Health Psychology Rutgers New Material Final Exam

What are Szasz and Hollender's (1956) 3 models of physician-patient interaction?

Activity-passivity: physician in control, patient passive

i. Many problems are caused by too much physician dominance

b. Guidance-cooperation - patient has voice, physician makes decisions

i. This is the dominant interaction now

c. Mutual participation - equal partnership in making decisions

i. Most dignity/respect towards patient, which they appreciate

ii. Best in many situations, assuming

the patient is a sound-minded adult

How important is patient history (what the patient says) in making a diagnosis?

a. 56-85% of diagnoses can be made on the basis of what the patient says

i. aka, Very important that physicians hear what patients are saying

How frequent are physician interruptions in a medical visit?

Beckman and Frankel (1984) analyzed visits with patients and coded them for

how long patients could speak before being interrupted

Results:

i. Only 23% of patients completed their opening statements before physician

interruption

ii. After being interrupted, most

patients never finished their statements

iii. The average time before

interruption was only 18 seconds

1. In 2003 Simon found it was 23 seconds

What were the results of Levinson et al.'s (1997) study of physicians' communication

style and malpractice lawsuits?

Never-sued physicians:

i. Had longer visits (on average, 3 minutes per visit)

ii. Laughed more and used more

humor

iii. Were more likely to orient the

patient to what to expect

iv. Used more partnership-style

exchanges

What is Medspeak?

Specialized or technical language that patients may not understand

How well do average patients understand the terms frequently used by physicians?

a. Samora (1961) showed a list of common medical terms that physicians wouldn't

hesitate to use with patients. None were correctly identified by every patient and

no patient was able to accurately identify every term

b. 78% of people discharged from ER did not understand discharge instructions, and half of them didn't know that they didn't understand (Health & Hospitals Network, 2008)

Possible alternate reasons besides medical miscommunication:

i. 40% of the time they just forgot

ii. May be harder to process

information in stressful situations

What did Fried et al. (2003) find with regard to patients' recall of a discussion of a poor

health diagnosis with their physician?

Physicians all said they told patients that their condition was terminal, but 46% of

patients didn't know their condition was terminal

i. The physician did tell them, but they forgot and did not process the

information so as not having to face it

What were the results of the study reported by Talbot (2000) on the warm/empathic vs.

cold/brusque anesthesiologist?

When patients were treated by the warm condition of the physician before the

procedure, they asked for 50% less pain medication and recovered in the hospital

for 2.6 fewer days than those exposed to the aloof condition

What was found in Roter et al.'s (1998) and Haskard et al.'s (2008) studies on

communication training for physicians?

It can be taught. Physician communication skills were much better, clearer,

provided more information and showed more empathy without spending more

time with patients. Patient satisfaction was higher post-training

What is iatrogenic illness? How common is it? What are its possible causes?

a. Health problems that are caused by medical intervention

b. 4.5% of US hospital patients acquire an infection in the hospital

i. 9-37% in the ICUs of developed countries, and worse in developing

countries

c. Reasons:

i. There's a history of silence and blame in the case of mistakes out of

concern for personal consequences

1. Make it not about blame, but preventing it in the future

ii. Prevention and handling of

mistakes not taught in med school

1. A lot of medical personnel don't know what to do in the case of

error

iii. Nurses don't challenge doctors

because they perceive themselves as lower on the hierarchy

What are nosocomial infections?

Health-care related acquired infections

What did Albert and Condie (1981) and Erasmus et al. (2010) find regarding the

frequency of hand-washing among hospital personnel?

Albert and Condie (1981) covertly observed hand washing among hospital staff

for 2 months and found an average hand washing compliance of 40%

i. Physicians tended to be the worst offenders for this

b. Erasmus reviewed studies of hand-washing and still found 40% overall

compliance

i. The range was 4% up to 100% - some hospitals are excellent about it

1. When doing clearly dirty tasks, they're more likely to wash hands

2. More likely to sanitize when an alcohol-based rub was introduced

a. Easier, but not as good at removing germs

3. More likely to sanitize when the sink or rub were easily accessible

How did White (2012) and Grant and Hofmann (2011) improve hand hygiene

compliance?

