Coping with illness and treatment

Question 1

WHO Definition of Health:

Answer 1

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Question 2

define:
impairment
disability
handicap

Answer 2

 impairment refers to a problem with a structure or organ of the body 

disability is a functional limitation with regard to a particular activity 

handicap refers to a disadvantage in filling a role in life relative to a peer group, as a result of impairment and disability

Question 3

What are the links between the terms handicap, disability and impairment

Answer 3

Disability strongly correlates with handicap.
 BUT research shows a very low correlation (r=0.19) between impairment and disability in 763 CHD patients.
 Suggesting other factors in addition to impairment (structural problem), influencedisability (functional limitations)…

Question 4

Crisis Theory of Coping with Illness (Moos, 1977)

description

Answer 4

• Similar to homeostasis, we have a need for social and psychological equilibrium.
• Serious illness presents ‘a crisis’ and our usual, habitual ways of coping are inadequate.
• A state of disorganisation, feelings of fear, guilt, sadness etc .
• A crisis by definition is self-limited because we cannot remain in an extreme state of disequilibrium.
• Adaptive responses lead to personal growth and adjustment to the illness.
• Maladaptive responses lead to poor adjustment (psychological problems, low functioning etc).

Question 5

Crisis theory of coping with illness

Answer 5

see diagram

Question 6

Illness related factors

Answer 6

• Unexpected • Cause & Outcome/Prognosis • Disability • Stigma • Disfigurement • Prior experience

Question 7

background/personal factors to do with understanding illness

Answer 7

• Age of onset • Gender • SES & occupation • Pre-existing illness beliefs • Pre-existing personality

Question 8

how can the big 5 personality traits affect how one understands their illness

Answer 8

• Openness – no clear link to health
• Conscientiousness - +2 years life expectancy
• Extraversion – lower rates of CHD, protective respiratory disease
• Agreeableness – Hostility associated w/ CHD
• Neuroticism – higher use of alcohol and smoking; higher symptom reportin

Question 9

The Impact of Agreeableness

Answer 9

Big Five Personality Traits: Different adaptation for high and low agreeableness  ‘I see myself as someone who has a forgiving nature’  May be explained by more agreeable individuals…  Having more social support & better quality of friendships  More likely to follow self-care instructions & have positive, active coping strategies

Question 10

Physical and Social Environment

Answer 10

• Hospitalisation • Accommodation and physical aids/adaptations • Societal attitudes • Social support & social role

Question 11

impact of cardiac patients and socially isolation

Answer 11

The most socially isolated cardiac patients scored higher on a hostility measure, had lower incomes, and were more likely to be smokers…
• Although when these variables were adjusted for, social isolation remained robust predictor of cardiac mortality.

Question 12

influence of social relationships on risk for mortality

Answer 12

The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.

Question 13

crisis theory of coping with serious illness

Answer 13

see diagram

Question 14

define illness representations

Answer 14

“A patients own implicit, common sense beliefs about their illness”

Question 15

5 factors of illness representations

Answer 15

about their illness” 1) Identity 2) Cause 3) Consequences 4) Time line 5) Curability/controllability

Question 16

a picture of health

-what were they required to do?

Answer 16

74 patients after MI were asked to draw pictures of their heart (before discharge from hospital)
 Recovery was assessed 3 months later, measuring work, exercise, distress about symptoms and perceptions of recovery

Question 17

a picture of health: conclusions

Answer 17

Patients who drew damage to their heart perceived that their heart had recovered less at 3 months, that their heart condition would last longer and had lower perceived control over their heart condition  Extent of damage drawn correlated to slower return to work  Peak troponin-t not related to 3-month outcomes or return to work

“Drawings of damage predict recovery better than medical variables”

Question 18

Maladaptive Coping Appraisals & Responses examples

Answer 18

 “Stress caused my heart attack, smoking helps me reduce my stress levels, so I’m going to continue smoking”
 “Now I’ve had a heart attack, my life is as good as over, I’ll never be able to enjoy myself again” => low mood => reduce activity levels, avoid seeing friends => depression

Question 19

2 types of adaptive tasks

Answer 19

1) Tasks related to illness or treatment • Coping with symptoms or disability • Adjusting to hospital environment/medical procedures • Developing and maintaining good relationships with healthcare professionals
2) Tasks related to general psychosocial functioning • Controlling negative feelings and retaining a positive outlook • Maintaining a satisfactory self image and sense of competence • Preserving good relationships with family and friends • Preparing for an uncertain future

Question 20

define coping

Answer 20

Coping: ‘Cognitive and behavioural efforts to master, reduce or tolerate external and internal demands and conflicts’ (Strauss, 1988).

