Chapter 11: Management of Chronic illnesses
- Quality of life: For many years, quality of life was measured as the length of survival
and signs of presence of disease, with no consideration of psychological consequences of
the illness. One important aspect of quality of life is peoples perception of their own
health (self-reported assessment e.g. how you would rate your health? The most
important impetus for evaluating the quality of life is the psychological distress that
comes with a chronic illness and stress can exacerbate the symptoms, making them
- Quality of life has several components, specifically physical & social functioning,
psychological status, and disease or treatment related symptoms. In chronically ill
patients, quality of life is assessed on how much the disease and its treatment interferes
with the activities of daily life, such as sleeping, eating, going to work and engaging in
social and recreational activities. For more advanced diseases, assessments include
whether person is able to bathe, use the toilet, eat without assistance, be mobile and be
- SF-6 survey used to evaluate quality of life. Quality of life may fluctuate depending on
the characteristics of the illness, acute changes in symptoms, and age-related changes.
With some diseases (rheumatoid arthritis) quality of life declines with time.
- Why study quality of life? 1) Documentation of exactly how illness affects your
activities, provides an important basis for interventions designed to improve life. 2)
Quality of life measure can help pinpoint which problems are likely to emerge for
patients with diseases and help in anticipating the interventions that are required. 3) Can
assess the impact of treatments and unpleasant therapies and to identify some
determinants. 4) used to compare therapies. 5) can inform decision makers about care that
will maximize long term survival with highest quality of life.
- Another point to consider when examining quality of life is that people live with multiple
chronic diseases, mostly we just consider one. Those who live with multiple chronic
health conditions may require specialized treatment and management strategies.
- After diagnosis of a chronic illness, people can be in a state of crisis marked by physical,
social and psychological disequilibrium. After the crisis phase of chronic illness passes,
people begin to develop a sense of how the illness will alter their lives. At this point,
more long term difficulties that require ongoing rehabilitation may set in.
- Denial: is a defense mechanism by which people avoid the implications of an illness.
Patients may act as if illness were not severe, as if it will shortly go away or if it will have
few long term implications. Can serve as a protective function immediately after
diagnosis. Keep the patient from having to come to terms with the illness. Can mask the
fear of the illness, until the patient is better able cope. However, it may interfere with
their ability to monitor their conditions, to take the initiative in seeking treatment, or to
follow through when they must act as responsible co-managers of their illness.
- Anxiety: Many patients become overwhelmed by the potential changes in their lives, and
in some cases by the prospect of death. Anxiety is especially high when people are
waiting for results, receiving diagnoses and anticipating or experiencing adverse side
effects of treatment. Anxiety is a problem that is not only intrinsically distressing but also
it can interfere with good functioning. Anxious patient might be debilitated by emotional
distress even before therapy begins, and cope poorly with treatment such as
chemotherapy. Although anxiety directly attributable to the disease may decrease overtime, anxiety about possible complications, the diseases implications for the future, and
its impact on work and leisure time activities may increase over time.
- Depression: Depression can be a sign of physical decline, among elderly men especially.
Depression exacerbates the risk of chronic disorders such as heart disease. Complicates
treatment adherence and medical decision making. Depression is sometimes a delayed
reaction to chronic illness, takes time for patients to understand the full condition.
Depression is important not only for the distress it produces but it can also have an
impact on the symptoms being experienced and the overall prospect of recovery.
- Depression may be linked to suicide, can be long term, unlike anxiety.
- Assessing depression is problematic because many signs of depression like fatigues, not
sleeping etc may also be sign of the disease itself, hence it may go untreated. Therefore,
experts recommend routine screening for depression symptoms as they can affect brain
functioning during illness.
- Depression increases with the severity of the illness, experiences of pain and disability in
particular may lead to depression.
- How is the self changed by chronic disease? To fully understand changes in response
to chronic illness requires a consideration of the self, its sources of resilience and its
vulnerabilities. Self concept is a stable set of belief about ones qualities and attributes.
Self esteem refers to the general evaluation of the self-concept- namely whether one feels
good or bad about personal qualities and attributes.
- The Physical Self: Body image is the perception and evaluation of ones physical
functioning and appearance. Not only is the affected part evaluated negatively but the
whole body image may take a negative aura. For several reasons, body image is related to
low self-esteem and an increased likelihood of depression and anx