White showed a 10-minute online training module on improving hand hygiene

and had visible reminders on patient doors. They did the post-test after 11 months

i. At the pre-test, the compliance rate was 68% among physicians and 11

months later the post-test had 95% compliance

b. Grant and Hofmann (2011) did an intervention to improve hand hygiene

compliance in hospitals, using messages of personal consequences or patient

consequences (or control)

i. For the physicians, patient consequence messages were more effective in boosting hand hygiene compliance

Why is pain considered to be a subjective experience?

Given the same amount of painful stimulus, the range of how much pain people

can tolerate is 8-fold

What is the difference between acute and chronic pain?

a. Acute pain: intense but time-limited

b. Chronic pain: lasts longer than 3 months

i. Can be intermittent or constant, mild or severe

ii. Can lead to heightened incidence

of depression and hopelessness

1. People may not know what causes their pain and be disbelieved

a. Leads to interpersonal difficulties and decreased self-

esteem

What is the difference between pain threshold and pain tolerance?

Pain threshold: point at which a person first perceives a stimulus as painful

i. Physiological(body) variable

ii. Can be measured with blood

pressure cuffs

b. Pain tolerance: point at which a person is not willing to accept stimulation of a

higher magnitude

i. Psychological variable

17. What is the gate control theory of pain (Melzack & Wall, 1982)?

How can pain

messages be blocked?

What is counterirritation?

a. Pain message to brain is modulated by a neural "gating" mechanism in spinal cord

i. Determines how much information is transmitted from spinal cord to brain

ii. Can be opened (pain goes through to the brain) or closed (doesn't go through) by brain or competing sensations

1. Signals from the brain / psychological states

a. Anxiety, stress and depression open the gate

b. Relaxation and distraction close the gate

2. Counterirritation - competing sensation

a. Some signals are blocked before reaching brain

b. When hitting your elbow, you rub it not to heal the elbow, but because the sensation of the rubbing can compete with the pain sensation!

What were the results of Yoshino et al.'s (2010) study on emotion and pain?

In an fMRI study, Yoshino (2010) induced pain with electrical shocks and

induced mood with pictures of (happy, sad, or neutral) faces & measured subjective pain rating and activity in brain regions associated with pain

i. Being shown sad pictures was associated with more processing of pain

while happiness was associated with less processing of pain

ii. Subjects in the happy condition

reported less subjective pain

1. Mood represents subjective and objective feelings of pain

What were the differences between Beecher's observations of soldiers and civilians with

similar injuries?

a. Only ½ soldiers reported medium to significant pain while ¾ of civilians did, and soldiers asked for significantly less medication

b. Interpreted it as a difference of context and the meaning of pain

i. Social comparison - other soldiers got way more injured than I did, so I'm

relatively lucky

ii. The meaning of getting injured is

much more severe for a soldier, they have to leave

What did Ulrich (1984) find in his study of patients recovering from gallbladder surgery

with different views from their window?

a. Those who had a view of plants had a shorter postoperative hospital stay (7.96 v

8.70 days) and took significantly less pain medication

b. Patients with a view of the brick wall were more anxious and upset

c. Environment determines our pain experience

What were the results of Beauchemin and Hays's (1998) study on heart attack patients in

sunlit vs. dark rooms?

a. Females in a sunny room stayed 2.3 days as opposed to 3.3 days in a dark room

b. For those who had a sunny room, 7.2% of patients died, while 11.5% of patients

in a dark, sunless room died

i. Sunlight minimized depression and the chances that a heart attack would

kill them!