Question 21

define problem focussed coping

Answer 21

Problem Focussed coping: Efforts directed at changing the environment in some way or changing one’s own actions or attitudes.

Question 22

define emotion focussed coping

Answer 22

Efforts designed to manage the stress-related emotional responses in order to maintain one’s own morale and allow one to function.

Question 23

examples of problem focused coping

Answer 23

•Seeking relevant information about an illness •Learning specific illness related procedures eg pacing activities •Changing behaviour eg diet

Question 24

examples of emotion focussed coping

Answer 24

•Seeking reassurance and emotional support •Learning relaxation strategies •Meditation

Question 25

Emotion vs Problem

Answer 25

focussed coping •Many studies have found that use of emotion focussed coping strategies associated with poorer adjustment and greater levels of depression. •However, circular reasoning (i.e. those who are more distressed may need to engage in more emotionfocussed coping). •Optimal coping depends on the individual and the situation- flexibility is the most beneficial

Question 26

Why is medical treatment stressful? refers to Transactional definition of stress: :

Answer 26

• Stress is a condition that results when the person / environment transactions lead the individual to perceive a discrepancy between the demands of the situation and the coping resources available.

Question 27

Why is patient distress a bad thing?

Answer 27

1. Moral/ethical responsibility to minimize suffering if possible. 2. Distress during treatment related to longer term psychological morbidity. 3. Distress during treatment related to wide variety of treatment outcomes, eg, patients not complying.

Question 28

Is it helpful to prepare patients? (Egbert, 1964)

Answer 28

Prepared group reported less pain, used less analgesic medication and their post-operative stay in hospital was an average of 2.7 days shorter.

Question 29

what is the difference between Procedural vs sensory information

Answer 29

* Procedural information – Information about the procedures to be undertaken * Sensory information – Information about the sensations that may be experienced

Question 30

which is more beneficial sensory or procedural information?

Answer 30

Results showed that the participants given sensory information reported significantly less distress during the procedure. combined is better tho

Question 31

what is the Dual process hypothesis

Answer 31

* Proposes that procedural and sensory information are both helpful because they work in different ways. * Procedural information works by allowing patients to match ongoing events with their expectations in a nonemotional manner. * Sensory information works by “mapping” a nonthreatening interpretation on to these expectations.

Question 32

Effective communication is key | -what are the key points

Answer 32

• Prepare patients with information – not all patients like/know to ask questions • Try to gage patient preference for level of information and involvement • Check patient’s understanding – anxiety can block information being heard. • Try to avoid medical jargon • Provide written information as an well as verbal

Question 33

Nursing Home Study: Results

Answer 33

On behavioural measures floor 1 residents (enhanced control group) showed greater engagement in activities. * Self report and nurse's ratings showed Floor 1 residents had better general well being (psychological & physical measures). * 18 Months later – 15% of Floor 1 residents had died compared to 30% of Floor 2 residents.

Question 34

how can you increase control in medical situations

Answer 34

Examples: • A device for patient to signal their pain/discomfort during dental treatment can reduce distress • Patient can squeeze a buzzer during an MRI to halt the procedure • Control over treatment options for fertility procedures related to greater well-being

Question 35

preparing children for treatment

Answer 35

Preparatory information should be specific and include procedural & sensory information. •Older children (> 7yrs) benefit most from information presented about a week before a procedure, younger children closer to the procedure. •Modelling and coping skills interventions can be helpful •eg. Film ‘Ethan has an operation’ depicting a child in hospital using positive coping strategies reduced anxiety in children undergoing operations (Melamed & Siegal, 1975)

Question 36

how do children cope?

Answer 36

* Children use the same types of coping as adults, but preference for problem-solving increases with age, whilst avoidant coping declines. * Distraction is the most effective coping strategy for younger children. * For older children (>9yrs) matching coping strategy to child’s preferred coping strategy is more effective.

Question 37

describe the combined show-tell-do approach

Answer 37

1) Tell: Using simple language and a matter-of-fact style, the child is told what is going to happen before each procedure (comparisons the child understands are used and negative, emotive words avoided). 2) Show: The procedure is demonstrated using an inanimate object (eg a doll), a member of staff or the clinician. 3) Do: The procedure does not begin until the child understands what will be done.

Question 38

The impact of parents’ behaviour

Answer 38

Children’s distress during a routine immunization was correlated with the amount of distress shown by parents but not to subjective anxiety (Frank et al, 1995)