chronic trajectory

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