illness and disability - week 3 and week 4 part 1

Factors connected to women’s satisfaction with their hospital experiences:

* Respect through communication.
* Maintenance of dignity.
*  Day-to-day control.

Loss of Control total institution

* A new patient entering a hospital finds it to be what Goffman  called a “total institution”:


1.  Takes control of virtually every aspect of life: 
2.  Eat and sleep at specified times. 
3.  Receive visitors only at specified hours. 
4.  Conform to hospital procedures. 
5. Make the body available for examination when requested.

Activist vs delegator

1. “Activist”: wants total control 
2.  “Delegator”: wants to relinquish control 

Psychological Reactance Theory (PRT) :

* When an external stimulus (e.g., a persuasive message) is perceived to threaten, hinder, or eliminate an individuals’ freedom to choose, psychological reactance occurs.
* Magnitude of reactance aroused is positively correlated with the importance of the threatened freedom 
* Highly reactant individuals are characterized by 


1. a resistance to rules and regulations
2.  high desire for autonomy
3. high defensiveness
4. low concern for social norms

Learned Helplessness : 

* A result of constant frustration. 
* Learning to do nothing when put into stressful situations in which one has no control.
* Generalizes to other situations: 


1. failure to make adaptive responses when put into similar situations where control can be gained. 

*  In hospital settings: 


1.  Empowering care: fosters independence; learned mastery. 
2.  Disempowering care: fosters dependence; learned helplessness. 

*  Patients with learned helplessness are at risk for norepinephrine depletion, depression, general erosion of health, and possibility of sudden death. 
*  Patients who respond with reactance are likely to experience anger, heightened secretion of stress hormones, and possible aggravation of cardiovascular problems.

Monitors vs Blunters

* Monitors”: welcome information and seek it out; show great stress when given too little info. 
* “Blunters”: avoid information; show great stress when given too much info

“Uniformity Myth”: 

* belief by some practitioners that all patients cope better with info and should therefore get the same info in preparation for a hospital stay.
*  On the other hand: 


1. All patients, regardless of coping style, seem to benefit from relaxation training prior to surgery. 
2.  Monitors benefit from the relaxation since they are generally more anxious.
3. Blunters benefit from the distraction it provides.

*  How to give more control to patients? 


1. Try to match the amount of information with coping style. 

* Give patients choice to reduce behavioral, physiological and subjective signs of distress.

Mammography 

* Moderately invasive, both physically and psychologically. 
* False-positive results: results that indicate abnormality when none actually exists.


1.  Rate of false-positives for mammograms is considered to be quite high (e.g., between 1% and 14%). 
2. Can put women through unnecessary anxiety. 

* Women who experience false- positives developed a greater sense of risk for breast cancer, and lost confidence in their ability to do breast self-examinations well 
* Can prompt breast biopsy: majority are benign but nonetheless produce significant distress. 

Magnetic Resonance Imaging (MRI) : 

* About 70% of patients cope reasonably well. 
* 10%-20% are significantly distressed and 3%-5% cannot complete the examination
* Short-term effects: 


1.  Claustrophobia: the greatest psychological concern for those undergoing MRI

*  5%- 20% of cases. 
* Fear of suffocation and fear of restriction. 


2. Anxiety in 37% of cases. 
3.  Motion artifacts: distortions to the MRI image caused by the patient's movement.

* Can render the scan useless. 
* Up to 40% of scans have some degrees of motion artifacts, impairing the quality of diagnosis 8%-17% of the time.

Long-term effects:


1. New fears of enclosed spaces that surface weeks or months after an MRI experience

* 10% of cases


2. Children (pediatric oncology):

*  30% report moderate to extreme distress during an MRI. 
* Parents tend to overestimate their child’s distress.

Developmental complications: Brief

* Interaction of chronic illness and growth and puberty 
* Psychosocial Development 
* Education and school:

1. Interaction of chronic illness and growth and puberty 

* **Delayed growth and puberty** 
* Apparent immaturity may result in low self-esteem in boys 
* Difficulty in separating from parents, hard time becoming independent  and getting work due to apparent immaturity 
* Puberty and the adolescent growth spurt pose a significant caloric and metabolic burden on the healthy adolescent body, and may destabilize chronic illnesses


1. Ex: Teenagers with diabetes will have an increased level of GH, physicians who do not take this into consideration will cause harm in medicine dosage

* This may be transient or permanent growth loss 

Psychosocial Development 

* **Wellbeing and mental health:** 


* Chronically ill girls are more likely to have emotional problems than their healthy counterparts, but that the same was not true for boys. 
* Ill adolescents are more likely to develop psychiatric and behavioral disorders
*  more likely to be depressed or have low self-esteem 
* **Cognitive capacities:** 
* unlikely that chronic illness affects the basic neuronal maturational mechanisms that underlie the development of abstract thinking capabilities in adolescence : some exceptions like diabetes 


1. diabetes and sickle cell disease are known to have long term neuropsychological effects in adolescence

Education and school:

* many parents and teenagers are reluctant to disclose some conditions
* may lead to the development of a crisis situation within the school.
* strongly encouraged to disclose information in an appropriate and stepwise manner 
* impact on school attendance and educational achievement 
* Issue of absenteeism 
* The deleterious effects of chronic illness on educational and vocational outcomes may be overcome by higher family and professional support


1. We want to avoid labelling as much as possible as it causes stigma.
2.  Don’t want to teach them in specialized facility unless absolutely necessary

Factors determining the psychological effect of chronic illness: Brief

* Type and degree of physical impairment
* Visibility of the illness. 
*  Uncertainty about the course or nature of a disease:
*  A disease with irregular and unpredictable effects:
*  5. An illness with high cost of treatment or great pain:

Improving Adherence with Adolescents:

* Risk-taking increases from childhood through to adolescence: NO


* Due to limited cognitive abilities? : no because Cognitive abilities mature from childhood through to adolescence. 
* Adolescents believe that they are invulnerable to risk? : maybe but conflicting
*  Poorly developed abstract thinking: For sure 
* Lack of shared health beliefs and goals with the health professionals or family
* The degree of change required in lifestyle may impair compliance with therapeutic regimens


1. This is not their entire life, this is just part of their life; they want physician to take this into consideration when they look at a treatment plan
2. We should not change the lifestyle for teenagers ; they do not want to feel different

Shared Health Decision Making Approach : Brief

* Choice talk
* Option talk
* Decision talk

Decision talk:

1. Good communication with patients
2. Tailor treatment to each individual patient
3. Listen to patients' needs, what are their concerns??
4. We want to actively engage participants 
5. We get patient to actively compare and contrast short term and long term benefits
6. Use concrete examples
7. Physicians need to counteract effects of peer pressure :

* You can control your future with your decisions


8. Establish peer support network
9. Short term reward system:

* Teenagers seek rewarding behaviour
* Parental praise/ material reward

* BRAN MODEL:

1. Benefits
2. Risks
3. Alternatives
4. What if I do nothing??