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4 - Hadsoc > deck_2226127 > Flashcards

deck_2226127 Flashcards

1
Q

Define a chronic condition

A

A wide range on conditions which are long term and have a profound influence on the lives of sufferers. Tend to have palliative care for them and manifestations vary day-to-day. Are controlled but not cured.

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2
Q

Why is a good understanding of chronic conditions needed?

A

– high prevalence in elderly population and we have an aging population– understanding the condition will lead to better treatment for people with those conditions

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3
Q

Describe the onset of a chronic illness

A

Symptoms can be strikingMore often they are slow in their onsetOther explanations for the symptoms are often available

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4
Q

Describe the process of getting a diagnosis of a long term condition

A

May be a prolonged period of uncertaintyAmbivalent status of some diagnosesE.g. Chronic fatigue syndrome, irritable bowel syndromeThe process of diagnosis can be quite unpleasant

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5
Q

Describe an illness narrative

A

The story-telling and accounting practices that occur in the face of illness– how do you understand your condition and how do you explain it

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6
Q

What is a biological disruption?

A

A disruptive event which threatens an individuals sense of a taken-for-granted world. New consciousness for body and fragility of life. Chronic illness is a biological disruption.

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7
Q

What is a narrative reconstruction?

A

The process by which the shattered self is reconstructed in ways that explain the appearance of illness. “how you explain your illness to yourself”- comes from a desire to create a sense of coherence, stability and order in the aftermath of biographical disruption

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8
Q

What are the components of the work of chronic illness?

A

Illness workEveryday workEmotional workBiographical/narrative workIdentity work

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9
Q

Describe illness work

A

Symptom management- dealing with the physical manifestations of the illness

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10
Q

Describe everyday life work

A

Maintaining daily living and trying to keep a pre-illness lifestyle and identity intact. Also, re-designating the new life as normal. – Balancing demand on other whilst remaining independent.

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11
Q

Describe emotional work

A

Managing one own emotions and those of other– work that paitetns do in order to protect the emotional well-being of others (downplaying symptoms)– impact on social relationships– impact on role in life (being the breadwinner or a mother and a loss of identity)

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12
Q

Describe biographical work

A

Loss and the subsequent reconstruction of health– the way that you see yourself changes– trying to maintain a positive definition of self

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13
Q

Describe identity work

A

Working to maintain an acceptable identity– illness can affect how people see themselves and how others see them. It can become the defining aspect of identity.

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14
Q

Define stigma

A

A negatively defined condition, attribute, trait or behaviour conferring “deviant” status; a “spoiled” identity.

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15
Q

What types of stigma are there?

A

Discreditable vs discreditedEnacted vs real stigma

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16
Q

Describe discreditable stigma

A

An illness that can’t be physically seen e.g. mental illness, HIVCondition is kept hidden and stigma is yet to be revealed

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17
Q

Describe discredited stigma

A

Physically visible characteristics or a well known stigma that sets a person apart. e.g. physical disability or a known suicide attemptAs it is known, it affects the behaviour of the patient and those around the patient

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18
Q

Describe enacted stigma

A

The real experience of prejudice, discrimination and disadvantageDiscrimination has actually occurred as a result of the condition

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19
Q

Describe felt stigma

A

Fear of enacted stigmaEncompasses a feeling of shameDiscrimination has not actually occurred, felt stigma is the fear of the stigma occurring and affecting the behaviour and judgement of others

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20
Q

Give some positives about self-management of long term conditions

A
  • allows for learning about coping and condition management skills- aims to reduce hospital admissions- is the epitomy of patient centered care
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21
Q

Give some negative about self-management of long term conditions

A
  • responsibility is placed on the often very ill patient- do patients really understand their treatments?- little evidence that it is more efficient
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22
Q

What are the two models of disability?

A

Social modelMedical model

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23
Q

Describe the medical model of disability

A

Disability is a change form the medical norms. Disadvantages are a direct consequence of impairment and disabilities. Medical intervention is needed to cure or to help.

24
Q

What is a disadvantage of the medical model of disability?

A

Does not take psychological and social factors into account – it only focuses on the biological. Also stereotypes and uses stigmatising language.

25
Q

Describe the social model of disability

A

Disability is a form of social oppression. Disadvantages are a product of the environment and its failure to adjust. Political action and social changes are needed in order to help. Leaves out biological factors. Fails to recognise bodily realities and the extent to which they are socially solvable

26
Q

What is the International Classification of Impairments, Disabilities or Handicaps?

A

Attempts to classify the consequences of disease. 1. Impairments – abnormalities in structure of functioning body2. Disability – concerned with performance of activities3. Handicap – concerned with broader social and psychological consequences of living with impairment and disability

27
Q

What are some negatives of the ICIDH?

