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PSYC 2301 (154)
Lecture 8

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PSYC 2301
Tarry Ahuja

Chronic and terminal illness Overview - What is chronic illness? - Quality of life - Evaluating quality of life - Death across our life span - Psychological issues with terminal illness What is chronic illness? - Chronic refers to the duration of the disease/illness - Has long term effects on your body - Ranges from relatively mild to severe (life threatening) - You may be born with this or develop later in life - Factors include: • Genetics-Alzheimer’s, MS • Environmental- cancer, asthma • Lifestyle- CVD, HIV, gout • Previous injury or prolonged strain- lower back pain, tinnitus Prevalence and impact (no need to memorize numbers) - 58% of the population has a chronic condition - 81% in the elderly subpopulation - 2/3 of the Canada’s health spending - Chronic conditions are more common in: • Women • Lower-income • Seniors • Certain ethnic subpopulations (aboriginal people) - More than 63% of death globally - Can impact quality of life - Staggering economic consequences: • Diabetes- 10 billion • Cancer- 18 billion • Arthritis- 20 billion • CVD/hypertension/stroke- 26 billion Quality of life - Different from “standard of living” - Impacted by severity of chronic illness (ex: cancer = in bed all day) - Influences patients interpretation of the illness - Helps determine psychological contribution: • Depression • Anxiety • Distress • Stress (contributor) - Quality of life has several components: • Physical functioning • Psychological status • Social functioning • Disease or treatment-related symptomology - QoL assessments gauge the extent to which normal life activities have been compromised Evaluating quality of life - Assessment tools can be used to determine QoL (ex: SF-36) - Population norms can be established - Allows for a comparative analysis across conditions between countries - WHO also developed an assessment tool in 1991 named WHOQOL-BREF: • Comprised of 26 items • Physical health, psychological health, social relationships, and environment Evaluating quality of life - Quality of life may fluctuate: • Characteristics of the illness  Acute phase vs. symptom-free or managed phases • Acute changes in symptoms  Progression of the illness, flare-ups • Age-related changes over time  Elderly vs. patients under 25 yrs • Culture  Impact how people experience common illness Why study quality of life? - Why study quality of life: • Documentation or history • Identify trends between illness and QoL factors • Impact of treatment on QoL • Comparative effectiveness between treatments • Inform decision and policy makers - To consider: multiple chronic condition and QoL Emotion and chronic illness - Chronic illness requires long-term dramatic change - Emotional phases of chronic illness: • Denial  Helps pt control emotional reactions  May interfere with treatment • Anxiety  Elevated self-vigilance  May interfere/hamper treatment • Depression  Potentiates chronic illness symptoms  Increases risk of suicide  Difficult to diagnose  Increases with the severity of chronic illness Chronic disease and “self” - Self-concept- stable set of beliefs about one’s qualities and attributes - Self-esteem- general evaluation of self-concept - Self concept is a composite of: • Physical self  Body image- perception of physical function/look  Poor body image linked to low self-esteem and higher rates of depression and anxiety  Disfigurement of body image • Achieving self  Job and hobbies contribute to self-esteem/concept  May be used as motivator • Social self  Social interaction helps with self-esteem  Source of information and support • Private self  Increased dependence on others  Loss of an unrealized dream Coping with chronic illness - Chronic illness can be considered a chronic stressor - Avoidant coping- may cause psychological distress - Active coping- less psychological distress, better overall outcome - Social support can provide positive reinforcement - Multiple coping strategies are most effective - Physic
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