Chronic & Terminal Illness

Question 1

Factors Determining Chronic Illness

Answer 1

Genetics
Environmental (asthma, cancer)
Lifestyle- drinking, exercise, unprotected sex
* Most common is lower back pain and osteoporosis of the knees

Question 2

Prevalence and Impact of Chronic Illness

Answer 2

2/3 of Canadas health spending
More common in:
- women, lower-income, seniors, specific subpopulations (aboriginal people)

Question 3

Quality of Life

Answer 3

-Different from standard of living- ex. could be living in a country with high standard of living but have a low QoL OR high QoL in afganistan
- Impacted by severity of chronic illness
> Chronic illness

Question 4

Components of QoL * know this

Answer 4

• Physical Functioning (how well does your body work)
• Psychological Status ( how well does your brain work)
  Social Functioning (presence of friends + family)
  Disease vs Treatment Related Symptoms- Chronic Migraines or something that appears once a year

Question 5

Evaluating QoL

Answer 5

• Fluctuating characteristics
• Population Norms- comparison between countries
• Acute changes (progression, flare ups)
• Age related changes (elderly vs 35)
• Culture- how people experience common illness (do they talk about it )

Question 6

Why study QoL

Answer 6

• Documentation (have things got better or worse)
• Trends
• Impact of treatment
• Comparing effectiveness between treatments
• Decision and policy makers- should we keep reinforcing and paying for this drug

Considering: Multiple chronic conditions and QoL

Question 7

Emotions and Chronic Illness

Answer 7

• Denial - may interfere with treatment
• Anxiety - you now think everything is linked to disease- hypervigilent.
• Depression

Question 8

The Self

Answer 8

Self Concept: what you think of yourself
Broken down into..
- Physical Self = linked to low self esteem, body image.
- Achieving Self
- Social Self = social interaction helps
- Private Self = increased dependence of others, loss of unrealized dream

Question 9

Coping with Chronic Illness

Answer 9

Avoidant Coping: deny and avoid it.
Active Coping: Yes I have this disease and I’m going to make the best out of it.
Social support = positive
Multiple coping strategies is best

Question 10

Physical Rehabilitation Goals

Answer 10

• Different for youth vs elderly
• Treatment - stretching
• Learning how to adapt in new environment

Question 11

Psychological Interventions

Answer 11

• Individual Therapy (episodic vs continuous, your family being there rooting for you)
• Patient education
• Relaxation, MBSR (yoga)
• Social support interventions (support group)
• Family support

Question 12

Death Across Our Life Span

Answer 12

• Average life is 81 years

- Low rates of death from infectious disease

Question 13

Infant Mortality

Answer 13

High- 5.1 per 100
Factors contributing: location and low SES
- SIDS (sudden infant death syndrome)
- accidents, cancer

Question 14

Death in Middle Age

Answer 14

• more realistic and fearful
• Premature death is before 79
• Sudden > Prolonged

Question 15

Death in Old Age

Answer 15

• Dying mostly of degenerative diseases
• Women tend to live longer than men
• Men dont do well with widowhood

Hope for Good Death:

• free of suffering
• Pain management
• Clear decision making-DNR

Question 16

Euthanasia

Answer 16

• Ending life of a person who is suffering from a painful and terminal illness
  Request when..
• distress and fatigued
• pain + suffering
• Burden to their family
• A lot of physicians won’t do this because of doctors oath.
• Called MAID in Canada (2016)

Question 17

MAID

Answer 17

Medical Assistance in Dying (2 types)

1st: Doctor or nurse give you something to kill you
2nd: Prescribe you something for you to take yourself
- Two independent HCP need to evaluate if someone qualifies

Question 18

Criteria for MAID

Answer 18

• eligible for government funded health insurance
• Over 18
• Are not being externally pressured
• Give informed consent
  GRIEVOUS AND IRREMEDIABLE:
• serious & incurable illness, disease or disability
  -Advanced and irreversible decline
• Physical and psychological suffering is intolerable
• Natural death is reasonably foreseeable

Question 19

Living Wills-DNR

Answer 19

• directives that extraordinary measures would not be taken

- Many physicians disregard are are unaware of DNR

Question 20

Kubler Ross’s 5 stage theory

Answer 20

• Denial- being optimistic
• Anger-why me
• Bargaining- trading in good behaviour
• Depression
• Acceptance

Question 21

Alternatives to Hospital Care

Answer 21

Hospice Care:
- Acceptance of death, improving QoL, pain management, emotional support, unrestricted family visits

Home Care:
- Still regular contact with medical staff, increased responsibility of family members, psychological benefits for patient.

• Both of these becoming more of the norm instead of hospitals