Psychosocial Considerations and Coping

Question 1

Name the 4 Psychosocial Considerations in Health

Answer 1

1. mental / thinking
2. social / relating to others
3. spiritual / being - what do we find meaning in?
4. Emotional / feeling - feelings, mood, affect - influence behaviours

Question 2

List Components of Self Concept

Answer 2

1. identity
2. body image
3. role performance

Question 3

Define:

Identity

Answer 3

Sense of who you are as an individual - consistency
* evolves and develops over time
* valuable at key times throughout life
* influenced by age, life period, and developmental milestones
* people with chronic illness may call identity into question - may occur continuously as chronic illness and individual states change

Question 4

Define:

Body Image

Answer 4

relates to physical appearance, structure and function
* stresses can impact body image
* with chronic illness, we add things to our appearance - ex. mobility devices - which influences our body image and how we perceive others

Question 5

Define

Role Performance

Answer 5

people with chronic illness often experience role change
* with each role we have, we have different expectations of ourselves.
* expectations over time become goals for role mastery
* when someone experiences chronic illness, their ability to meet role expectations change. May have to renegotiate role expectations. Role expectations may vary from person to person

Question 6

Self Concept vs. Self Esteem

Answer 6

• self esteem: sense of self-worth
• self concept influences self-esteem

Question 7

Explain

“sick role”

Answer 7

• described as a deviant behaviour that permitted avoidance of social responsibilities; learned behaviour where patient is seen as a victim and subordinate to clinician
• no longer acceptable, yet still a stance taken by some - we want people to take responsibility and ownership in their care
• emphasizes victim stance - rather want them to view selves as experts in illness

Question 8

Coping and Adaptation Model

Moos and Holahan

Answer 8

• personal resources - innate: gender, age, optimism - more likely to seek support with more personal resources
• health related factors - onset of chronic illness, signs and symptoms of illness; severity of illness
• social and physical context - family and friends, support, networks we live within, physical environment, sensory and stimulation we experience all at once and influence how we appraise
• cognitive appraisal - assessing threat vs. challenges - activates adaptive tasks and identifies what coping skills we use

everything connects back to eachother - part of a process and a cycle

Question 9

List

Health Related Adaptive Tasks

(3)

Answer 9

• managing symptoms
• managing treatment
• forming relationships with healthcare providers - essential because managing symptoms and treatment rely on info given by healthcare providers; also based on trust developed with HCPs

Question 10

List

General adaptive tasks

(4)

Answer 10

• managing emotions
• maintaining a positive self-image
• relating to family members and friends
• preparing for an uncertain future

Question 11

Name and describe

Categories of Coping Skills

(8)

Answer 11

• logical analysis and the search for meaning - connects to spirituality
• positive reappraisal - may minimize - “well it could be worse”
• seeking guidance and support
• taking problem-solving action
• cognitive avoidance or denial - can only be a temporary coping skill in persons with chronic illness
• acceptance and resignation - can support individuals to find and discover meaning
• seeking alternative rewards - finding new ways to bring joy (ex. volunteering)
• emotional discharge - ex. venting to others

Question 12

Identify

Risk factors for poor coping

(6)

Answer 12

• inability to accurately assess stressor - may be d/t lack of info, insufficient understanding, congition
• denial or avoidance of stressor
• an acutal or perceived lack of control over the situation
• an actual or perceived lack of support
• no experience or poor past experiences handling stressful situations
• varied by life stages - ex. components of self concept develop and change over time; can also predict coping

Question 13

List

How to assess adjustment and adaptation

3 components

Answer 13

1. past social history
2. observation of behaviuor
3. general observation

thought process through conversation is essential

Question 14

Explain/expand upon

Assessing Adjustment and Adaptation

Answer 14

past social history
* family history or family’s coping strategies
* how the individual navigated through difficult situations in the past

observation of behaviour
* how individual responds to presence of stress
* how individual reacts when speaking of the stressor

general observations
* personal presentation/appearance
* cognitive ability
* coping ability

Question 15

Define

Uncertainty

in the context of chronic illness

Answer 15

the inability to determine the meaning of illness-related events and accurately anticipate or predict health outcomes

Question 16

Explain

the process of uncertainty

Answer 16

1. stimuli frame include antecedents to uncertainty - symptom pattern, event familiarity, event congruency
2. cognitive capacity helps us assess response to stimuli
3. structure providers are other factors that work with cognition to understand and appraise stimuli
4. appraisal determines how we cope
   * danger = coping related to mobilizing strategies and affect control
   * opportunity = coping related to buffering strategies
5. coping leads to adaptation - may look different based on appraisal and personal coping mechanisms

Question 17

List

Goals of treatment for heart failure

(5)

Answer 17

• prevent progression
• reduce exacerbations
• recognize early signs of decompensation
• control symptoms
• assist patient with co-managing disease and improve QOL

