Clinical HP. Preoperative psych screening

Clinical HP

Application of psychology to the prevention and treatment of non-mental illnesses

Public HP

Application of psychology to the development of public health: psychosocial epidemiology

Models in health promotion

• Explaining individual behavior

• Interpersonal behavior

• Process of behavior change

• Models of community action and organisational change

• Broader ecological models

Prevention science

Focuses on preventing dysfunction and disease by eliminating or reducing underlying causes

Implementation science

Focuses on development of effective prevention programs to build an implementation plan

Community HP

Studies relationships between individual communities and society to understand and improve QoL, community and social change through community empowerment and action

Occupational HP

Application of HP in a workplace context with the aim of designing, creating, maintaining healthy work environment

Presurgical psychological screening

Involves a referral to a HP for further evaluation involving a semistructured IW, psychometrics, review of the course of the patient’s medical conditions with the aims of determining a patient’s outcome prognosis and developing a customised treatment plan

The Risk Identification and Mitigation Model

1. Objective risk factor identification

2. Risk factor validation

3. Risk factor mitigation

4. Data integration

5. Treatment recommendation

Risk factor validation

• expectations, motivations, nerdiness for surgery, adherence, duration of symptoms

• Demoralisation, distress, desperation

• Under- and over reporting

• Financial burden

• History of legal difficulties

• Support systems

• Appropriate medication use, adherence to treatment

Risk factor mitigation

• Realistic/positive outcome expectations

• Patient investment and activation in treatment process

• Resilience and self-efficacy

Important psychosocial factors

• Emotional (anxiety, depression, presurgical emotional distress)

• Interpersonal (patient’s support systems)

• Coping (dominant coping strategies)

• Patient’s history

• Compliance/adherence

• Body image

• Pain perception and somatic sensitivity

• Knowledge and expectations

• Financial incentives

Key components of the transplant psychosocial assessment

• Psychiatric (psychiatric symptoms, coping & adjustment, substance abuse, mental status)

• Social (health literacy, collaboration with medical team, social support, housing & finances)

• Functional (adherence, values & beliefs, motivation for transplant, QoL)

Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) subscales

A. Patient’s readiness level and illness management

B. Social support system level of readiness

C. Psychological stability and psychopathology

D. Lifestyle and effect of substance use

Surgical stress importance components

• Psychological stress response

• Clinical effects

• Health psychology perspective

Surgical stress importance: Psychological stress response

• Activation of the HPA axis and SNS

• Stress hormones are released

• Increased energy demand, insulin resistance, decreased immune response

Surgical stress importance: Clinical effects

• Increased susceptibility to infections

• Slower wound healing

• More frequent postoperative complications

Surgical stress importance: HP perspective

• Psychological distress intensifies psychological stress response

• Relaxation and coping strategies can reduce it

• Psychologists play a key role here

Prehabilitation’s goal

To optimise the patient’s physical and psychological outcomes → better postoperative outcomes

Prehabilitation components

• Physical training (endurance and muscle strength)

• Nutritional intervention (protein and vitamins)

• Psychological support → stress management

• Lifestyle changes (smoking cessation, alcohol consumption reduction)

Second Victim Syndrome (SVS)

Defined as the health care professionals who are involved in an unexpected adverse event, medical error, or patient harm and are traumatised by the event, manifesting

• Psychological (shame, guilt, anxiety, grief, depression)

• Cognitive (compassion dissatisfaction, burnout, secondary traumatic stress)

• Physical reactions That have a personal negative impact

Types of medical teams in which CHPs work

• Coordinated: independently identify care plans & deliver services with important info relayed between providers and patients by a case manager (depression)

• Multidisciplinary: have a shared care plan, which is created by a team leader based on recommendations from team members (cancer)

• Interdisciplinary: consistently meet to create shared care plans, discuss patient progress, collaboratively solve emerging challenges