What are the cognitive outcomes of pain? What were the results of Lorenz and Bromm's

(1997) study?

a. Pain interferes with our ability to use our cognitive resources

i. It's harder to pay attention and concentrate while in pain

b. Lorenz & Bromm (1997) experimentally induced pain and found that their subjects'

memory abilities suffered --> We're not at our cognitive best while in pain

i. Therefore, we can use cognitive impairment as a way of measuring pain

more objectively

Why do patients often take less than the effective dose of pain medication?

a.Physicians' reluctance to prescribe

i. Pain management is not covered extensively in training

ii. Pain not viewed as serious

problem, secondary after the need for survival

iii. Fear of dependence and addiction

1. You don't want to be a physician that prescribes medication that

gets their patients addicted

b. Patients' reluctance to use medication

i. Belief that they should bear pain

1. Some wait it out to see if it gets worse, but many medications work

at their best when they're taken early before the pain gets too bad

ii. May decide the pain medication

isn't worth the side effects

iii. Expensive

iv. Don't want to swallow pills or get

injection

What were the results of Master et al.'s (2009) study of pain and social support?

a. The pain rating was lowest when holding partner's hand, more when holding an

object, and even more when holding a stranger's hand

b. Even if someone isn't actively providing social support, just thinking about them

and activating the idea of support can reduce pain ratings

What were the results of Bandura's (1987) study of pain control? What was the

mechanism identified?

Cognitive coping increases pain tolerance due to an increased production in

endorphins

What is the placebo effect?

Any therapy that is without specific activity for the condition being treated

What are placebo control and zero control groups?

Placebo groups---> groups that are told they are receiving the drug when they are not(or dont know whether or not they're receiving the drug)

Zero control groups--> groups not taking any drug placebo or otherwise

What types of placebos tend to be more effective than others?

Some types of placebo are more effective than others - the more it resembles an

official therapy, the more effective it works as a placebo

i. Injections are better than Pills

ii. Capsules are better than tablets

iii. Brand names are better than generic names

iv. Hospital setting/medical uniform>

home setting/street clothes

v. Enthusiastic medical personnel >

unenthusiastic

What were the results of Graceley et al.'s (1985) study of physicians' expectations?

Significant difference in pain in placebo group based on physician's expectations

i. Everyone got placebo injections, but those in the group whose physicians

were told they may be helping had significantly less pain

What are the theories of how placebos work (e.g., nature taking its course)?

Nature taking its course

Process of treatment

Classical conditioning

Change in patient's behavior

Physiological changes

Placebo Theory: Nature taking its course(doesnt seem to be good explanation)

Nature taking it's course could make sense because when we have a medical condition, we eventually regress to the mean of the medical condition(less pain, consistency)

1. Basically, nature taking its course would be that the placebo didn't do anything, you'd get better anyway and

attribute that to the placebo

ii. However, we can see that in cases where there's - no treatment vs. placebo -

placebo more effective, so its gotta be something else

Placebo Theory: Process of treatment

i. People might improve when they get medical care due to how the provider

treats them socially/emotionally

ii. The fact that someone paying

attention to and caring for you could be causing a placebo effect

1. People get the same care when taking a placebo vs. real treatment

Placebo theory: Classical conditioning

i. Paired association between treatment setting and outcome in the past

ii. We ARE conditioned to have a

physiological response to this treatment/setting

1. If you take Advil for headaches, then your body could be

conditioned to respond even to an Advil placebo

Placebo theory: Change in patient's behavior (Doesn't seem to be a good explanation)

i. Due to expectations of feeling better, patient may change behavior, and

the behavior changes cause improvement

Placebo theory: Physiological changes

i. When people take placebos, they have an increase in endorphins and

decreased activity in pain regions of the brain

What is the evidence for the 'Physiological Changes' theory of how placebos work?

a. Hashish et al. (1988) - Those with the actual ultrasound wand therapy for their

wisdom tooth extraction and both placebos had significantly less swelling

b. Wager et al. (2004) - He gave everyone a painful shock on the wrist and using fMRI saw that when they were told the wrist cream reduced pain, their brains

were less active in processing pain

c. Bandura et al. (1987) - In the cold pressor test from before, taking a placebo

showed an increase in endorphins

d. Moseley et al. (2002) - Results showed no significant difference in pain at any

time between those who got an actual surgery for their knee osteoarthritis and

those who got a placebo surgery

This next section is on Serious and Disabling Chronic Illness

Sure.