Question 18

Define

QOL

Answer 18

• expresses a value judgement: the experience of living as a whole or in some aspect, is judged to be “good” or “bad”, “better” or “worse”
• each person’s unique experience and cirucmstances shape their perception of QOL - ex. socioeconomic conditions, living arrangements, community environment, culture, personal values, happiness, life satisfaction, spiritual well-being
• subjective in the definition depending on person’s perception
• objective in the way we evaluate it - outcomes of QOL

Question 19

Explain

QOL related to chronic illness

Answer 19

• fundamental goal of medical care - relief of pain and improvement of function
• all activities - examining, evaluating, diagnosing, testing, curing, comforting, educating - aim at improving QOL

Question 20

Define:

HR-QOL

Answer 20

• term used to focus on ways in which health influences quality of life
• individual level: perceptions of physical and mental health status and key variables assocaited with health status
• community level: includes resources, conditions, policies, and practices that influence a population’s health perception and functional status

Question 21

Six Domains of QOL

Answer 21

HRQOL
* physical health
* psychological health
* level of independence
* social relationships

QOL
* spirituality, religion, personal beliefs
* environment

Question 22

QOL and Heart failure

Answer 22

• physical and mental complications such as fatigue, depression, anxiety, edema, SOB, and therapeutic processes have a serious and negative impact on QOL
• Measures of QOL: SF-36 = most commonly used
• moderate to poor QOL reported in CHF patients
• QOL in elderly group more disrupted
• females more disrupted overall

Question 23

recommendations for improving QOL in CHF include:

Answer 23

• getting information about disease
• symptom monitoring - ex. daily checkup of common sx including SOB, weight loss, BP changes, and coughing-
• family support

Question 24

Patient definition of QOL

three components

Answer 24

1. ability to perform physical and social activities
2. maintaining happiness
3. Engaging in fulfilling relationships

Question 25

# List components of THRIVE Framework | (6)

Answer 25

1. therapeutic interventions 2. habit and behavioural factors 3. relational and social factors 4. individual differences 5. values and beliefs 6. emotional factors

Question 26

# THRIVE:Define... Therapeutic intervention | definiton, aims, outcomes

Answer 26

* any intervention on the part of a third party practitioner that is intended to improve the patient's physical functioning and psychological wellbeing * aims included providing more knowledge and updates regarding chronic condition, teaching new coping skills, improving adherance, exploring ways to gain satisfaction, examining emotional consequences, incorporating new healthcare technologies * have been associated with more positive mood, disease acceptance, increased QOL, and improvements in patient knowledge and self-care behaviours; predict positive coping outcomes

Question 27

# THRIVE: Define... Habit and Behavioural Factors

Answer 27

* habits: repeated behaviours that become somewhat automatic over time * patients who are able to engage in appropriate behaviours and elements of self-care exhibit fewer symptoms, better physical functioning, and improved psychological adjustment * suggested that self-management can be perceived to take large amounts of itme and effort - lead to difficulty and noncompliance * encouraging self-management involves fostering patient empowerment - leads to positive health outcomes incl. increased acceptance and adjustment to chronic illness among affected individuals

Question 28

# Habit and Behavioural Factors (Goal management strategies)

Answer 28

1. adjusting personal goals when they become threatened by chronic illness 2. maintaining goals that are within reach - person perceives opportunities to attain them 3. searching for new goals that complement existing goals or replace unattanable goals *linked to decrease in anxiety and depression and increases in reported well-being and purpose in life*

Question 29

# THRIVE: Define... Relational and Social Factors | def'n social support, impacts, considerations

Answer 29

social support: * degree to which person's need for affection, approval, belonging, and security are met by significant others * can include offering emotional concern and caring aid, informaiton, and appraisal information Associated with: * better overall adjustment, less symptomatology, and higher self-esteem * can buffer/protect patient from negative effects of stress as well as wider cultural forces such as stigma and social exclusion * lead to more positive self-esteem, greater perception of control, feelings of worth, importance and prestige * can offer ill person range of different resources: financial aid, information, appraisal support * other less tangible resources: loved one providing compassion and empathetic support Considerations: * may not be effective if social relationship is characterized by disapproval or misunderstanding * if felt to be inappropriate, feelings of self-efficacy and control become threatened; relationship becomes one of dependency - negative coping consequences

Question 30

# Relational/Social support Benefits of Support Group

Answer 30

Allow individuals to: * secure more information * talk to others who understnad their sx * learn how to cope with sx * persue belief that another person with same dx understands how they feel * deal with sx that frighten them * derive enjoyment from helping others help themselves Associated with: * better psychological adjustment

