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KHA359 Lecture Notes - Lecture 6: Safe Sex, Cognitive Dissonance, Goal Setting

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tealporpoise102
30 Jun 2018
School
University of Tasmania
Department
KHA
Course
KHA359
Professor
Dr Ben Schuez

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Health Psychology week 6: Individual and population based approaches to
behaviour
Screening programs:
- aims to identify genetic risk for disease
ooutcome: try to identify early signs of disease and preventative
procedures
- early detection of disease or precursors
- Behavioural risk for disease:
oRecommend behaviour change
oWant to find before illness breaks out
oPrevention is better than the cure
- Bring people from stage of not being motivated to make health changes to
someone who is motivated to someone who changes their behaviour
oPeople who don’t know or who are not motivated: need different
support than those who are motivated
oMotivation stage
oVolition stage
Idea that people differ according to where they are on the
course to behaviour change
oScreening as opposed to treating:
Inform about risk status
Know whether you have to do something about it or not
Helps encourage motivation
If already told they have risk: then often motivation is in place
- Screening:
oEach type of screening carries significant implications and brings
particular benefits and challenges
Those identified with genes carrying risk for breast cancer, may
choose to take prevention action such as breast removal before
the onset of disease and will have to live with the knowledge of
their risk for many years
People identified as ?? placed on medications
Behavioural risk factors when identified may result in
behaviour change
Study:
Women in study to find out whether they have breast
cancer risk
Anxious and high levels of intrusive thought about the
potential negative consequences:
oHigh worrying before and after testing
oBefore is understandable: potentially negative
results
oAfter: even if found not at risk they still worry
more
oScreening puts you in a mindset of high
alertness and increased anxiety
Distress among those given apparently good news
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11 percent without mutation and 13% of their partners
were clinically anxious
why do people worry after genetic testing:
should put your mind at rest
clients are often totally healthy
genetic information is problematic and uncertain, and
predicts events that may or may not occur far in the
future
probabilistic information that we sort of understand
o80/100 wont get disease; still makes it highly
uncertain
control over disease onset is limited
oreminded of this lack of control when we get
tested
obad at dealing with situations we perceive as not
having control
the cause of disease lies in the person’s own biologic
make up and individual and family self esteem may be
affected
Consequences of worrying and psychological morbidities:
if testing illicit this anxiety and distress, we tend to
overestimate our risk
oeven if given good news
oreassess the information
non-adherence to:
ofollow up examinations
oeg. Mammograms and clinical breast
examination
may actually lead to getting genetic testing
oStrategies to minimize distress:
Time intervals: having to wait for results after testing
Guaranteed quick results
Know that you get result asap
Most women seem to benefit from this
‘one stop shop solution’
those found to have abnormalities however, reacted
worse
oeven though it is distressing experience,
sometimes the time interval might encourage
acceptance preparation
eg. Mammography:
regular mammography very effective in reducing breast
cancer incidences
oup to 30% reduction for those over 50
oless effective in younger age groups
less prevalent in this age group
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makes it more tricky- if test isn’t perfect,
there is a higher chance of false positives
if doing in population with low
prevalence, then you get more false
positives than correct positives
difficult for us to understand prevalence and screening positives
frequencies easier to understand that conditional
probabilities
suggests we should remodel outcomes of screening
procedures and figures
- Volition stage: when people are motivated and they want to change their
behaviours
oStrategies to change risk behaviour
Interventions based on stage s of change
Motivational readiness
Motivational interviewing:
Targeted at individuals without motivation to change
behaviour
Motivational interview is non-confrontational: the key
questions within the interview are:
oNon-confrontational
oWhat are some of the good times about your
present behaviour?
oWhat are the not-so good things about your
present behaviour?
Mostly people know there are negative
consequences involved
Repeatedly exposing these individuals to
these ideas
Aim: increase dissonance, provide means to adaptively
resolve dissonance
Different to cognitive dissonance:
oBecause people are good at tolerating
dissonance: employ a change of cognition
oHere: increase an unpleasant state which makes
them realize they need to change
Key elements of this:
oExpressing empathy by the use of effective
listening:
Report back and make sure on the right
track
oAvoiding arguments by assuming that the
individual is responsible for the decision to
change
oRolling with resistance rather than confronting
or opposing it
oSupporting self efficacy and optimism for
change
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Document Summary

Health psychology week 6: individual and population based approaches to behaviour. Screening programs: aims to identify genetic risk for disease: outcome: try to identify early signs of disease and preventative procedures early detection of disease or precursors. Behavioural risk for disease: recommend behaviour change, want to find before illness breaks out, prevention is better than the cure. Idea that people differ according to where they are on the course to behaviour change: screening as opposed to treating: Know whether you have to do something about it or not. If already told they have risk: then often motivation is in place. Screening: each type of screening carries significant implications and brings particular benefits and challenges. Those identified with genes carrying risk for breast cancer, may choose to take prevention action such as breast removal before the onset of disease and will have to live with the knowledge of their risk for many years. People identified as ?? placed on medications.

