Week 13: Health Services and Challenges in Health Psychology

Question 1

What is patient consumerism?

Answer 1

• 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

Question 2

What is the patient perspective in the patient-provider setting?

Answer 2

• Need to present and convey symptoms in 12-15 mins
• Feeling sick, discomfort, anxious
• Feeling low status (compared to doctor)

Question 3

What is the provider perspective in the patient-provider setting?

Answer 3

• 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

Question 4

What are some problems in patient communication?

Answer 4

• Poor health literacy, esp. among less education and elderly
• Language barrier
• Anxious, neurotic patients (exaggeration of symptoms)
• Patient expectations about what should be treated

Question 5

What are some problems with provider communication?

Answer 5

• Inattentiveness
• Stereotypes (SES, race, gender, illness)
• Depersonalisation (concentration & emotional protection)
• Use of jargon (prevent questions, hide uncertainty)
• Baby talk (talk down to patients)

Question 6

What are the challenges to assessing and understanding patient-provider communication?

Answer 6

• 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

Question 7

What are the consequences of poor patient-provider communication?

Answer 7

• 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)

Question 8

How is non-adherence usually assessed?

Answer 8

• Directly asking patients if they adhered to treatments

- Indirectly assessed by no. of follow-up or referral appts kept

Question 9

What is a placebo?

Answer 9

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

Question 10

How do placebos work?

Answer 10

The placebo response is a complex, often PSYCHOLOGICALLY MEDIATED effect that can also TRIGGER REAL CHANGES IN PHYSIOLOGY

Question 11

What are the two pathways in which placebos work?

Answer 11

Placebo -> Beliefs & expectations -> Improvement

Placebo -> Beliefs & expectations -> Dampening of negative affect and stress physiology -> Improvement

Question 12

What is the nocebo effect?

Answer 12

Occurs when info about potential adverse effects of a procedure, rather than the procedure itself, produces the adverse effects

Question 13

How do nocebo effects work?

Answer 13

Nocebo effects can be PSYCHOLOGICALLY (e.g. negative expectations & beliefs) and PHYSIOLOGICALLY MEDIATED (e.g. increase negative affect and activate stress systems)

Question 14

How does patient-provider communication relate to placebo effects?

Answer 14

Patient-provider comm. can enhance placebo effects by:

1) Creating symbolic value
2) Increasing treatment adherence

Question 15

How does patient-provider communication enhance placebo effects by creating symbolic value?

Answer 15

• 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

Question 16

How does patient-provider communication enhance placebo effects by increasing treatment adherence?

Answer 16

When patient-provider comm. is POSITIVE, it increases treatment adherence, which enables placebo effects to occur

Question 17

What is the procedure of the study investigating whether provider characteristics can affect placebo/nocebo response?

Answer 17

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

Question 18

What are the results of the study investigating whether provider characteristics can affect placebo/nocebo response?

Answer 18

• 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

Question 19

How can providers help improve treatment success?

Answer 19

• Enhancing provider communication

- Probing barriers to adherence

Question 20

How can providers help improve treatment success by enhancing provider communication?

Answer 20

• 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

Question 21

How can providers help improve treatment success by probing barriers to adherence?

Answer 21

• 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

Question 22

What is defensive medicine?

Answer 22

Deviation from sound medical practice due to fear of medical malpractice

Question 23

What are some trends in health psychology?

Answer 23

• 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)

Question 24

What are the challenges and future areas of focus in health psychology?

Answer 24

• 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?

Question 25

What are the areas of focus for health promotion?

Answer 25

• 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

Question 26

What is personalised medicine?

Answer 26

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