Flashcards in ASBHDS - Session 2 Deck (34):
What is "coping"?
The sum of COGNITIVE and BEHAVIOURAL efforts (which are constantly changing) to HANDLE PARTICULAR DEMANDS (whether internal or external) that are viewed as TAXING/DEMANDING.
Describe the transactional model of stress.
Potential stressor -> primary appraisal (is this a threat?) -> secondary appraisal (do I have the skills to cope?) -> stress
What are the two factors that must be considered in coping with the social and psychological impact of illness?
Adjustment to new identity and socioeconomic impact of illness.
What is the difference between emotion and problem focussed coping?
Emotion focussed coping seeks to change the emotion behind the issue through behavioural or cognitive approaches, while problem focussed coping seeks to change the problem itself, eg by reducing demands of situation or finding resources to deal with it.
Give three ways to aid coping.
- help patients increase social support
- increase personal control (eg. Pain management, involve patients more)
- prepare patients for stressful events by reducing ambiguity and uncertainty
Give some outcomes of successful coping.
Tolerating/adjusting to negative events/realities, maintaining positive self image and emotional equilibrium, continuing satisfying relationships with others, reducing threats from future
Which two things are people who are diagnosed with a chronic/life-threatening illness more likely to suffer from?
Depression and anxiety
What is an anxiety disorder?
A normal reaction to stress which has become excessive, experienced as intense dread or uneasiness. Likely to occur at various stages during illness.
Give some symptoms of depression due to another medical condition.
Depressed mood and irritable, decreased interest in activities, weight change, sleep change, activity change, fatigue, guilt, indecisiveness, suicidality
True or false - co-morbid depression does not affect risk of mortality?
False - it does. It also adversely affects other illness outcomes.
Give some barriers to recognising psychological problems in patients.
Symptoms may be inadvertently missed, patients my not disclose symptoms, HCPs may avoid asking.
Is it important to be aware of the possibility of psychological problems?
Give three commonly used measures of health.
Mortality, morbidity and patient-based outcomes.
What do patient based outcomes do?
Attempt to assess well-being from patient's point of view by comparing scores before and after treatment or over longer periods.
Give some reasons for using patient-based outcomes.
Increase in conditions where aim is managing rather than curing, need to focus on patient's concerns, need to pay attention to iatrogenic effects of care.
What can patient-based outcomes be used for?
They can be used clinically, to assess cost-benefits, in clinical audit, to measure health of populations, to compare interventions in a clinical trial, as a measure of service quality.
What are two reasons often given in favour of introducing PROMs?
Improves clinical management of patients, allows comparison of hospitals.
What are the challenges of PROMs?
Minimising the time and cost of collection/analysis/presentation, achieving high rates of patient participation, providing different output to diffferent audiences, avoiding misuse.
What is "health-related quality of life"?
The functional effect of an illness and its consequent therapy on a patient, as perceived by the patient.
What are the two basic groupings of "instruments" that can be used to measure health related QoL?
GENERIC (can be used with any population, cover general perception of overall health, can cover emotional health too), SPECIFIC (evaluates a series of health dimensions specific to a disease)
Give some advantages of generic instruments.
Can be used for much broader range (or if no disease specific instrument), enables comparison across treatment groups, can detect unexpected effects, can assess health of populations.
Give some disadvantages of generic instruments.
Less detailed, loss of relevance, less sensitive to changes, may be less acceptable to patients.
What type of instrument are the SF-36 and the EuroQoI EQ-5D?
What is the difference between the SF-36 and the EuroQoI EQ-5D?
SF-36 contains 36 items in 8 dimensions, generates score from 1-100 for each dimension which cannot be added up. EuroQoI generates single value from 1 (healthy) to 0 (death). 5 dimensions with 3 levels for each.
What are the three types of specific instruments?
Disease specific, site specific, dimension specific.
Give some advantages of specific instruments.
Very relevant content, sensitive to change, acceptable to patients.
Give some disadvantages of specific instruments.
Can't be used on people who don't have the disease, comparison is limited, may not detect unexpected effects.
What are long-term conditions?
An illness that can be controlled but not cured, where the manifestation varies greatly day to day.
What is rheumatoid arthritis?
Chronic autoimmune disease. Symptoms include joint tenderness and swelling, anaemia, pain, fatigue, muscle atrophy and osteoporosis. Usually between ages of 40 and 60.
What are "illness narratives"?
The story-telling and accounting practices that occur in the face of illness.
What is "stigma"?
A negativetly defined condition, attribute, trait or behaviour conferring deviant status.
What is the difference between discreditable and discredited stigma?
Discreditable stigma is where the illness is not seen but may cause issues if found out, eg HIV.
Discredited stigma has a physically visible characteristic or well known stigma which sets them apart, eg. Physical disability.
What is the difference between felt and enacted stigma?
Enacted is a real experience of prejudice/discrimination/disadvantage. Felt stigma is a fear of enacted stigma, which also encompasses a feeling of shame.