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Related Questions

While the concepts of screening and surveillance are intertwined there are subtle distinctions between the two ideas. The main goals are data collection to measure magnitude, changes, and trends in populations. The objective is to create interventions in defined populations. On the contrary, testing to identify individuals with infection or disease is the main goal of screening. The area of breast cancer screening and breast cancer surveillance has been a point of contention. Please read the following article and weigh in on which side seems most convincing:

There is a heated debate in this country about the risks and benefits associated with screening mammography. Proponents on both sides of the debate feel equally as strongly for or against annual breast cancer screening. Despite one’s opinions regarding the utility of screening mammography, it is difficult to deny that the rates of false-positive exams, the rates of overdiagnosis, and the cost of annual screening are too high. We can do better. It is time to stop devoting energy to arguing about data from studies performed decades ago and start working toward gathering new evidence. In late 2015, we will initiate the WISDOM study to investigate the safety and effectiveness of a personalized breast cancer screening model. This model will use a comprehensive risk assessment process to determine individualized screening regimens for women in the interventional arm. The data collected in this study will better inform the screening debate and will allow us to shed more light and less heat on the issue.

There is a great debate in this country about the risks and benefits of screening mammography. On one side of the debate are those in favor of the one-size-fits-all model of performing annual mammograms starting at the age of 40 for women who are not known to be at greatly elevated risk of developing breast cancer. The radiology community argues that this model reduces the rates of interval cancers, aids early detection, and should not be changed. On the other side of the debate are those who support the United States Preventive Services Task Force (USPSTF) recommendations to screen women biennially starting at age 50, and to screen women in their 40s based on personal preferences regarding the potential benefits and harms of screening.1 Specialists on this side of the debate believe that annual screening results in unacceptably high rates of false-positive recalls, overdiagnosis, and overtreatment.

Recently, the USPSTF published a draft update to the 2009 breast cancer screening recommendations, and the debate has once again intensified. The solution to this problem is not to continue the debate with repetitious reviews of studies that were performed more than 30 years ago, but to focus ahead on how to make breast cancer screening safer and more effective. The time has come to put the debate to rest by conducting a modern-era screening trial.

Before focusing on the future, let us first take a moment to review the current state of breast cancer screening in the United States. The majority of providers in this country continue to recommend annual screening starting at age 40.2 Proponents of annual screening mammography cite a resulting relative reduction in breast cancer mortality of 21%, which is based on data from randomized screening trials performed in the 1970s and 1980s.3 However, this estimated benefit comes with significant drawbacks. After 10 years of annual screening, over one-half of women screened will receive a false-positive recall, and 7% to 9% will undergo a benign biopsy.4,5 False-positive recalls and benign biopsies can cause long-lasting psychological distress that can negatively impact a woman’s willingness to undergo screening for breast cancer in the future. Additionally, false-positive recalls and overdiagnosis cost the United States an estimated $4 billion per year,6 and screening in aggregate is estimated to cost between $8 and 10 billion per year.7 This estimate is based on a screening mammogram costing between $135 and $195. If the cost of mammography increases, the overall cost of breast cancer screening increases proportionally. As a country and as healthcare professionals, we can and should do better.

Breast cancer screening should harness the advances that have been made in breast cancer risk assessment and our understanding of breast cancer tumor biology. Screening should be more effective at finding relevant and consequential cancers, and should result in fewer benign biopsies. Screening should also be better integrated with prevention. Lastly, screening should be more cost-effective. A personalized screening model could potentially achieve all of these goals.

The aim of a personalized screening model would be to focus resources on those women who are most likely to benefit. The foundation of the model would be a comprehensive risk assessment that would take into consideration a woman’s classical risk factors for breast cancer, such as her personal and family history of breast disease. This comprehensive risk assessment would also include an evaluation of breast density and germline genetic testing. These risk factors would then be placed into a breast cancer risk model that would estimate the woman’s 5-year risk of developing breast cancer, and personalized screening recommendations would be made according to this risk. Women at high risk of developing breast cancer would be screened more frequently, and women at low risk would be screened less frequently. This risk estimation could also be used to make recommendations regarding chemoprevention, thereby integrating screening and prevention, which is the real key to reducing mortality from breast cancer.

