PSYC 365: Week 7 - Chronic and Life-Threatening Illnesses

Cancer

Involves uncontrolled growth of abnormals cells, which form a tumour
1. Metastasized when abnormal cells spread from original site to others of the body
2. Leading cause of death worldwide and in Canada

Burden of Cancer

1. Diagnosis response may be denial or perception as death sentence
2. Patients have to cope with aggressive treatments and unpleasant side effects
3. Stigma (Blame the victim)
4. Economic Burden

Physical and Psychological Burden of Cancer

Physical: Fatigue, pain, side effects (both treatment and illness caused)

Psychological: Fear, depression, intrusive cognitions, coping style

Cancer & Physical Distress

1. Pain management is a major challenge. More than 90% of pain can be controlled by current treatment but tends to be underused
2. Patients' attitudes and behaviour are a major influence
-Fear drug tolerance or addiction, so hesitant to seek treatment
-Believe pain must be tolerated, so hesitant to report pain

Cancer & Psychological Distress

1. Depression and Anxiety are common
2. Negative consequences of depression include: Poorer quality of life, reduced adherence, longer hospital stays, higher mortality rates, greater reported pain

Emotion-Focused Coping

Focus on reducing the emotional impact of disease without trying to cure it

Problem-Focused Coping

Focus on addressing stressors, typically through action (adherence, increase knowledge)

Treatment of Cancer

Surgery: Remove Tumour
Radiation Therapy: Shrink tumour
Chemo: To treat metastasized cancer or prevent from spreading
Hormone Therapy: Reduce presence to tumour-stimulating hormones

Radical Cancer Surgery

1. Removal of Considerable amount of normal tissue
-Can impact appearance and autonomy (Radical breast mastectomy)

2. Side effects of chemo and radiation do harm to healthy cells
-Fatigue, nausea, vomiting, hair loss, pain, increase risk of infection that can last years
-Fatigue can be treated with physical activity (better than pharmacological options)
-Anticipatory nausea

Help-Intended Communication

1. Attempts to alleviate emotional distress
-Advantage to use pre-existing communication patterns and preferences as guide

Support Groups & Cancer

1. Provide empathy, knowledge from shared experiences
2. Survivors may report post-traumatic growth

Navigator

Helps patients find their way through complicated world of hospitals and treatment

Social Comparison

Monitoring the opinions and experiences of other to determine what is normal or abnormal and use in decision making

Psychotropic Medications w/ Cancer

Antidepressants: Possible negative or positive interactions with other cancer-related treatments

Psychotherapy: Can be used to help patient adopt a problem-focused approach to coping with cancer
-Useful for pain management
-Helpful for family caregivers who also experience emotional and physical distress

Dibates

1. Affects ~5% of Canadians
2. Treatment may include insulin injections, controlled diet, blood sugar monitoring

Type I Dibates

Little to no insulin produced; 10% of cases

Type II Diabetes

Insulin insufficiently produced or used; 90% of cases

Gestational Dibetes

Temporary Condition, affects 2-4% of pregnant women

Dibetes & Psychological Distress

1. Fear and Depression
2. Fear may relate to long-term consequences, self-testing and self-injection
3. May lead to decrease self-efficacy, affecting disease management
4. Depression 3x in Type I and 2x in Type II
5. Depression and blood sugar linked bidirectionally
-Low blood sugar worsen depression
-Depression impacts disease management

Goals of Diabetic Education Programs

1. Ensure compliance
2. Treat psychological distress

Diabetic Support

1. CBT
2. Education and Support Groups
3. Support from social network

Cardio Disease

Every 7min someone dies
1. Myocardial Infarction (HA)
2.Coronary Artery Bypass Graft (Bypass Surgery)
3. Angioplasty (Surgery to open a blocked artery)

Cardio Disease & Distress

1. Anxiety and fear of future attacks
2. Cardiac Invalidism: limited activity leading to negative life quality and sedentary lifestyle
3. Depression is common (40%)
-Increase risk for future cardiac problems and death
-Worth for women and people over 65

Coping with Cardio Disease

1.Social Network
2. Holistic Rehab Program - Peak Benefit at 9 Months
3. Psychotherapy - Cognitive reappraisal & restructuring to promote anger management
4. Sometimes antidepress

HIV & AIDS

Population with greater risks:
1. Men who have sex with men
2. People who use injection drugs
3. Receive blood and use blood products
4. Indigenous

Differences of HIV with other Illnesses

1. No cure
2. Social stigma
3. Myths of infectivity

Psychological Challenges for those with HIV

1. Personal responsibility or guilt
2. Rejection and alienation
3. Anxiety about uncertain future

Coping w/ Aids

1. Antiretrovirals and protease inhibitors (Many adverse side effects)
2. Social support often lacking due to stigma
3. Antidepress. may worsen symptoms
4. Group therapy found to be effective

Quality of Life

Impact of symptoms and treatment on physical, social, cognitive and emotional functioning
1. Treatment may alleviate symptoms but negatively impact other areas of life
2. Tradeoff between duration and quality of life may be recognized
3. Phenomenologically, according to patient own report, therefore patient must be involved in all decision-making

Death & Dying

1.Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Bereavement and Grief

1.Friend and family must cope with bereavement
2.Grief: Psychological response to bereavement

Bereaved are a High Risk Group:
1. High suicide rate
2. Higher incidence of depression and substance abuse
3. More medical problems