Long Term Conditions

Question 1

What is a long-term condition?

Answer 1

Those conditions that cannot, at present, be cured but can be controlled by medication and other therapies

Question 2

What is co-morbidity?

Answer 2

Comorbidity is the co-existence of other conditions with an index condition that is the specific focus of attention.

Question 3

What is multimorbidity?

Answer 3

Multimorbidity is the co-existence of several conditions where none are considered an index condition that is the specific focus of attention.

Question 4

What is the Academy of Medical Science’s definition of multimorbidity?

Answer 4

The co-existence of two or more chronic conditions, each one of which is either:
- A physical non-communicable disease of long duration, such as a cardiovascular disease or cancer.
- A mental health condition of long duration, such as a mood disorder or dementia.
- An infectious disease of long duration, such as HIV or hepatitis C.

Question 5

What is the burden of living with multiple long-term conditions? (6)

Answer 5

• more unscheduled hospital admissions, and for longer periods
• Reduced functional ability and quality of life
• Polypharmacy
• Fragmented care
• poorer health outcomes
• higher mortality rate

Question 6

What is stigma?

Answer 6

attribute that discredits the individual, denying full social acceptance

Question 7

What is felt stigma?

Answer 7

direct experience of a negative judgement

Question 8

What is enacted stigma?

Answer 8

anticipation of a negative judgement

Question 9

What are the 3 factors of biographical disruption?

Answer 9

1. A taken-for-granted state of wellness until the onset of chronic illness that provokes awareness of “bodily states not usually brought into consciousness”
2. Disruption to biography – necessitates a “fundamental rethinking of the person’s biography and self-concept”
3. Response to disruption – mobilise resources to remodel their biography

Question 10

What did Williams (2000) observe of biographical disruption? (2)

Answer 10

• Ignores demographic characteristics e.g. age and class - calls for wider personal, cultural, social and economic influences on biography
• Is adult centric - needs to consider experience of children and young adults with chronic illness

Question 11

Who came up with the biographical disruption theory?

Answer 11

Bury (2000)

Question 12

Who came up with the Shifting Normalities theory?

Answer 12

Sanderson et al. (2011)

Question 13

What did Sanderson et al. (2011) argue?

Answer 13

Argue that Bury’s theory of biographical disruption fails to recognize that normalization is a common feature of the illness experience.

Question 14

What did Sanderson et al. (2011) suggest?

Answer 14

Suggest people present differing perceptions of normality as they fluctuate between disease quiescence and exacerbation.

Question 15

What are the 6 shifting normalities suggested by Sanderson (2011)?

Answer 15

• Disrupted normality.
• struggling for normality
• fluctuating normality
• returning to normality
• continuing normality
• Re-setting normality

Question 16

What is an illness narrative?

Answer 16

People attempt to reconcile the disruption between ‘body, self and the world caused by the intrusion of chronic illness

Question 17

What is Charmaz (1983)’s loss of self theory? (4)

Answer 17

• Argued disruption is one of many ways people experience chronic illness
• Recognized the assault on identity, self-worth and impact on social interaction
• Focused on loss of ‘self’ identity
• ‘Crumbling away’ of previously held images of self

Question 18

What are the 4 themes of Charmaz (1983)’s loss of self?

Answer 18

• leading restricted lives,
• experiencing social isolation,
• being discredited
• burdening others

Question 19

what are the impacts of chronic illness in terms of loss? (6)

Answer 19

• Loss of control and personal power – Self-esteem
• Loss of independence
• Loss or change of Role – family, work
• Loss of financial security
• Loss or change of hopes and dreams
• Loss of identity

Question 20

What is Kubler-Ross (1969)’s view on chronic illness?

Answer 20

Coming to terms with a LTC has been described by many as like the experience of grief and bereavement

Question 21

How can health professionals support self-management? (6)

Answer 21

• Disease education programmes
• Expert patient programme
• Personalised care planning
• Telehealth
• Personal health budgets
• Shared decision making

Question 22

What are examples of treatment burdens? (6)

Answer 22

1. financial (treatment costs),
2. medication (managing, organizing and performing),
3. administrative (arranging tasks and appointments),
4. lifestyle (changing habits),
5. health care (navigating and accessing services),
6. time/expense of travel (to attend medical appointments).

Question 23

What factors influence mental health and wellbeing? (4)

Answer 23

• Life - work pressure, school/education, parenting, celebrations, holidays, carer responsibilities
• Feelings - burnout, diabetes distress, depression, fear of hypos, eating disorder.
• Failings in professional care - technology, education, continuity of care, lack of empathy, or even blame, from professionals.
• Denial.

Question 24

What are some variables related to better quality of life? (9)

Answer 24

• Age
• Gender
• Marital status/relationships
• Educational level
• Disease duration
• Disease and treatment burden
• Symptom management
• Multimorbidity
• Social support.