Chapter 9: Chronic & Terminal Illness

Question 1

Chronic Conditions - Stats

Answer 1

• most of us likely to develop at least 1 chronic condition that may lead to our death
• 2/3 of canada health spending is on chronic conditions
• more common among lower income, women, seniors

Question 2

Crisis Theory

Answer 2

factors that influence how ppl adjust/cope after first learning they have a chronic illness (illness-related factors, personal, physical/social)

Question 3

Adaptive tasks in coping

Answer 3

1. tasks related to the illness or treatment (adjusting to hospital environment, etc.)
2. tasks related to general psychosocial functioning (control negative feelings, positive outlook, etc.)

Question 4

Coping with Cancer - patient strategies

Answer 4

• social support
• distancing
• cognitive escape
• behavioural escape

Question 5

maladaptive coping

Answer 5

• rumination
  -interpersonal withdrawal
• avoidant coping (denial)

Question 6

Informal Caregiving

Answer 6

The provision of physical/emotional care to a family member or friend at home

Question 7

caregiving as a chronic stressor

Answer 7

The stress of caregivers is generally higher than non-caregivers and for that reason caregiving is considered a chronic stressor

Question 8

Factors in caregiving stress

Answer 8

• not having te time to care for oneself
• engaging in unhealthy behaviours due to lack of time
  disrupted or insufficient sleep
• poor stress management and stress prevention
• degrading social relationships and social support
  caregivers are also m ore likely to believe that stress is having a negative impact on their physical health

Question 9

Economic burden of caregiving

Answer 9

• extra expenses
• postponed education
• declined promotion
• missed days of work
• reduced hours of work

Question 10

Health Costs of Caregiving

Answer 10

Higher levels of depression and physical health problems in caregivers when compared with non-caregivers
- abnormalities in measures of endocrine (cortisol) and immune system function
- spouse caregivers are at risk of premature death

Question 11

Benefits of caregiving

Answer 11

• majority of caregivers consider it a positive experience
• providing the best care possible
• staying connected or becoming closer
• rewarding sense of accomplishment, giving back to someone who has cared for them
• sense of meaning and purpose
• passing on a tradition of care in family
• learning new skills

Question 12

Future of Caregiving

Answer 12

based on stats Canada:
- there will be approx 120% more older adults using home care support
- there will be approx 30% fewer close family members avail to provide unpaid care
- family members will need to increase their efforts by 40% to keep up with care needs

Question 13

Managing Terminal Illness

Answer 13

mortality is the main issue of concern to patients in the first few months of being diagnosed with a seriously life-threatening illness

Question 14

High mortality illness

Answer 14

a high mortality disease does not typically mean a person will die in a few weeks or months
- however, families must adapt to this uncertainty (a source of stress in terminal illness)

Question 14

denial in terminal illness

Answer 14

Denial is common in terminal illness - in some cases can be extreme and persistent
- many patients also hope they will be cured or hope for a miraculous recovery

Question 15

denial and acceptance

Answer 15

denial is more common early on and acceptance is more common closer to death

Question 15

acceptance in terminal illness

Answer 15

acceptance is important for both patients and their loved ones

Question 15

Initial Response to pain

Answer 15

Sense of control is lowered; secondary appraisal is common
- engage in more emotion-focused coping early on

Question 16

Crisis theory

Answer 16

Describes factors that influence how ppl adjust/cope after first learning they have a chronic illness

Question 17

Adaptive Tasks in Coping

Answer 17

1. Tasks related to the illness or treatment
   - coping with the symptoms or disability of illness
   - adjusting to hospital environment, procedures, treatments
   - developing good relationships with practitioner
2. Tasks related to general psychosocial functioning
   - controlling negative feelings
   - having positive outlook
   - maintaining satisfactory self-image, sense of competence
   - preserving good relationships with family/friends
   - preparing for uncertain future

Question 18

Coping strategies cancer patients found most useful

Answer 18

• social support
• distancing
• positive focus
• cognitive escape/avoidance
• behavioural escape/avoidance

Question 19

Maladaptive Coping

Answer 19

• rumination
• interpersonal withdrawal
• avoidant coping

Question 20

Rumination

Answer 20

associated with exacerbation of symptoms

Question 21

interpersonal withdrawal

Answer 21

associated with loneliness and low relationship satisfaction

Question 22

avoidant coping

Answer 22

associated with increased psychological distress and can exacerbate the disease process - leads to poor adjustment to illness