A

Handicap is used negatively as a term and the model implies that problems are either intrinsic or inevitable.

28
Q

What is the International Classification of Functions, Disability and Health (ICF)?

A

The WHOs framework for measuring health and disability at both individual and at a population level.

29
Q

What are the key components of the ICF?

A

Body structure and function (impairments of these)Activities undertaken (difficulties and limitation experienced)Participation or involvement in life situations (may be restricted)All these factors are taken into account in order to assess the disability of a person.

30
Q

Why should health be measured?

A

– Indication of the need for healthcare– Target resources where they are most needed– Assess the effectiveness of health interventions– Evaluate the quality of health services– To use evaluations of effectiveness to get better value for money – To monitor patients’ progress

31
Q

What are the common measures of health?

A

MortalityMorbidityPatient-based outcomes

32
Q

Why are patient based outcomes used?

A

Attempt to assess well-being from the point of view of the patient. e.g. HRQoL – have an increase in number of condition where good management is the goal rather than cure. Therefore need to focus on the concerns of the patient because they are the one who has to live with the condition

33
Q

What are PROMs?

A

Patient-reported outcome measures. Measures of health that come directly from the patient.

34
Q

How can patient based outcomes be used?

A

Be used clinically– Be used to assess benefits in relation to cost– Be used in a clinical audit– Be used to measure health status of populations– Be used to compare interventions in a clinical trial– Be used as a measure of service quality

35
Q

What is a Health Related Quality of Life (HRQoL)?

A

Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient. – the illness and treatment effects and how they affect the patient

36
Q

What are some of the things that are assessed in HRQoLs?

A
  • physical function- symptoms- global judgements of health- psychological well-being- social well-being- cognitive functioning- personal constructs- satisfaction with care
37
Q

What are the key points of the HRQoL?

A

Emphasis on patient’s own viewsEmphasis on functional effectsEmphasis on therapy as well as illness

38
Q

What are the ways to measure HRQoL and which is more used?

A

Quantitative and qualitativeQuantitative methods are used more

39
Q

Describe qualitative methods of measuring HRQoL

A

Good for initial looks at HRQoL– use a lot of resources (time and training)– not easy to use in evaluation

40
Q

Describe quantitative methods of measuring HRQoL

A

Relies on questionnaires (instruments or scales)that need to be reliable and valid

41
Q

Describe reliability of instruments

A

Should be accurate over timee.g. if there is no change in health, they should ge tthe same score each time

42
Q

Describe the validity of instruments

A

Does it measure what it is meant to measuree.g. are you measurign pain but forgetting social aspects?

43
Q

Describe generic instruments

A

Can be used with any population and generally covers perceptions of overall health. – also includes questions on social, emotional an dphysical functioning paina nd self-care

44
Q

What is the name of a generic instrument?

A

Short-form 36-item questionnaire (SF-36)

45
Q

Describe the SF-36

A

Had 36 items to assess HRQoL gourped into 8 dimensions. Responses are scored and added together to give an overall score between 0-100 (do not add between dimensions as it makes interpretation difficult)

46
Q

Give some postive reasons for using hte SF-36

A

– is acceptable to people– takes 5-10 mins– has good reliability– is responsive to change

47
Q

Describe the EuroQol (EQ-5D)

A

Instrument with 5 dimensions- mobility- self care- usual activities- pain/discomfort- anxiety/depressionHave three levels for each dimension- no problems- some/moderate problems- extreme problems

48
Q

How has the use of the EQ-5D changed over time?

A

Used to be used to complement other methods but is now being used as a stand-alone measure.

49
Q

Give some positive aspects of the EQ-5D

A
  • is widely used- good population data is available- is well validated and tested for reliability- particularly suitable for use in economic evaluations
50
Q

What type of specific instruments can you get?

A

Disease specificSite specificDimension specific

51
Q

Give some disease specific instruments

A

– Asthma Quality of Life Questionnaire– Arthritis Impact Measurement Scale (AIMS)

52
Q

Give some site specific instruments

A

– Oxford Hip Score– Shoulder Disability Questionnaire

53
Q

Give some dimension specific instruments

A

– Beck Depression Inventory– McGill Pain Questionnaire

54
Q

What are the advantages of specific instruments?

A

Have relevant contentAre sensitive to changeAre acceptable to patients

55
Q

What are some disadvantages of specific instruments?

A

Cant be used with people who do not have the disease. Comparison is limitedMay not detect unexpected effects

56
Q

What questions do you ask when selecting an instrument to use?

A
  • Is there published work showing established validity and reliability?- Is there other published work showing successful use of the instrument- Is it suitable for your area of interest- Does it adequately reflect patients’ concerns in this area?- Is the instrument acceptable to patients?- Is it sensitive to change?- Is it easy to administer and analyse?

4 - Hadsoc (9 decks)

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