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3
Q

What are 3 common characteristics of most chronic illnesses?

A
  1. Preventable
  2. Degenerative
  3. Costly
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4
Q

Why should we as doctors look at chronic illness?

A

Because its a common experience where aetiology and prognoses are very diverse but they have very similar social and psychological sequelae - there is also an association between social and emotional experiences + coping and managing

Informs the NHS mandate of health care priorities

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5
Q

What are common elements from patient’s illness narratives that experience chronic illness?

A
  • Search for meaning + explanation
  • Uncertainty + unpredictability
  • Coping + resilience
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6
Q

How 4 factors does chronic illness impact?

A
  1. Daily activities
  2. Social relationships
  3. Sense of self (biographical disruption)
  4. Social identity
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7
Q

What is biographical disruption?

A

When having a chronic condition causes a person to rethink the way that they live

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8
Q

What are the common coping strategies patients with chronic illness use?

A
  1. Denial
  2. Normalisation
  3. Resignation
  4. Accommodation
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9
Q

What are the pros and cons of coping via denial?

A

Useful in early stages helping the person to take stock but presents difficult if it persists

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10
Q

What is a normalisation coping strategy?

A

Trying to maintain pre-condition identity via a ‘passing’ strategy trying to pass as normal and concealing their illness OR re-designation of ‘normal’ life i.e. “this condition is normal to me now”

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11
Q

What is the resignation coping strategy?

A

“That’s it I just have to live with this now” i.e. acceptance

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12
Q

What is the accommodation coping strategy?

A

Positive strategy where patients accept their condition, deal with the problems but dont see it as central to everyday lives

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13
Q

How can you promote good self-management?

A

Using patient’s lay knowledge of what works for them and sharing their knowledge/expertise

Self-help groups (individual/collective)

Pushing them to becoming ‘expert patients’

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14
Q

What is an expert patient?

A

Patients who take the lead in managing their condition and someone who:

  • Feels confident and in control of life
  • Aims to manage condition + its treatment in partnership with healthcare professionals
  • Communicates effectively with professionals and willing to share responsibility for treatment
  • Realistic about how their condition affects them + family
  • Uses skills + knowledge to lead a full life

= better outcomes

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15
Q

What are expert patient programmes?

A

A peer-led self-management programme that aims to improve self-management

6-week programme suitable for any long-term condition (disease-specific ones available) covering topics such as healthy eating, exercise, pain management, relaxation, action planning + problem solving

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16
Q

What are the evidence-based benefits of the expert patient programme?

A
  • Felt more confident that their symptoms would not interfere with their lives
  • Felt better prepared for appointments with healthcare professionals
  • Fewer visits to GP
  • Fewer visits to emergency dept.
17
Q

What are the potential problems with expert patient programmes?

A
  • Not attractive to everyone
  • Everyone not able to participate
  • Extra pressure on patient organisations
18
Q

When talking to patients about chronic conditions, what questions should you ask?

A

How the patient experiences their illness via the 4 areas of impact

How have things changed for them since the onset of their condition?

How effective is their self-management? Could it be improved? How?

19
Q

What is the self-regulatory model (SRM)?

A

System of conscious personal management that involves the process of guiding one’s own thoughts, behaviours, and feelings to reach goals

The interaction of factors in influencing how patients cope with their chronic illness, such as:

  • Representation of illness (identity, cause, consequences, timeline, cure/control)
  • Interpretation (symptoms perception, social messages)
  • Emotional response to illness (fear, anxiety + depression)
  • Coping (approach or avoidance coping)
  • Appraisal (was my coping effective?)
20
Q

What are illness representations?

A

Illness beliefs refer to a patients own implicit common-sense understanding of their illness formed by dimensions directing illness behaviours - may have numerous beliefs for a particular illness

21
Q

What are the 5 belief dimensions?

A
  1. Identity: what is it?
  2. Cause: what caused it?
  3. Time: how long will it last?
  4. Consequence: how will it impact my life?
  5. Control-cure: can it be treated, controlled, managed, etc.?
22
Q

What is the illness perception questionnaire (IPQ-R)

A

9 item testing to gauge how patients perceive their illness - comes in both normal and brief versions and is used by clinicians and researchers

23
Q

How has the self-regulatory model (SRM) been clinically applied?

A

Has been applied to a range of chronic illnesses (e.g. MS, chronic fatigue syndrome, diabetes etc.) via the IPQ-R to help understand adaptation and coping - allows you to develop a appropriate management plan and work with the patient

24
Q

What types of things do patients with chronic illness need to do to cope in a healthy way?

A
  • Adjust to symptoms + disability (acceptance)
  • Maintain a reasonable emotional balance
  • Preserve a satisfactory self-image + sense of competence
  • Learn about symptoms/treatments + self-management (self-efficacy)
  • Relationships with friends + family
  • Form + maintain relationships with health-care professionals
  • Prepare for an uncertain future
25
Q

What do a lot of patients tend to feel is the worst part about their chronic illness?

A

Their identity as people will constantly ask about it so patients may suffer in silence to get their identity back separate to the illness

26
Q

What is the crisis theory?

A

Finding a social and psychological equilibrium in managing/coping with chronic illness - challenges, setbacks + social influences are important and can influence coping responses

27
Q

How can we help patients manage their long-term condition?

A
  • Pain management programmes
  • Reinforce message of gate control theory
  • Involve clinicians, specialist nurses, physiotherapists + psychologists
  • Intense, residential or spread over 6-8 weeks
28
Q

How can you reinforce the gate control theory to patients?

A

By baring in mind that a combination of psychological and physical factors can open and close the gate - they can be told this too

29
Q

What are the benefits of a pain management programme?

A
  • Helps patient manage pain rather than pain controlling them
  • Learn to change cognitive perceptions of pain, less catastrophising, challenging unhelpful thoughts
  • Management of stress + anxiety as well as low mood, depression
  • Not feeling so isolated with condition when in a group
30
Q

What are the challenges of a pain management programme?

A
  • Managing group dynamics
  • Stages of change - are they ready to change behaviour?
  • Commitment
  • Managing fears
31
Q

How do people with chronic illness find a meaning in life?

A
  • Enhanced relationships with family/friends
  • Finding inner strength + discovering a new sense of personal resilience
  • Accepting own vulnerabilities + limitations
  • A greater appreciation of life + living, changed philosophy of life
32
Q

How many people live with a chronic condition?

A

1 in 3 where 24% have 2 LTCs and 20% have 3 or more LTCs

33
Q

How much does chronic conditions use up health services?

A

50% of GP appointments
64% of outpatient appointments
70% of inpatient bed days

Block 3 (40 decks)

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