Question 23

denial in cancer patients

Answer 23

- denial of diagnosis - denial of impact - denial of emotions Impact on physical and social functioning were inconsistent; the impact on psychological functioning depended on the form of denial Distractive strategies were found reduce distress, whereas passive escape mechanisms turned out to decrease psychological well-being

Question 24

Depression in cancer patients

Answer 24

may be delayed as patients try to understand implications of condition - physically debilitating - direct impact on symptoms - history of depression is associated with poorer adjustment to cancer and other chronic illnesses

Question 25

Can depression impact cancer survivability

Answer 25

increasing depression = decreasing months of survival!

Question 26

cancer stigma

Answer 26

cancer stigma depends on the extent to which a person's identity and sense of self are affected by the diagnosis - perceived controllability and visibility of cancer, and whether it interferes with daily functioning are also main factors in cancer stigma

Question 27

effects of cancer stigma

Answer 27

stigma is associated with more problematic outcomes (ex. depression) - cancer stigma is correlated with reduced cancer screening for cervical, breast, and colorectal cancer

Question 28

adaptation

Answer 28

making changes in order to adjust constructively to life's circumstances Successful adjustment to chronic conditions involves several major adaptive tasks that continue indefinitely

Question 29

Cancer survivor

Answer 29

Long-term cancer survivor have higher rates of emotional distress, especially those of lower SES and those who are single and disabled Social relationships are impacted, especially for couples most cancer patients display a remarkable amount of resilience

Question 30

Quality of Life

Answer 30

The degree of excellence people appraise their lives to contain Based on physical, psychological, vocational, and social functioning; includes disease or treatment related symptoms Emphasis is placed on daily living an important indicator of recovery from

Question 31

Evaluating quality of life

Answer 31

the most important aspect of quality of life is a person's perceptions of their own health (Self reported or subjective health)

Question 32

is subjective health consistent with objective health

Answer 32

Yes! Self reported health is associated with prevalance of all diseases, onset if all diseases, and labratory parameters of health

Question 33

Is subjective health predictive of mortality?

Answer 33

Self reported health significantly predicts mortality in longitudinal research often more than objective indices of physical health

Question 34

Is life satisfaction predictive of morbidity

Answer 34

YES - there is also a significant association between life satisfaction and onset of many chronic diseases

Question 35

Is life satisfaction predictive of mortality

Answer 35

YES - life satisfaction scores predict mortality (although less consistently than self-reported health)

Question 36

What psychological interventions are used to manage chronic illness and disease

Answer 36

- Psychopharmacological - patient and family education - individual or family therapy - stress management/relaxation - support groups

Question 37

psychological benefits of Cancer Support Groups

Answer 37

there is a significant survival benefit from support groups at one-year, but not 4 years - improved mood reduced uncertainty -improved self-esteem - enhanced coping skills - improved quality of life

Question 38

Factors in caregiver stress

Answer 38

- not having time to care for oneself; feeling overwhelmed - engaging in unhealthy behaviours due to lack of time - disrupted or insufficient sleep - poor stress management - degrading social relationships and poor support caregivers are also more likely to believe that stress is having a negative impact on their physical health

Question 39

Health costs of caregiving

Answer 39

higher lvls of depression and physical health problems abnormalities in measures of endocrine (cortisol) and immune system functioning premature death

Question 40

benefits of caregiving

Answer 40

overwhelming majority of caregivers consider it to be a positive experience - providing the best care possible - staying connected or becoming closer - rewarding sense of accomplishment, giving back to someone who has cared for them - sense of meaning and purpose - passing on a tradition of care in family - learning new skills

Question 41

Future of caregiving

Answer 41

- there will be approx 120% more older adults using home care - approx 30% fewer close family members who will be avail to provide unpaid care - family members will need to increase their efforts by 40% to keep up with care needs

Question 42

Denial in terminal illness

Answer 42

enial is common in terminal illness yet it can pose significant challenges for the person and their family Many patients also hope they will be cured or hope for a miraculous recovery. This can lead patients to choose aggressive care, even if it is futile

Question 43

Denial/Acceptance

Answer 43

There is evidence that denial is more common early on and acceptance is more common closer to death

Question 44

Acceptance in Terminal Illness

Answer 44

Acceptance is important for Both patients and their loved ones. But acceptance means different things to different people