Coping with chronic illness

Question 1

What does WHO define a chronic illness as?

Answer 1

A disease of long duration and slow progression
Common examples include heart disease, stroke and cancer.
Has a major impact on quality of life

Question 2

What are some statistics around chronic illness?

Answer 2

1 in 3 people in the developed world are living with a chronic illness.
15 million people in England have a chronic illness

Question 3

What are some current problems with chronic illness?

Answer 3

Improvements in treatments means people are living longer - more strain on the NHS
Treatments needs to shift from cure to management
Patients often suffer to adjust and cope, balance the demands of illness with everyday life and often have issues of multimorbidity

Question 4

What are the main stressors in chronic illness?

Answer 4

Medical - symptoms, illness, treatment, investigations
Personal - interferes with life, limitations, social construct of disbaility
Living with a chronic illness without reasonable adjustments

Question 5

What is coping?

Answer 5

Cognitive and behavioural efforst to manage external or internal demands that are seen as taxing or above the resources of that person.

Question 6

What does Amrosio 2015 say are some key stages of living with chronic illness?

Answer 6

Disavowal - experiencing a lack of control and normality
False normality - the experience of partial control as adjustments become part of routine, but is not long term sustainable
The new normal - acceptance of illness and the appropriate changes needed, less vulnerable to distress
Disruption - expsure to stressful situation (illness related or not) interputs the normal coping mechanisms.

Question 7

What are the three different elements of coping?

Answer 7

Coping skills
Coping styles
Coping stratergies

Question 8

What is meant by coping skills?

Answer 8

Similar to responses
The behavioural and cognitive methods used to manage a situation and its emotional impact. Problems solving in nature

Question 9

What is meant by coping stratergies?

Answer 9

Responses adapted to a particular stressor.
Actions determined by a coping skill
E.g more positive coping skill is more likley to go to the doctors when ill

Question 10

What is meant by coping style?

Answer 10

The tendency to respond to stressful situations in certain ways.

Question 11

What are the different focuses of coping skills?

Answer 11

Problem focuses - what to do about the problem (cognitive)
Emotional focused - a persons reaction to a stressor, e.g acceptance, negative self talk,
Appraisal focused - how a person understands and appraises the situation - logical anaylsis, wishful thinking, preparation, dread

Question 12

What are the four different coping styles according to van Schaik and van Wersch 2004?

Answer 12

Appraoch
Reappraisal
Emotional regulation
Avoidance

Question 13

What is meant by approach as a coping style?

Answer 13

Seeks out the stressor to find out more information, adapt and solve the problem

Question 14

What is meant by reappraisal as a coping style?

Answer 14

Changing the way you think about a stressful situation to make it motivational or beneficial. Is no longer apprasied as a threatning situation

Question 15

What is meant by emotional regulation as a coping style?

Answer 15

A persons ability to recognise and cope with their own emotions, not letting them affect their logic or decision making

Question 16

What is meant by avoidance as a coping stratergy?

Answer 16

Adapting behaviours that allow a person to deny the existence of a stressor.

Question 17

How does information seeking fit into coping stratergies of chronic illness?

Answer 17

Doctors often underestimate the amount of information a patient needs
Information desire varies by person if they are a monitor or a blunter
Information source is important
Sometimes too much information or incorrect information can be maladaptive

Question 18

What is the use of denial in coping with chronic illness?

Answer 18

Refusal to accept the diagnosis or new limitations on life
Desire to continue as normal
Can reduce short term anxiety
Long term denial can affect adherence

Question 19

What are the different types of illness behaviour?

Answer 19

Avoidance
Normalising - is ageing an illness?
resignation - illness seen as new centre of life
Accommodation - illness is not seen as central to life

Question 20

What is considered the best type of coping strategy for controllable and non-controllable illness?

Answer 20

controllable - problem focused
non-controllable - emotional focused

Question 21

What are some predictors of how well a patient will cope with an illness?

Answer 21

Timing of illness - teenage years, just about to be married etc, other stressors
External resources - social support, finances
Internal resources - individual beliefs and coping styles

Question 22

What are some examples of external resources in stress coping?

Answer 22

The presence and the quality of these resources is important
Social context - additional life stressors or lack of
Social companionship
Professional support
Emotional support
Informational support
Instrumental (physical) support.

Question 23

What are some effects of social support?

Answer 23

Associated with health promoting behaviour and wellbeing, often changes patient persepctives and reduces stress
However, can also be maladpative.

Question 24

What are some examples of internal resources in regards to stress coping?

Answer 24

Prior experiences
Beliefs
Learned helplessness - illness cause and cure seen as external
Locus of control - percieved ability to influence own life
Self efficacy - belief that they can complete tasks
Social skills related to help seeking
Psychological flexibility
Thinking style - optimisim

Question 25

Can coping skills be learnt?

Answer 25

CBT and ABT are thought to teach people coping skills.
However, we are uncertain if the interaction with the therapist as social support is actually the benefit of these.

Question 26

What are the four stages of learning to live with a chronic illness?

Answer 26

Adaptation/adjustment
Response shift
Growth/meaning shift
Integration

Question 27

What is included in the adaptation stage of learning to live with a chronic illness?

Answer 27

Illness related - learning to live with pain, treatment and healthcare needs
General tasks - self image, social and emotional consequences of illnesss
Learning to be okay with an unclear future.

Question 28

What can make adjusting to a chronic illness hard?

Answer 28

Limited experience or knowledge of life with illness
Decisions need making quickly
Unpredictability and uncertainty
External sressors
Percieved meaning of chronic illness

Question 29

What is meant by the response shift stage of learning to live with a chronic illness?

Answer 29

Changing perspectives and prioritise.
Realign goals with new situation
Re-engagement in life and accessible activities

Question 30

What is meant by the growth and meaning making stage of learning to live with a chronic illness?

Answer 30

Finding a positive change as a result of thier chronic illness
This can include order or purpose (such as fundraising) or new perspective (appreciation of loved ones)
Seems most beneficial long term, need time to process and work through crisis.

Question 31

What is part of integration of learning to live with and cope with a chronic illness?

Answer 31

When new life experiences are resolved with past and present identities
Person feels like illness makes sense and they can cope
Is often a non-linear and unpredicatable process.

Question 32

What is part of self management of a chronic illness?

Answer 32

Active involvement of the patient in care
Care becomes part of patients everday life often including life style changes and compliance.
NHS long term plan ecourages supported self-management through empowerment