chapter 7 - chronic & life-threatening illnesses

chronic condition

condition that does not go away or get better

- CONSTANT symptoms > discouragement & fear

- LESSENED symptoms > hope

- ERRATIC symptoms > anger & frustration

- PROGRESSIVE symptoms > overwhelming exhaustion

acute illness

illness w/ a defined beginning and end

cancer

uncontrolled growth of abnormal cells which form a tumour

- metastasized when abnormal cells spread to other parts of body

- leading cause of death worldwide and in Canada

- most common = breast, prostate, lung, and colorectal

illness burden of cancer

- some view diagnosis as death sentence or respond w/ denial

- must cope w/ aggressive treatments, possible death, and stigmatization (e.g., victim blaming)

- economic (out-of-pocket) costs

- physical or psychological

physical (burdens of cancer)

two types: illness-caused or treatment-caused

- fatigue, pain, side effects

why is pain management a major challenge?

- issues related to healthcare system, healthcare practitioners, and patients/their families

- forgetfulness

- fear of drug tolerance or addiction

- belief that pain should be tolerated

- concerns abt side effects

psychological (burdens of cancer)

most common are depression and anxiety

- depression is prevalent at initial diagnosis, if cancer has metastasized, and when in poor physical condition

- anxiety of relapse, side effects, and changes to self-image

- linked to intrusive cognitions

- response influenced by coping style

intrusive cognitions

unwanted thoughts related to one's ideas about cancer and death

negative consequences of depression

poorer quality of life, reduced adherence, longer hospital stays, higher mortality rates, greater reported pain

emotion-focused coping

focusing on ways to reduce emotional impact of a disease w/o trying to cure it

- avoidant-oriented

problem-focused coping

actively addressing stressors associated w/ a disease, such as cancer and treatment

- approach-oriented

emotional-approach coping

facing emotional responses to a disease and dealing effectively w/ those responses

treatment of cancer

involves one or a combination of...

- surgery: tumour removal

- radiation therapy: shrink tumour

- chemotherapy: treat metastasized cancer/prevent spread

- hormone therapy: reduce presence of tumour-stimulating hormones

radical surgery

requires removal of considerable amount of tissue

- can impact appearance + autonomy

side effects of chemotherapy and radiation therapy

harms healthy cells - causing fatigue, nausea, vomiting, hair loss, pain, increased risk of infection

- anticipatory nausea

coping with cancer

perceptions/beliefs abt availability of support are as important as actual support

- family-oriented care

- help-intended communication

- support groups

- navigator

- social comparison

help-intended communication (helping ppl cope - cancer)

attempts to alleviate emotional distress

- advantage of using pre-existing communication patterns and preferences as a guide

support groups (helping ppl cope - cancer)

members can provide empathy through shared experiences

- better for 'monitors'

- some report post-traumatic growth

post-traumatic growth

positive outcome resulting from an experience w/ a life-threatening illness, attributed to benefit-finding

navigator (helping ppl cope - cancer)

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

social comparison (helping ppl cope - cancer)

monitoring the opinions and experiences of others to determine what is normal/abnormal and + use of this info to help w/ decision-making

- upward (those better off) vs downward (those worse off) comparisons

antidepressants (coping w/ cancer - treatments)

possible negative or positive reactions w/ other cancer-related treatments

psychotherapy (coping w/ cancer - treatments)

can be used to help one adopt a problem-focused approach

- useful for pain management

- helpful for family caregivers who also experience distress

diabetes

pancreas produces too little insulin; affecting ~5% Canadians

- type 1 (insulin-dependent)

- type 2 (non-insulin-dependent)

- gestational diabetes

type 1 (insulin-dependent) diabetes

one produces very little to no insulin, thus required to take insulin on a daily basis via self-administered injection (~10% cases)

- must monitor blood sugar levels + control diet

type 2 (non-insulin-dependent) diabetes

one does not produce enough insulin or is not able to use insulin effectively (~90% cases)

gestational diabetes

temporary condition affecting 2-4% of pregnant women

fear (diabetes & psychological distress)

