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 would you 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 worse.
- Quality of life has several components, specifically physical functioning,
psychological status, social functioning, and disease or treatment related
symptoms. In Chrnoically ill patient, 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 wether 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
vocational, social and personal activities, as well as the general activities of
daily life, 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. (e.g. some diseases sexual functioning might be a problem,
is some depression). 3) Can assess the impact of treatments on quality of life,
the impact of unpleasant therapies and to identify some determinants of
poor adherence to those therapies. 4) Quality of life info can be used to
compare therapies. 5) Quality of life info can inform decisions 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.
- Chronic disease may need the patient to make permanent changes in their
physical, social and vocational activities. 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 full range of problems that come with the illness as the
patient is not ready to do so. Can mask the fear of the illness, until the patient
is more accustomed to the diagnosis and better able to sort the restrictions
that the illness will pose. 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
- Anxiety: Many patients become overwhelmed by the potential changes in
their lives, and in some cases by the prospect of death. Eevry twinge of chest
pain may raise concern of another heart attack for the patient recovering
from MI. Anxiety is especially high when people are waiting for results,
receiving diagnoses and anticipating or experiencing adverse side effects of
treatment. Anxeity 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 a chemotherapy. Although anxiety directly
attributable to the disease may decrease over time, 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 impending physical decline, among
eldery men especially. Depression exacerbates the risk and course of several
chronic disorders such as heart disease. Complicates treatment adherence
and medical decision making, Depression is sometimes a delayed reaction to
chronic illness because it often takes time for patients to understand the full
complications of their condtion. Once the acute phase of illness has ended,
the full implications of the condition may begin to set in.
- 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 rehabilitation or recover. Dperession may be linked to suicide. Unlike
anxiety, which ebbs and flows during the course of an illness depression can
be long term.
- 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? T fully understand changes in
response to chronic illness requies a consideration of the self, its sources of
resilience and its vulnerabilities. Self concept is a stable set of belieft about
ones qualities and attributes. Self esteem refes t the general evaluation of the
of the self-concept- namely wether one feels good or bad about personal
qualities and attributes.
- The Phsycial 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 anxiety. Second, body image may influence how adherent a
person is to the course of treatment and how willing they are to adopt a
management course. Finally, body image can be improved by psychological
and educational interventions. Two expectations are when patients with
facial disfigurement or extensive burns. Patients who facial appearances
have been disfigured or scarred may never accept heir alter appearances.
Because the face is often associated with personality, and when the face is
deformed both patients and the people reacting to the