Question 31

# THRIVE: define..... Individual Differences | definition, considerations and trends

Answer 31

Individual Differences * ensuring or disproportionate factors a person has that can be associated with positive coping outcomes * unique to patient - gender, age, ethnicity/background, health status, sx severity, SES - characteristics that can impact coping outcomes Considerations/Trends: * lower SES have more negative coping outcomes because they: experience more intense stress, have less resources to cope * more likely to report depressive sx and have been shown to rely more on interpersonal relationships to cope * personality traits predicts successful adaptation to chronic disease * high self-esteem, hardiness, and disproportionate optimism were related to positive coping outcomes * social role - having a clearly defined social role helps preserve patient's self concept

Question 32

# Individual differences coping styles and outcomes

Answer 32

Oppositional coping styles * related to less positive physical, congitive, emotional, and behavioural outcomes Emotion focused coping * worse adjustment Problem focused coping * better coping and adjustment

Question 33

# THRIVE: define... Values and beliefs | explanation and positive psychological beliefs

Answer 33

* changeable over time and situations * can be related to positive coping outcomes * spirituality an important predictor for QOL and highly associated with adopting a 'fighting spirit' in cancer patients other relevant positive psychological beliefs involve thoughts about the natural course, and consequence of disease can be strong predictors of adjustment * beliefs and cognition about acceptance, perception of control, and positive reinterpretation - better psychological and physical functioning * acceptance: willingness to acknowledge true existence of illness and incorporate into lifestyle - strong predictor of coping * beliefs about personal control and self-efficacy: relate to degree of confidence one can carry out a behaviour necessary to meet a desired goal * self-efficacy + acceptance = how passive or active coping is * benefit finding can lead to better outcomes: self-responsibility, positive attitudes, belief in self * finding meaning in experience of chronic illness leads to more positive coping outcomes while seeing personal growth = better adjustment

Question 34

# THRIVE: define... Emotional factors

Answer 34

* positive and expressive emotional responses generally lead to factorable coping outcomes; negative and repressive responses tend to predict negative adjustment positive: * support groups who receive mutual encouragement express emotions and exhibit better coping responses * emotion of **hope** linked to positive adjustment to chronic disease - leads to important belief that a favorable outcome might come about negative emotional responses: * depression can impair ability to adjust = lower QOL; * loneliness = negative coping outcomes * avoidant behavioral responses lead to negative adjustment

Question 35

# define: uncertainty

Answer 35

* inability to determine meaning of illness related events * common psychological reaction to illness experiences * common at diagnosis, initiation of new treatments, and transitions of care when patients must cope with unfamiliar, complex, and threatening situations associated with negative physical and psychological consequences including * sx severity and interference in daily life * emotional distress, fear * reduced resourcefulness * sense of losing control * diminished QOL

Question 36

# List Components of uncertainty in illness theory | (4)

Answer 36

1. antecedents generating uncertainty 2. appraisal of uncertainty 3. coping with uncertainty 4. adaptation to illness

Question 37

# uncertainty in illness theory: describe... Antecedents generating uncertainty

Answer 37

* include the stimuli frame, cognitive capacities, and structural providers * new stimuli lead to uncertainty when patients are not familiar with the experience or when expectations are inconsistent with experience * interpretation of illness-related stimuli is moderated by individual's cognitive capacity and by structure providers * stronger cognitive capacity facilitates understanding and reduces uncertainty * structure providers influence patient interpretation - can more accurately predict and understand experiences with appropriate social support, education, and support from HCPs

Question 38

# uncertainty in illness theory: describe... Appriasal of uncertainty

Answer 38

appraisal: * congitive process used to determine whether a stressor is a danger or opportunity and evaluate the availability of coping resources to respond to the stressor * if stressor of uncertainty is appraised as a danger, patients will attempt to use coping strategies to reduce uncertainty * if uncertainty appraised as opportunity, potential resulting in a positive outcome, patients will attempt to use coping strategies that maintain uncertainty - ex. uncertainty about prognosis may be preferential to preserve hope

Question 39

# uncertainty in illness theory: describe... Coping with uncertainty

Answer 39

Coping: * mental and physical effort used to manage the stressor of uncertainty * different coping strategies used based on appraisal of uncertainty appraised as danger: * patients use mobilizing strategies to do something to eliminate source of uncertainty - ex. direct action, seek info, vigilence; and/or use affect-control strategies -ex. faith, emotional distance, emotional support - to minimize distress appraised as opportunity * patients aim to use buffering strategies to maintain situation and continue uncertainty * buffering strategies act to block input of new stimuli, which may change an individual's appaisal of unertainty from an opportunity to a danger * buffering strategies may incl. avoidance, selective ignorance, neutralization of threatening info

Question 40

# uncertainty in illness theory: describe... Adaptation to illness

Answer 40

* adaptation: achieving new balance and adjsting to new illness experience that triggered uncertainty * if coping strategies are effective, adaptation is achieved

Question 41

# Define: Dyadic Coping

Answer 41

* common endeavor to manage stress faced by the patient-partner dyad Involves strategies such as: * stress communication * supportive exchanges between patients and partners * joint problem solving * emotion focused coping Impacts: * as dyadic coping increases, uncertainty decreases and QOL improves