Living With Chronic Illness Flashcards
(33 cards)
What is chronic illness?
The experience of a long-term condition for which there is currently no cure and which is managed with drugs and other treatment
List some examples of chronic conditions.
Diabetes COPD Arthritis HPN Some mental health conditions
What are 3 common characteristics of most chronic illnesses?
- Preventable
- Degenerative
- Costly
Why should we as doctors look at chronic illness?
Because its a common experience where aetiology and prognoses are very diverse but they have very similar social and psychological sequelae - there is also an association between social and emotional experiences + coping and managing
Informs the NHS mandate of health care priorities
What are common elements from patient’s illness narratives that experience chronic illness?
- Search for meaning + explanation
- Uncertainty + unpredictability
- Coping + resilience
How 4 factors does chronic illness impact?
- Daily activities
- Social relationships
- Sense of self (biographical disruption)
- Social identity
What is biographical disruption?
When having a chronic condition causes a person to rethink the way that they live
What are the common coping strategies patients with chronic illness use?
- Denial
- Normalisation
- Resignation
- Accommodation
What are the pros and cons of coping via denial?
Useful in early stages helping the person to take stock but presents difficult if it persists
What is a normalisation coping strategy?
Trying to maintain pre-condition identity via a ‘passing’ strategy trying to pass as normal and concealing their illness OR re-designation of ‘normal’ life i.e. “this condition is normal to me now”
What is the resignation coping strategy?
“That’s it I just have to live with this now” i.e. acceptance
What is the accommodation coping strategy?
Positive strategy where patients accept their condition, deal with the problems but dont see it as central to everyday lives
How can you promote good self-management?
Using patient’s lay knowledge of what works for them and sharing their knowledge/expertise
Self-help groups (individual/collective)
Pushing them to becoming ‘expert patients’
What is an expert patient?
Patients who take the lead in managing their condition and someone who:
- Feels confident and in control of life
- Aims to manage condition + its treatment in partnership with healthcare professionals
- Communicates effectively with professionals and willing to share responsibility for treatment
- Realistic about how their condition affects them + family
- Uses skills + knowledge to lead a full life
= better outcomes
What are expert patient programmes?
A peer-led self-management programme that aims to improve self-management
6-week programme suitable for any long-term condition (disease-specific ones available) covering topics such as healthy eating, exercise, pain management, relaxation, action planning + problem solving
What are the evidence-based benefits of the expert patient programme?
- Felt more confident that their symptoms would not interfere with their lives
- Felt better prepared for appointments with healthcare professionals
- Fewer visits to GP
- Fewer visits to emergency dept.
What are the potential problems with expert patient programmes?
- Not attractive to everyone
- Everyone not able to participate
- Extra pressure on patient organisations
When talking to patients about chronic conditions, what questions should you ask?
How the patient experiences their illness via the 4 areas of impact
How have things changed for them since the onset of their condition?
How effective is their self-management? Could it be improved? How?
What is the self-regulatory model (SRM)?
System of conscious personal management that involves the process of guiding one’s own thoughts, behaviours, and feelings to reach goals
The interaction of factors in influencing how patients cope with their chronic illness, such as:
- Representation of illness (identity, cause, consequences, timeline, cure/control)
- Interpretation (symptoms perception, social messages)
- Emotional response to illness (fear, anxiety + depression)
- Coping (approach or avoidance coping)
- Appraisal (was my coping effective?)
What are illness representations?
Illness beliefs refer to a patients own implicit common-sense understanding of their illness formed by dimensions directing illness behaviours - may have numerous beliefs for a particular illness
What are the 5 belief dimensions?
- Identity: what is it?
- Cause: what caused it?
- Time: how long will it last?
- Consequence: how will it impact my life?
- Control-cure: can it be treated, controlled, managed, etc.?
What is the illness perception questionnaire (IPQ-R)
9 item testing to gauge how patients perceive their illness - comes in both normal and brief versions and is used by clinicians and researchers
How has the self-regulatory model (SRM) been clinically applied?
Has been applied to a range of chronic illnesses (e.g. MS, chronic fatigue syndrome, diabetes etc.) via the IPQ-R to help understand adaptation and coping - allows you to develop a appropriate management plan and work with the patient
What types of things do patients with chronic illness need to do to cope in a healthy way?
- Adjust to symptoms + disability (acceptance)
- Maintain a reasonable emotional balance
- Preserve a satisfactory self-image + sense of competence
- Learn about symptoms/treatments + self-management (self-efficacy)
- Relationships with friends + family
- Form + maintain relationships with health-care professionals
- Prepare for an uncertain future
