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Chapter 11

PSYC 328 Chapter Notes - Chapter 11: Chronic Obstructive Pulmonary Disease, Terminal Illness, Medically Unexplained Physical Symptoms

Course Code
PSYC 328
Barbel Knauper

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Chapter 11 Management of Chronic and Terminal Illness
LO1 What is Quality of Life?
Before, standard of life measured solely in terms of length of survival and signs of presence of disease,
o No consideration of the psychosocial consequences of illness and treatments
o But medical measures are only weakly related to patients’ or relatives’ assessments of quality of
People’s perceptions of their own health
o Important aspect of assessment of quality of life
o Self-reports of health status predict morbidity and mortality beyond medical and psychological
Psychological distress patients with a chronic illness often experience
o More likely to suffer from depression, anxiety, and distress
o Depression, psychological distress, and neuroticism increased risks for mortality
o Stress exacerbates the symptoms
Quality of life: physical functioning, psychological status, social functioning, and disease- or
treatment-related symptomatology
o People with chronic illnesses: emphasis on how much the disease and its treatment interferes
with the activities of daily living (e.g. sleeping, eating, going to work, and engaging in
recreational and social activities)
o Patients with more advanced diseases: focus on the functional aspects of daily living (e.g.
ability to bathe, dress, use the toilet, be mobile, be continent, and eat without assistance)
Extent to which a patient’s normal life activities have been compromised by disease and
One way of understanding how chronic illness may impact quality of life: how the quality of life of
people living with a chronic disease or condition compares to that of the general population.
o Establish population norms for a country
o Comparison standard for
Evaluating individual or group quality of life scores within the population
Evaluating Quality of Life
o A broad array of measures now available for adults and children
o Generic measures + chronic diseases + disease-specific measures
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o Characteristics of the illness, acute changes in symptoms, and age-related changes in health
over time
Certain illnesses (e.g. sclerosis and rheumatoid arthritis) are progressive rapid decline
of quality of life over a short period of time
o Developmental changes
o Quality of life remained relatively stable overall
o For certain groups quality of life improved while for others it deteriorated
o Under 35: significant improvements in mental health scores
o Over 65/chronic illness/psychiatric condition/both: declined
o Culture
o E.g. irritable bowel syndrome in Greece and Sweden
Women from Greece scored much lower on both general health-related quality of
life and mental health than women from Sweden
Why Study Quality of Life?
o Reasons to study quality of life among those with chronic illnesses
Important basis for interventions designed to improve quality of life
Assess the impact of treatments on quality of life
Compare therapies
Inform decision makers about care that will maximize long-term survival with the
highest quality of life possible.
o Presence of multiple chronic physical or mental health conditions
o Useful in pinpointing some of the areas that require particular attention and interventions
following the diagnosis of a chronic disease
LO2 What are the Different Responses to Chronic Illness?
Chronic diseases require patients to make intermittent or permanent changes in physical, vocational,
and social activities
People with chronic illnesses must integrate the patient role into their lives psychologically
Immediately after diagnosis, patients can be in a state of crisis marked by physical, social, and
psychological disequilibrium
o Regular coping techniques don’t work
o Results
Exaggeration of symptoms and their meaning
Indiscriminate efforts to cope
Worsening health
Anxiety, fear, and depression may temporarily take over
o BUT chronic illness signals a time of personal growth, and positive reappraisal of their lives
can heighten their sense of meaning and control.
o Denial: defence mechanism by which people avoid the implications of an illness.
Common reaction to chronic illness
Act as if the illness were not severe, will shortly go away, or will have few long-term
o Can be a protective function immediately after the diagnosis of illness
Keep the patient from having to come to terms with the full range of problems posed by
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the illness at a time
Can mask the fear associated with a chronic disease until the patient is more accustomed
to the diagnosis and better able to realistically sort out the restrictions that it will pose
o Can have adverse effects during the rehabilitative phase
Interferes with the ability to take in necessary information that will be part of the
patient’s treatment or self- management program
o In general:
May be useful in helping patients control their emotional reactions to illness
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
o More common in people with stroke, heart disease, and cancer
o Many cancer patients are constantly vigilant to changes in their physical condition, and
each minor ache or pain may prompt fear of a possible recurrence
o Anxiety is a problem
Intrinsically distressing
Interfere with good functioning
o Debilitated by emotional distress even before therapy begins
Anxious diabetic patients report poor glucose control + increased symptoms
Increase the risk of subsequent heart attacks
Increase the frequency of attacks of Raynaud’s disease
Hyper-reactivity in the gut for patients suffering from irritable bowel syndrome
Prevalent among people with
Especially prevalent among people with asthma and pulmonary disorders
o Compromises quality of life
o Symptoms of anxiety can also be mistaken for symptoms of the underlying disease
interfere with assessments of severity of the disease and its treatment
o Depression: common and often debilitating reaction to chronic illness.
Incidence of depression was highest among Canadians who had at least one chronic
May occur later in the adjustment process than does denial or severe anxiety
Can also occur intermittently
Common among stroke patients, cancer patients, and heart disease patients, as well as
for those suffering from many other chronic
For other conditions such as multiple sclerosis (MS) can have an unpredictable and
progressive course, depression is especially common
More likely among those with certain chronic health conditions
Chronic fatigue syndrome
Lower for those with diabetes, heart disease, hypertension, and thyroid disease
Its medical significance is increasingly being recognized.
Can be a sign of impending physical decline, especially among elderly men
Exacerbates the risk and course of several chronic disorders (coronary heart disease).
Complicates treatment adherence and medical decision making
Interferes with patients adopting a co-managerial role
Enhanced risk of mortality from a broad array of chronic
Depression is sometimes a delayed reaction to chronic illness often takes time for
patients to understand the full implications of their condition
Once the acute phase of chronic illness has ended, the full implications of the
disorder may begin to sink in.
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