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Chronic Illness Trajectory
persistent changes in mental, physical, and spiritual health status, requiring long-term management
- no cure
- nonreversible
- progressive
chronic disease
- long duration (3 mos) with long latency period and clinical course
- etiology, pathophysiology, signs, symptoms, and treatment implied that disease needs long term strategies
chronic illness
- alteration in health or function lasting 6 mos or duration of pts life
- lived experience of long term health disturbances
- how pt copes with disruption of illness
leading cause of death and disability are
all chronic illnesses
- HD
- cancer
- lung
- stroke
- alzheimers
- diabetes
- ckd
attributes of chronic illness trajectory
- care transition
- self care management
- health related quality of life
- uncertainty
care transition
- proactive plan of care with goals
- transition between levels and type of care or developmental
- created, documented, updated, revised with every pt
- comprehensive: community, nonclinical services, health services, that incorporates pt needs and preferences
- shared across all providers
- family focused, pt centered
self care management
- pt actively manage chronic illness
- interventions support behavioral skills to manage illness independently
- ex: meds, equipment, health monitoring, engagement in self care decision making
health related quality of life
- life satisfaction and life concerns that may change overtime
- health and illness affecting both the individual and their family
- take into account of what they can do if they can't do other things
uncertainty
- inability to determine the meaning of illness related events
- subjective experience influenced by ambiguity, complexity, communication with HCP
- inability to determine definite value or outcome due severity or erratic nature
- prevents delay in coping, increases distress
CIT phases
onset
stable
acute
comeback
crisis
unstable
downward dying
onset
signs and sx present
diagnostic period
stable
illness course and sx controlled by treatment regimen
maintains every day activities
acute
active illness with severe unrelieved sx
hospital may be required for management
comeback
gradual return to an acceptable way of life
crisis
life threatening situation occurs
emergency services needed
unstable
- cant keep sx/disease under control
- life becomes disrupted while pt works to regain stability
- hospitalization not required (at home
downward
- gradual deterioration in physical or mental status
- increasing disability and sx
- alterations in everyday activities
dying
relinquish interested and lifestyle, let go, die peacefully
immediate weeks days hours preceeding death
7 tasks of people with chronic illness
1) Prevent and manage crisis.
2) Carry out prescribed treatment regimen.
3) Control symptoms.
4) Reorder time. (prioritization)
5) Adjust to changes in unpredictable course of disease.
6) Prevent social isolation.
7) Normalize interactions with others.
interventions for CIT: education
prevent and manage crisis
treatment regimen
control sx
interventions for CIT: care coordination
prevent and manage crisis
regimen to prevent acute or crisis
control sx
reorder time
interventions for CIT: coaching/emotional support
adjust to changes
prevent social isolation
control sx
reorder time
