1. Living with chronic illness By Oliver Putt For WMS Peer Support – 14 th January 2015

2. Why is this clinically relevant? The epidemiological transition Key features Impact on your patients Impact on your employer

3. What is a chronic illness? A disease or disorder of slow progression and long duration which causes continuous or episodic periods of incapacity. (http://www.firststopcareadvice.org.uk/jargon-chronic-illness.aspx)

4. I don’t want to be ill! ‘Passing off’ as being well Hiding illness What are the affects?

5. Biographical disruption Changing the direction of lives

6. Crisis theory What influences how a person manages their chronic illness? Changes in identity Changes in location Changes in role Changes in social support Changes in the future

7. Affects of chronic illness Activities of daily living Social relationships Social identity Sense of self This slide has been added to help you remember the key words for this topic.

8. Experience of chronic illness Listen to your patient’s story

9. The patient as an expert Who knows best about living with a chronic condition? Expert patient program

10. Self regulatory model Representation of illness CopingAppraisal Emotional response to illness Interpretation

11. Supporting patients with chronic illness Bio-Psycho- Social model

12. Pain management programs for chronic pain What is it? Advantages Disadvantages

13. Management of a long term condition Pain Management Programmes Reinforce message of gate control theory – a combination of psychological and physical factors can open and close the gate. Involve – clinicians, specialist nurses, physiotherapists and psychologists. Intense, residential or spread over 6-8 weeks. Dr Alan Dolan and Dr Harbinder Sandhu 2014

14. An Example Back Pain Initially a painful sensation from initial injury or tissue stress Increase in disuse causing loss of fitness, depression and social withdrawal = more pain Avoidance of movement and activities (work, hobbies) due to fear of making it worse Worry about cause of pain and future consequences Dr Alan Dolan and Dr Harbinder Sandhu 2014

15. Benefits of a pain management programme Helps patients manage their pain rather then the pain managing/controlling them. Learn to change cognitive perceptions of pain, less catastrophising, challenging unhelpful thoughts Management of stress and anxiety as well as low mood, depression. Not feeling so isolated with the condition when in a group. Dr Alan Dolan and Dr Harbinder Sandhu 2014

16. Challenges of a pain management programme Managing group dynamics Stages of change – are they ready to change their behaviours Commitment Managing fears Dr Alan Dolan and Dr Harbinder Sandhu 2014

17. Summary Understanding the psycho-social impact of a long term condition is important in helping patients manage their condition. A combination of education and cognitive behavioral approaches can help patients manage their condition. Explore all options including self management groups. A multidisciplinary approach using the bio-psycho-social approach. It is important to work with patients to achieve an understanding the main goal is not a “cure” but to improve quality of life. Dr Alan Dolan and Dr Harbinder Sandhu 2014

18. Thank you Any questions?