Week 13: Health Services and Challenges in Health Psychology Flashcards
What is patient consumerism?
- Presenting patients with choices to empower them
- Patients do better when they are actively engaged
- Patients have their own abilities and competence, which needs to be tapped
What is the patient perspective in the patient-provider setting?
- Need to present and convey symptoms in 12-15 mins
- Feeling sick, discomfort, anxious
- Feeling low status (compared to doctor)
What is the provider perspective in the patient-provider setting?
- Need to extract key information relevant to diagnosis due to tight schedule
- Patients may not present the most impt or relevant symptoms for diagnosis
- High status professional
What are some problems in patient communication?
- Poor health literacy, esp. among less education and elderly
- Language barrier
- Anxious, neurotic patients (exaggeration of symptoms)
- Patient expectations about what should be treated
What are some problems with provider communication?
- Inattentiveness
- Stereotypes (SES, race, gender, illness)
- Depersonalisation (concentration & emotional protection)
- Use of jargon (prevent questions, hide uncertainty)
- Baby talk (talk down to patients)
What are the challenges to assessing and understanding patient-provider communication?
- Lack of feedback in general
- Unclear assessment of outcomes when patients don’t return for followup
- Patients with dissatisfying treatment are more likely to switch providers than complain
- Lack of positive feedback compared to negative feedback
What are the consequences of poor patient-provider communication?
- Increase stress and reduces willingness to use medical services in the future
- Increases non-adherence/non-compliance to treatment recommendations (directly affects process and likelihood of recovery)
How is non-adherence usually assessed?
- Directly asking patients if they adhered to treatments
- Indirectly assessed by no. of follow-up or referral appts kept
What is a placebo?
Any medical procedure that produces an effect (psychological or physiological) in the patient b/c of its THERAPEUTIC INTENT and not its specific chemical or physiological properties
How do placebos work?
The placebo response is a complex, often PSYCHOLOGICALLY MEDIATED effect that can also TRIGGER REAL CHANGES IN PHYSIOLOGY
What are the two pathways in which placebos work?
Placebo -> Beliefs & expectations -> Improvement
Placebo -> Beliefs & expectations -> Dampening of negative affect and stress physiology -> Improvement
What is the nocebo effect?
Occurs when info about potential adverse effects of a procedure, rather than the procedure itself, produces the adverse effects
How do nocebo effects work?
Nocebo effects can be PSYCHOLOGICALLY (e.g. negative expectations & beliefs) and PHYSIOLOGICALLY MEDIATED (e.g. increase negative affect and activate stress systems)
How does patient-provider communication relate to placebo effects?
Patient-provider comm. can enhance placebo effects by:
1) Creating symbolic value
2) Increasing treatment adherence
How does patient-provider communication enhance placebo effects by creating symbolic value?
- When patient-provider comm. is CLEAR, patients understand what is wrong and perceives that the provider is doing something about it
- This understanding and perception is soothing; reduces negative affect and stress
How does patient-provider communication enhance placebo effects by increasing treatment adherence?
When patient-provider comm. is POSITIVE, it increases treatment adherence, which enables placebo effects to occur
What is the procedure of the study investigating whether provider characteristics can affect placebo/nocebo response?
1) Histamine skin-prick test (Create infection)
2) Cream with no active ingredient
3) Information
- Placebo: Cream will REDUCE rxn (positive expectation)
- Nocebo: Cream will INCREASE rxn (negative expectation)
4) Physician characteristics
- 1) High or low WARMTH
- 2) High or low COMPETENCE
What are the results of the study investigating whether provider characteristics can affect placebo/nocebo response?
- Nocebo effects occurred, REGARDLESS OF PHYSICIAN CHARACTERISTICS
- Some placebo effects occurred, as long as physician was HIGH IN COMPETENCE/WARMTH
- Placebo effects were strongest when physician was HIGH IN BOTH WARMTH AND COMPETENCE
How can providers help improve treatment success?
- Enhancing provider communication
- Probing barriers to adherence
How can providers help improve treatment success by enhancing provider communication?
- Simple behaviours such as greeting, addressing patients by name, saying goodbye
- Increasing warmth through nonverbal behaviours e.g. maintaining eye contact, leaning forward, smiling
- Regular training and practice with supervision
- Encouraging patients to ask questions
How can providers help improve treatment success by probing barriers to adherence?
- Provide clear info about treatment
- When treatment is complex, break it down into manageable sub-goals
- Help address practical barriers to adherence, such as having little time and/or costly treatment
- Engage technology: Apps, email, and text reminders
What is defensive medicine?
Deviation from sound medical practice due to fear of medical malpractice
What are some trends in health psychology?
- Longer life expectancies
- Rise in lifestyle-related chronic illnesses
- Biological, psychological, and social bases of stress
- Reliance on technological and methodological advances (genetic testing, neuroscience, etc)
What are the challenges and future areas of focus in health psychology?
- How to ensure that ppl are aging well?
- Disease burden: How to better support caregivers, family and professionals?
- How to deliver quality palliative care?
- How to improve quality of healthcare delivery while keeping costs sustainable?
- How to manage costs of healthcare?
What are the areas of focus for health promotion?
- Focus on those at risk (e.g. youths, low SES, vulnerability to stress)
- Focus on increasing social support, cultivating resilience
- Living longer means a need to focus on aging well
- Prevention, reducing morbidity and costs to society
- Harnessing technology and methodological advances for precision health and medicine
What is personalised medicine?
Using knowledge about multi-level predictors of health (“cell-to-society” factors) and machine learning techniques to predict the best drug treatment or dosage that will work for the indiv