- possible long-term consequences, self-testing, self-injection, hypoglycemia

- may lead to decreased self-efficacy, affecting disease management

depression (diabetes & psychological distress)

- 3x more common in type 1 and 2x in type 2

- cause difficulty in communicating emotions and accepting help

- bidirectional link between depression and blood sugar

coping with diabetes

interrelated goals of education programs: ensure compliance + treat psychological distress

- includes CBT, education/support groups, and support from social network

diseases of the cardiovascular system

focuses on three main types:

- myocardial infarction

- coronary artery bypass graft

- angioplasty

in canada, smo dies from stroke/heart disease every 7 secs

myocardial infraction (MI) - diseases of the cardiovascular system

heart attack caused by lack of blood flow to heart

coronary artery bypass graft (CABG) - diseases of the cardiovascular system

bypass surgery; procedure in which healthy arteries from other parts of the body are grafted into the coronary artery system to bypass blocked arteries

angioplasty - diseases of the cardiovascular system

procedure in which a bubble-like device is inserted into the artery at the point of blockage

cardiovascular system and psychological distress

- anxiety and fear of future MIs leads to cardiac invalidism

- depression (~40%) increases risk for future cardiac problems + death - worse for women + ppl over 65

cardiac invalidism

anxiety causes patients to limit their activity levels far more than required

- negatively impacts quality of life + leads to sedentary lifestyle

coping with diseases of the cardiovascular system

- holistic rehab programs

- psychotherapy (cognitive reappraisal/restructuring promotes anger management)

- pharmacological therapy

- social support

human immunodeficiency virus (HIV)

virus that gradually breaks down body's immune system, making it susceptible to a host of other infections + eventually resulting in AIDS

- long delay between initial infection and serious symptoms

- transmitted through exchange of bodily fluids

populations at a greater risk for HIV

- men having sex w/ men

- sharing needles for drug injection

- receiving blood

- Indigenous ppl

acquired immune deficiency syndrome (AIDS)

disease caused by HIV

HIV / AIDS and psychological distress

important differences from other illnesses (no cure, social stigma, myths)

- personal responsibility/guilt, rejection by others, and anxiety abt future negatively impact self-esteem + quality of life

coping with HIV / AIDS

unique challenges...

- lack social support due to stigma/alienation

- antidepressants may worsen symptoms

some medications prolong life...

- antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), and protease inhibitors

quality of life

extent to which symptoms + treatment affect one's physical, social, cognitive, and emotional functioning

- treatments that alleviate medical symptoms may negatively impact other areas of life

- trade-off between duration + quality of life

- subjective phenomenality requires patient to be involved in decision-making

trade-off between duration and quality of life

efficacy of treatment often defined by extent to which it prolongs one's life

(e.g., throat surgery: 5 yrs with artificial voice + pain OR 1 yr with real voice + no pain)

quality of life as a subjective phenomenon

must be measured according to one's own report

- the more important a function, the more one is likely to give up duration of life

- multidimensional vs global measures

death and dying reactions (identified by Kübler-Ross)

- denial

- anger

- bargaining

- depression

- acceptance

denial (reactions identified by Kübler-Ross)

refusal to acknowledge that distressing events exist or that negative emotions are being felt

anger (reactions identified by Kübler-Ross)

feelings of unfairness that may be directed at various targets

bargaining (reactions identified by Kübler-Ross)

trying to buy more time

depression (reactions identified by Kübler-Ross)

feelings of hopelessness and helplessness

acceptance (reactions identified by Kübler-Ross)

being at peace w/ one's situation

bereavement

high-risk population; emotions attendant upon loss of a loved one

- may attend grief therapy + have death doulas

grief

psychological response to bereavement

grief therapy - six R's of mourning

1. recognize the loss

2. react to separation

3. recollect and;

4. re-experience the relationship w/ deceased

5. relinquish old attachments

6. readjust to new world w/o deceased in it