9. Managing Chronic & Terminal Illness Flashcards
9 Health Tips?
- Blame will get you nowhere.
- Your perception of your health is more important than your BP.
- Support groups fight cancer, too.
- Care for those who care for others.
Chronic Conditions in Canada?
* Hypertension: 25%
* Osteoarthritis: 14%
* Mood / Anxiety Disorders: 13%
* Osteoporosis: 12%
* Diabetes: 11%
* Asthma: 11%
* COPD: 10%
* Ischemic Heart Disease: 8%
* Cancer: 8%
* Dementia: 7%
44% of adults (20+) have at least 1 of 10 common chronic conditions. (60% if we consider ALL chrinoic conditions)
Most of us are likely to develop at least one chronic condition that may lead to our death.
Chronic conditions account for 2/3 of Canada’s health spending
Chronic conditions are more common among lower-income Canadians, women, and seniors
-> Not inherent aspect of agining becuse they are largely determined by socioecomic facotrs which can be overcome
What unique psychological / social challenges arise when the diagnosis is terminal?
/
And how do people adapt to the prospect of dying?
There is a huge different psychologically between these two. Certain things become worse as you have less time.
The psychological and social challenges people are confronted with differ.
Adjusting to Chronic Illness, 3 main topics?
Coping, Adaptation, and Psychosocial Interventions
Adjusting to Chronic Illness - Immediately after a chronic disease is diagnosed?
Patients are often in a state of crisis or shock -> an acute stress reaction.
- Stunned, bewildered, and behaving in an automatic & detached way.
-> not sustained over long-term
Adjusting to Chronic Illness - Feeling Involved in The Initial Response?
Anxiety (nervousness, worry) and anger(“Why did this happen to me?” frustration, irritability, hostility) are also common.
Sense of control is lowered; secondary appraisal is common (especially in regards to social resources)
- The degree of social support can vary for the individual, a lot of people have no one to help them.
- A diagnosis can further isolate those who are already isolated.
Engage in more emotion-focused coping early on.
Denial: Inability to recognize, accept, or deal; plays mixed.
- Can be healthy early on, but becomes problematic long-term -> not consistent across all situations.
Crisis Theory - Overlook? (one sentence)
Describes factors that influence how people
adjust/cope after first learning they have a chronic illness.
Crisis Theory - Breakdown?
- Illness-related factors (difficultues walking)
- Background, personal factors (SOS, family history)
- Physical/social environments (School teaching, stigma)
->
Coping Process
- Appraisal of the diagnosis (determines how we cope with it)
- Adaptive Tasks (specific problems that have to be overcome)
- Coping Skills
->
Outcome of Crisis
- Adjustment
Adaptive Tasks in Coping
People who are ill must address 2 types of adaptive tasks?
- Tasks related to the illness or treatment.
- Coping with the symptoms or disability of illness.
- Adjusting to hospital environment, procedures, treatments (chemo-side effects).
- Developing good relationships with practitioners. - Tasks related to general psychosocial functioning.
- Controlling negative feelings, having positive outlook.
- Maintaining satisfactory self‐image, sense of competence (body image, losing hair/gaining weight, amputations).
- Preserving good relationships with family/friends.
- Preparing for an uncertain future.
Coping with Cancer over Time
Dunkel Schetter et al. (1992) Asked cancer patients to indicate the coping strategies they found most useful…? (5)
- Social support/direct problem solving
(“Talked with someone to find out more about the illness/situation”) - Distancing
(“I didn’t let it get to me”) - Positive focus
(“I learned something from this experince”) - Cognitive escape/avoidance
(“I wished that the situation would go away”) - Behavioural escape/avoidance
(e.g., eating, drinking, sleeping, etc.)
Which coping strategies tend to be maladaptive over time?
1. 2. 3. Leads to…
Rumination:
Associated with exacerbation of symptoms.
Interpersonal withdrawal:
Associated with loneliness and low relationship satisfaction.
Avoidant coping (e.g., denial):
Associated with increased psychological distress and can exacerbate the disease process; leads to poor adjustment to illness. -> How?
- Not seeking care, following up on treatment plan, poor management of the disease
Denial in Cancer Patients
In a review of research on denial in cancer patients…
* Denial of diagnosis ranged in 4 to 47% of patients.
* Denial of impact (outcomes) occurred in 8 to 70% of patients.
* Denial of emotions occurred in 18 to 42% of patients.
The impacts on physical and social functioning were inconsistent; the impact on psychological functioning depended on the form of denial.
Distractive strategies were found to reduce distress, whereas passive escape mechanisms turned out to decrease psychological well-being (maladaptive).
Depression?
May delayed as patients…
The avarege person’s depression…
Depression: Feelings of sadness, despair, helplessness, hopelessness.
May be delayed as patients try to understand implications of condition; physically debilitating; direct impact on symptoms.
- The more people realize the nature of their diagnosis, more likely to feel helplessness -> lead to depression
The averge person deppression increases, over the long-term it oftem improves, but it varies. Long-term we see a negative emotional impact.
How can depression complicate medical?
Overall asseesment, it is difficult to seperate the sympoms of the depression from the disease. Example, Fatigue
History of depression is associated with poorer adjustment to cancer and other chronic illnesses.
Can depression impact cancer survivability?
Giese Davis et al. (2011, Journal of Clinical Oncology
Followed 101 women with metastatic breast cancer for 1 year.
* Monitored depression over the course of year; measured 3 X using Center for Epidemiology Studies Depression Scale (CES D), a leading measure of depression.
* Controlled for demographic & medical factors.
“Median survival time was 53.6 months for women with decreasing CES D scores over 1 year and 25.1 months for women with increasing CES D scores.”
Those who experienced decreasing depression in that one year, lived longer compared to those who experienced increases in depression.
Mental health may not save people from the diagnosis, but it can add years of survival.