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Chapter 11

Chapter 11.docx

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York University
PSYC 3170
Gerry Goldberg

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 continent. - 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 illness. - 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
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