1. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Eleven: Management of Chronic Illness

2. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Quality of life Emotional responses to chronic illness Personal issues in chronic disease Coping with chronic illness Comanagement of chronic illness Psychological interventions and chronic illness 2

3. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Assessments measure the extent to which a patient’s normal life activities have been compromised by disease and treatment Components Physical functioning Psychological status Social functioning Disease- or treatment-related symptoms 3

4. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Provides basis for interventionsHelps identify the problems likely to emerge for patientsAssesses the impact of treatmentsUsed to compare therapiesCan inform decision-makers about care 4

5. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Denial: Defense mechanism by which people avoid the implications of an illness Interfere with absorption of treatment information and compromises health Anxiety - