Long-Term Conditions Flashcards
(37 cards)
1
Q
What is a long-term condition (LTC)?
A
- A persisting condition that lasts for longer than a few months, and has a long-term prognosis
- Examples: Asthma, epilepsy, HIV, diabetes, arthritis, and Alzheimer’s Disease.
- Regular treatment
- Symptoms, disabilities, and ongoing treatment mean that the chronic illness affects patients in many ways.
2
Q
How common are LTCs?
A
- 15 million people in England
- Older adults (58% 60+ vs 14% under 40)
- Lower SES groups (60% greater high v.s. lowest SES)
- £7 in ever £10 health and social care expenditure
3
Q
In what groups are LTCs more common?
A
- Long-term conditions are more prevalent in older people
- 58 per cent of people over 60 compared to 14 per cent under 40
- More common in more deprived groups
- People in the poorest social class have a 60 per cent higher prevalence than those in the richest social class and 30 per cent more severity of disease
4
Q
What are some LTCs?
A
- About 15 million people in England have a long-term condition
- Long-term conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment, for example: diabetes, chronic obstructive pulmonary disease, arthritis and hypertension.
5
Q
How are LTCs impacting the NHS?
A
- People with long-term conditions now account for about 50 per cent of all GP appointments, 64 per cent of all outpatient appointments and over 70 per cent of all inpatient bed days.
- Treatment and care for people with long-term conditions is estimated to take up around £7 in every £10 of total health and social care expenditure
6
Q
What are the projections of LTCs?
A
- They are not straightforward
- The Department of Health (based on self-reported health) estimates that the overall number of people with at least one long-term condition may remain relatively stable until 2018.
- However, analysis of individual conditions suggests that the numbers are growing, and the number of people with multiple long-term conditions appears to be rising
7
Q
What is the socio-economic distribution of LTCs?
A
- Most individual long-term conditions are more common in people from lower socio-economic groups, and are usually more severe even in conditions where prevalence is lower
- For example, stroke. General Household Survey data (2006), analysed by the Department of Health below, shows those from unskilled occupations (52 per cent) suffer from long-term conditions more than groups from professional occupations (33 per cent).
8
Q
What has the WHO said about LTCs?
A
Thinking more globally:
- Non-communicable diseases (NCDs)
- Kill 41 million people each year (71% of all deaths globally).
- 15 million die from an NCD (30-69 years)
- 85% of “premature” deaths occur in low- and middle-income countries.
- Most NCD deaths due to cardiovascular diseases
9
Q
What does NCD stand for?
A
Noncommunicable diseases
10
Q
What are NCDs?
A
- Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 71% of all deaths globally.
- Each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 85% of these “premature” deaths occur in low- and middle-income countries.
- Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9million), and diabetes (1.6 million).
- These 4 groups of diseases account for over 80% of all premature NCD deaths.
- Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD.
- Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs.
- Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors.
- The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.
- NCDs disproportionately affect people in low- and middle-income countries where more than three quarters of global NCD deaths – 32million – occur.
11
Q
What is HIV?
A
Human Immunodeficiency Virus (HIV)
- HIV is a retrovirus
- Not everyone who is exposed to HIV virus becomes HIV positive
- Time for progression from HIV to AIDS is variable
- Not everyone with HIV dies from AIDS
- This variability may illustrate a role for psychology
- 36.7 million people worldwide with HIV
- Prevalence peaked late 1990’s but it is mostly stabilised now
- Increased number of people living with HIV in population growth & improved life expectancy
12
Q
What are the three main parts to psychological involvement in HIV?
A
1) Susceptibility/Illness onset
2) Progression
3) Longevity
13
Q
What does susceptibility/illness onset of HIV relate to?
A
Being exposed to HIV virus relates to:
• Beliefs about HIV (e.g. Susceptiblity, attitudes, norms)
• Health related behaviours (e.g. Condom use, needle use)
Becoming HIV+ may relate to:
• Use of drugs
• Exposure to other viruses
14
Q
What does the progression of HIV pertain to?
A
Lifestyle may speed up progression through: - Drug use - Unsafe sex - Unhealthy behaviours - Stress Cognitions may influence progression: - Adherence to medication - Stress - Cognitive adjustment - Negative expectations - Finding meaning in stressors - Coping - Emotional in expression
15
Q
What does the longevity of HIV relate to?
A
- General health status
- Health behaviours
- Social support
- Expression of anger and hostility
- Realistic acceptance
16
Q
How can the progression of HIV to AIDS be linked to psychology?
A
Adherence to medication
- Reasons for non-adherence to highly active anti-retroviral therapy (HAART)
Comorbidities
- Hypertension and HIV (Chepchirchir et al., (2018)
- Most of pts had hypertension too
Lifestyle
- Injecting drugs can exacerbate HIV
- Persistent heroin use sig increase in CD4 count (Edelman et al., 2015)
17
Q
What was found by Anotni et al. (2006)?
A
Stress management and HIV
- 130 gay men HIV CBSM and MAT versus MAT alone
- 9 and 15 month F/U (viral load)
- No difference between groups
- Analyses of men with detectable viral loads at baseline.
- Men with CBSM and MAT showed reduction in viral load at 15 months compared with MAT alone (medication adherence controlled for)
- Stress can exacerbate symptoms
- Stress management - aid effectiveness of treatment and reduce consequences of being ill
18
Q
What s cancer?
A
- Cancer is the uncontrollable growth of abnormal cells
- Cancer cells are present in most people but not everyone gets cancer
- The progression of the illness varies between people
- Not all cancer sufferers die of cancer
- This variability may illustrate a role for psychology
19
Q
What are the four main parts of psychology in cancer?
A
1) Initiation and promotion of cancer
2) Psychological consequences
3) The alleviation of symptoms
4) Longevity
20
Q
What is the initiation and promotion of cancer stage?
A
- Behaviour: eg. smoking, diet, sex - 75% of all cancers are linked to behaviours (smoking, poor diet, alcohol & sexual behaviours (Doll & Peto, 1981; Mokdad et al. 2004; Khaw et al. 2004). See Lectures 2 & 4. Screening and help-seeking behaviour influence early detection & health outcomes (Hale et al. 2007; Fang et al. 2006; Ali et al. (2015).
- Stress: uncontrollable stressors exacerbate progression in animals (Laudenslager et al. 1983)
- Life events: contradictory evidence –may play a role (e.g. higher number of event in families with someone with cancer. Meta-analysis (Petticrew et al. (1996) did not support this.
- Coping: maladaptive coping (smoking) could relate to initiation.
- Depression: some evidence - Bieliauskas (1980) relationship between two
- Personality: some evidence for type C personality developing cancer (Temoshok & Fox, 1984).
- Hardiness: may be protective
21
Q
What is the psychological stage relating to cancer?
A
- Lowered mood: Depression; Grief; Lack of control; Anger; Anxiety
- Poor body image: Lowered body esteem; Hair loss; Loss of breast
- Cognitive adaptation: Helplessness and fatalism relate to lowered mood; Finding meaning, mastery, self enhancement and creating illusions
- Benefit finding: Sense making: seeing the benefits
22
Q
What is the alleviation of symptoms stage of cancer?
A
- Pain management
- Social support
- Treating nausea and vomiting
- Body mage counselling
- Cognitive adaptation strategies
23
Q
What is the longevity stage of cancer?
A
- Some evidence for:
- Fighting spirit
- Denial
- Not helplessness
- Life events
- Stress
- Personality
- But often evidence is contradictory
24
Q
What is the psychological response to receiving a diagnosis?
A
Lowered mood
- Up to 20% of cancer patients have comorbidities of depression, anxiety as well as other emotions.
Body Image
- Women with breast cancer report changes in their sense of femininity, attractiveness and body image (Harcourt & Frith, 2008; Teo et al. 2016).
Taylor’s Theory of Cognitive Adaptation (1983)
- 1)Search for meaning, 2) mastery of cancer, 3) self-enhancement are ways to cope.
- Winger et al. (2016) having both a strong meaning in life and sense of coherence was related to reduced distress.
25
What is the psychology of managing the symptoms of cancer with psychosocial interventions?
Pain Management (see pain lecture)
- Syrjala et al. (2014) review of the evidence
- Catastrophizing is associated with increased pain whereas self-efficacy is associated with decreased pain
- Most effective techniques: education, hypnosis, CBT, relaxation with imagery
Social Support Interventions
- Holland & Holahan (2003) showed that higher levels of perceived social support related to positive adjustment
Cognitive Adaptation Strategies
- To improve self-worth, ability to be close to others and meaningfulness in life.
Cartwright et al (1973) described the experiencing of cancer patients, which include pain, breathing difficulties, vomiting, sleeplessness, loss of bowel and bladder control, loss of appetite and mental confusion
26
What did Anderson and Oakinci (2018) find?
- 4 databases
- RCT psychological interventions (2006-2016) to directly target and assess people with LTC to improve QoL were eligible
- 6 eligible interventions
- All 6 studies significantly improved at least one quality of life outcome immediately post-intervention. Significant quality of life improvements were maintained at 12-months follow-up in one out of two studies for each of the short- (0–3 months), medium- (3–12 months), and long term (≥ 12 months) study duration categories.
- Conclusions: All 6 psychological intervention studies significantly improved at least one quality of life outcome immediately post-intervention, with three out of six studies maintaining effects up to 12-months post-intervention.
- Future studies should seek to assess the efficacy of tailored psychological interventions using different formats, durations and facilitators to supplement healthcare provision and practice.
27
What is type 2 diabetes?
- The pancreas doesn’t produce enough insulin or the body’s cells don’t react to insulin – this causes a person’s blood glucose level to become too high
- Affects 3.4 million people in the UK (Diabetes UK, 2019) & 422 million worldwide (NCD-RisC, 2016)
- People with T2DM are more likely to have CVD and to die prematurely (National Collaborating Centre for Chronic Conditions (2008)
28
What is diabetes and self management?
- Structured education programmes can improve health outcomes and quality of life (Davies et al. 2008; Deakin, 2011; Khunti et al. 2012))
- <9% patients report access to structured education (National Diabetes Audit, 2018)
- UK DM education mostly group-based
- Not suitable for everyone
- A digital intervention may offer an additional method of delivering support
29
What is the integrating theory?
1) Impact of having a LTC & work required for self-management: Corbin & Strauss tasks for self-management
2) Individual behaviour change support: Taxonomy of BCTs
3) Ensuring that the final intervention would be implemented into routine healthcare: Implementation and Normalization Process Theory
30
What is a participatory design?
Participatory Design: Synthesis
Mapping and writing
- Core interdisciplinary writing team
Integrating
- worked with software engineers and a web designer
Revising
- Participatory design group (patients & HPs)
31
Why aren't we doing better in asthma?
- Complex, heterogenous disease with many reasons for poor control
- Therapy resistant disease
- Social factors (environmental factors)
- Behavioural factors (adherence, inhaler technique)
- Psychological factors (anxiety, depression)
32
What is the multifaceted nature of impact on quality of life in asthma?
- ‘Complex interplay of health, psychological factors and asthma’.
- 43 studies identified three themes
- Psychological (anxiety, depression, emotion regulation, illness perceptions)
- Health (BMI, rhinitis, cardiovascular disease, diabetes)
- Multifactorial (depression & asthma increases chance of obesity)
33
Why do psychological aspects matter in relation to asthma?
- Psychological dysfunction is 6 times as common in people with asthma
- Asthma control and asthma quality of life are worse if there is a psychological comorbidity, independent of cofounders
- Increased healthcare utilization & use of rescue medication
- Increased hospitalization
- Increased mortality
34
What are the behavioural issues in asthma?
- Dysfunctional breathing
- Trigger avoidance
- Action plans (healthcare utilization)
- Non-adherence (30-70%, 50% in children)
- Other lifestyle choices (smoking cessation, physical activity)
35
What is self-management of asthma?
- Self-management interventions with limited HCP input are relevant for asthma as they can cater to substantial symptom heterogeneity across/within participants.
- Proactive self-management of asthma has been convincingly shown to improve clinical outcomes and have been advocated in guidelines for 25 years
- People with asthma without a management plan are four times more likely to have an asthma attack needing emergency care in hospital, yet only 44% of people with asthma in the UK report having a self-management plan
36
How is theory integrated in relation to asthma?
- Necessity – Concerns Framework was a theory that we applied to asthma
- Low necessity perception is incredibly common
- “It’s nice – but it’s not for me”
- Approximately 1/3 patients have strong concerns about ICS
37
How are interventions developed in relation to asthma?
Person-based approach used to iteratively design and optimize intervention (Yardley et al., 2014)
1) Initial website planned and developed
2) Think-aloud interviews conducted
3) Retrospective / longitudinal interviews conducted
4) New evidence incorporated throughout
5) Feasibility trial conducted