What is known about depression, anxiety, and blame following a diagnosis of chronic

disease? What aspects of having cancer did Dunkel-Shetter et al. (1992) find were the

most stressful for patients?

a. Depression

i. Increases shortly after diagnosis, then tends to revert to baseline

ii. Facing death, loss of control,

change in lifestyle, dependency, strained relationships and lack of

autonomy over treatment may attribute to it

1. Also negatively affects adherence and can exacerbate the disease

b. Anxiety

i. Attributed to fear, uncertainty, waiting for results

1. Anxiety decreases as they're given more control

ii. Many people diagnosed with

cancer also qualify for having acute stress disorder or PTSD

iii. Can interfere with the course of the

disease, coping, and adherence

c. Self-blame

i. People often blame themselves, even when there's no clear behavioral link

1. Causes guilt

d. Fear and uncertainty about the future

How does the just-world hypothesis explain why people may blame others with serious

illness?

If I can blame him for bringing it upon himself, that makes me feel protected from that disease.

What are potential positive outcomes of chronic illness?

a. Closeness with family and friends

b. Greater appreciation of life

c. Feeling stronger, wiser

d. Health-promoting behaviors

e. All walks of Klal Yisroel come together to daven at the Kotel

What did Cordova et al. (2001) find in their comparison of women with breast cancer and

healthy controls?

No difference in depression levels

Is providing information helpful to patients with serious illness? What were the results of

Helgeson's (2001) study in which women with breast cancer were assigned to

educational or peer support interventions?

a. Yes, it is helpful to provide information to patients with serious illness.

b. Across all time points, the education-only group did the best regarding vitality,

social functioning, psychological functioning, and pain.

What were the results of Feros's (2013) study on acceptance and commitment therapy?

Those who received an acceptance and commitment therapy intervention had

lower levels of distress and negative mood, and higher quality of life.

What did Antoni (2001) and Fawzy (1990) find regarding interventions with seriously ill

individuals?

a. Antoni (2001) gave women with breast cancer a cognitive behavioral stress

management intervention and they had a significant reduction in depression

i. In terms of finding benefits of having breast cancer, participants found

benefits from the intervention only if they had low optimism previously

b. Fawzy (1990) took patients with malignant melanoma in a multifaceted structured

psychiatric group intervention

i. Across the next 5-6 years, those who had the intervention had a

(marginally) significantly lower rate of recurrence of the cancer and were

significantly more likely to survive across the next 5-6 years

ii. These interventions benefit

physical outcomes as well

What is hospice care? What are the various aspects of hospice care? What are the

outcomes of hospice care (i.e., Greer & Mor, 1986)?

a. Care for terminally ill patients

b. Focus on psychosocial issues and relief of pain

c. Acceptance of death

d. Emphasizes quality, not length of life

e. Bereavement care for family

f. Respite care provides a break for family members who are taking care of the

patient

g. Focus on the person

i. Low tech, high touch

h. Family interaction encouraged

i. Palliative care focuses solely on treating pain

j. Interactive team

i. Social workers

ii. Pharmacists

iii. Clergy

iv. Psychologists

k. Greer and Mor (1986) evaluated dying patients in hospice/hospital care and found

that those in hospice had better pain control, higher quality of life, were more

likely to die at home, had fewer radical interventions, and lived just as long

What were the results of Temel et al.'s (2010) study of cancer patients and palliative

care?

Those with palliative care had significantly higher quality of life, had significantly

less depression and better mood, and lived significantly longer