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PSY333H5 (42)
Lecture 8

PSY333 LECTURE 8.pdf

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Laura Simich

At any given time 58% of Canadain population has some chronic condition - 81% of senior population What is the impact of chronic disease? soicio economic status, means fhtere are fewer people in the no chronic condition, more chronic conditions and escalation of people with multiple chronic conditions females as a group have more chronic illnesses than males do. age also plays a role What is the impact of chronic disease? 1. Causes premature death - 2005: >60% of deaths globally result from chrinic disease - prevalence rates highest in developed countries 2. Economic and social burden to families, communities and society - direct (health care) + indirect (disability) cost of chronic disease - 10$ billion diabetes, 18 billion cancer, 20 billionArthritis 3. Compromise quality of life Quality of Life Historically measured only by length of life and + signs of disease - No consideration of psychological or social effects - Psychological distress often experienced by chronically ill Quality of Life: degree to which a person is able to maximize their functioning - Physical: limit activities? pain? energy? - Psychological: depression?Anxiety? -Vocational: return to work? - Social: limit interactions? Intercourse? Why do we study the quality of life (QOL) among the chronically ill? 1. Document effects of the illness - basis for interventions designed to improve QOL 2. Pinpoint particular problems patients with particular disease may expect 3.Address impact of treatments on QOL 4. QOL information can be used to compare therapies How is the self changed by the diagnosis PHYSICAL SELF body image: perception and evaluation of physical functioning people with amputations don't consider themselves "whole" anymore Poor body image --> Low self esteem, increased likelihood of depression and anxiety - influences adherence to treatement and how will patient is to adopt co-management role inTX - Can be improved through psychological and educational intervention ACHIEVING SELF Most of us gain a sense of achievement from our jobs or leisurely activities - brokered a deal today - saved a patients life - got anA on my midterm - Ran Marathon at personal best time Illness -> limits work and non-work activities -> reduced achievement - Self concept suffers SOCIAL SELF illness --> limit social interactions - hard to rebuild social relationships Family and friends = source of self- esteem - source of support -Fears about withdrawal of support aong most common worries of chronically ill PRIVATE SELF (INDEPENDENT SELF) - Illnesses create need to be dependent on others - help wiht choirs - Cant contribute to houselhold income - need more emotional support Loss of indepenece, strain of impostin on others Physical problems two types : resul of illness vs. consequence of treatment \ - disease: chest pain in heart patients, joint pain in arthritis - treatemnt: medication for hypertension--> drowsiness, weight gain impotence physical rehab: learn how to use body to its fullest Several goals: -- learn how to sense changes in the environment and in themselves to make appropriate physcial accomodations learn new physcial management skills learn how to control energy expenditure VOCATIONAL PROBLEMS - Illness may affect/ restrict work activities - paraplegic pharmacist - flight attendant with seizures Many chronically ill patients face discrimination - cancer patients are fired or laid off 5x as often as other workers - moved into less demanding positions, less likely to be promoted Financial impact - patient and family - many people do not have private insurance plans to cover mdical costs Social interaction problems - Patients don't want pity from others - Family friends and coworkers may have difficulty adjusting to the diagnosis - stereotpes about certain groups of chroncially ill patients :Aids and lung cancer see patient as having brough on the disease through their own negligence Social Interaction Problems - Intimate others of patients may be distressed worn down by dependency, pain, and disability - Feel increased burden of life responsibilities - resources stretched to the limit sexual activity decreased strain on social support Social Interaction problems Caregiver burden - typically a woman in her 60's caring for elderly spouse may be parents or disabled childs - At risk for - Distress - depression - decreased immune and endocrine function - poor quality of sleep - Increased risk of infectious disease - Strains relationship between patient and caregiver Interventions for psychological issues Pharmacological interventions - Antidepressants for treatment of depression in the chronically ill? - Individual therapy/ patient education - quite common;helps person adjust - Brief psychotherapeutic interventions - ranges from informal communication with a health care provider to brief psychotherapy - Can be used as preventative measure -explainign to the patient what the course of the illness is and what to expect Interventions for psychological issues after chronic illness Relaxation exercise - found to be useful in chemotherapy and the treatement of hypertension Social support - those who report good social relationships are more likely to adjust postively to their illness But these relationships can be threatened by the chronic illness Support Groups Provide specific information about how others have sucessfully dealt with illness-related problems provides opportunity to share fears can satisfy the need for social support that families and friends fail to provide the Healing journey in addition to medical tx patientsseek other forms of helaing Alastair Cunningham, director scientist, psychologist, professor at U ofT cancer survivor Diminish anxiety and depression Restore sense of control Relieve symptoms like fatigue, nausea, and pain The healing journey 5 levels: - focus on rlaxation, meditation, spituality - reduce stress At PMH in large group setting - Or at other sites such asWellspring - On own using workbooks and audiotapes - Privately or after forming a small group Level 1: Coping with Cancer Stress, includes stress management techniques such as deep relaxation, thought control, mental imaging, emotional expression and goal setting. Once a week for four weeks. Level 2: Skills for Healing, includes self-help methods such as meditation, consulting an inner healer, spiritual aspects of healing, journal writing and small group discussion. Once a week for eight weeks. Level 3: Steps towards Spiritual Healing, a course in understanding and diminishing the common obstacles to spiritual experience. Once a week for eight weeks. Level 4: BecomingAuthentic, ten weekly sessions designed to consolidate what has been learned in levels 1–3, and to foster the qualities we have found in people who have greatly outlived their prognoses: authenticity, autonomy and acceptance. Level 5A:“A New Earth” by EckhartTolle Level 5B: Introduction to "A Course in Miracles" !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!SPECIALTOPIC: CANCER INYOUNGADULTS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! no readings, only lecture material Young adult: 15-39 years of age IN Canada 6500YA's are diagnosed each year main cause of early death inYA women - 2/3 ofYA cancers occur in women - Breast cancer = most common - Lung cancer: F>M diagnosis and death Testicular cancer most common cancer in young men Melanaoma is the 2nd most common cancer amongYA's - Increases in incidence - thryoid cancer (M/F) - Lymphoma (F) - testicular cancer (M) Incidence decreasing amongYA's for many preventable cancers - avoid smoking, minimizing sun exposure and having regular pap tests Despite the demonstrated burden of cancer forYA's very little known about theri needs or how to treat them Canadians aged 50-79 years will represent almost 70% of all new cancer cases and 62% of cancer deaths in 2012. YA specific studies accounted for less than 0.1% of all research spending in Canada (2006) The forgotten generation What are the unique needs ofYA with cancer? top 7 needs ofYA with cancer 1. delayed diagnosis (#1) 2. disintrajectorization 3. isolation (#2) 4. fertility 5. independence 6. relationships 7. survivorship 1. Delayed diagnosis Cancer is often seen as a disease of the elderly young people don't get cancer 2. Disintrajectorization sudden change of path young adults at a stage of beginning school work relationships cancer and treatement takes you off planned paths feel that they've missed out on experiences 3. Isolation would you talk about sex with your grandmother most cancer patients are older adults - age difference = decades - support groups, chemo rooms... Only 8 support groups for young adults in the whole country 4. Fertility Cancer treatment permanently or temporarily kill fertility - Difference betwee n16 yerar old and 60 year old - Fertility options? - Do MD's discuss with patients? 5. Independence - Moving back in with your parents - reduced income - increased expenses - 6. Relationshi
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