This model has the potential to optimize the benefits of mammography in the context of modern systemic therapy while minimizing harms. Using a similar risk model in 3 independent study populations, it has been shown that 50% of cancers occur in women with the top 20% predicted risk.8 This model is also practical because these risk factors are easy to assess, and it is estimated to be more cost-effective than annual screening, despite the use of genetic testing, which has decreased in cost significantly since the Supreme Court ruling in June 2013 that stated that the human genome could not be patented.

Personalized screening may be the way forward, but this can only be determined in the setting of a randomized controlled trial. In the fall of 2015, a randomized controlled trial comparing personalized breast cancer screening with annual screening will be initiated within the Athena Breast Health Network that spans the University of California and the Sanford Health system in the Midwest. This study will be called the WISDOM study (Women Informed to Screen Depending on Measures of Risk). We have received a large grant from the Patient-Centered Outcomes Research Institute to perform this trial, and are also working with payers and self-insured employers, such as Blue Shield of California and UC Health, to create a Coverage with Evidence Development policy that will cover the medical costs of the trial. Using surrogate endpoints and long-term follow-up, we aim to determine whether personalized screening is as effective, less morbid, more preferred by women, and enables prevention more as compared with annual screening. Our hope is that this trial will provide us with the information we need in order to determine the safest and most effective way to screen women for breast cancer. Then, and only then, will we be able to put “The Great Mammography Debate” to rest.

As we move toward a more biology-based approach to the treatment of diseases, our approach to screening for and preventing those diseases should follow suit. The opportunity before us is to learn who is at risk for which type of breast cancer, and to optimize our screening and prevention strategies for each individual according to her personal risk. Over the last 20 years, many advances have been made in our understanding of the risk factors that contribute to a woman’s risk of developing breast cancer. The time has come for us to harness this knowledge and apply it in an evidence-generating fashion to shed more light and less heat on the screening controversy.

Do you believe that US Preventive Services Task Force (USPSTF) recommendations should be followed or do you believe screening should start at age 40? Why or why not?

Need 150 word response to the below discussion post

The heart is the most important muscle in your body. The heart is just like a pump that moves the blood throughout the body. This action is what keeps us alive. We are typically taught about the danger of a heart attack, and what we must change in our lives to prevent it; but just like many people, I am at a high risk for heart disease because of family history as well as because of my firefighter career, as heart disease is the number one killer of firefighters (Fire Engineering, 2012). According to the American Heart Association, “both the risk of heart disease and risk factors for heart disease are strongly linked to family history” (American Heart Association, 2016). However, even though your family history provided a picture or marker for possible issues, it is up to us to lower the risk by making changes in our lifestyles.

Heart attacks are caused by blockage that stops blood flow to the heart. A heart attack is when there is damage or death to the heart muscle tissue due to loss of blood supply and this does not necessarily result in an individual's death. A heart attack can show symptoms, such as radiating chest pain or discomfort, dizziness or nausea, sweating, anxiety, stomach pain and shortness of breath. Women have the same symptoms, but they do show some difference in that they describe the pain in their stomach and shoulder blades. In the field we treat heart attack by treating the symptoms; we use IV fluids, baby aspirin, as well as nitroglycerin.

There is another silent killer that most people do not hear much about or they think it is the same thing as a heart attack. As a medic, I deal with this life and death situation all the time, and it interesting to see how many people are not aware of the difference of a heart attack and a sudden cardiac arrest. Sudden cardiac arrest is the abrupt loss of heart function in a person who may or may not have diagnosed heart disease. This can happen at any time, its unexpected and occurs instantly, or seconds after symptoms occur. Cardiac arrest is caused when the heart’s electrical system malfunctions. This causes the heart to go into and irregular heart rhythm (ventricular fibrillation). When this happens, the hearts lower chambers suddenly start quivering and this stops the pump of blood in the heart. The only thing that can reverse cardiac arrest is early defibrillation and CPR. Most people think that a defibrillator can be used on heart attack patients, but this is not the case. The defibrillator is used to shock the heart and restore the normal heart rhythm, if the heart stops, then CPR has to be performed.

Unlike a heart attack, sudden cardiac arrest can happen to anyone, no matter how health or fit they are. According to the American Heart Association “cardiac arrest is a leading cause of death, nearly 360,000 out-of-hospital cardiac arrest occur annually in the United States” (American Heart Association, 2016).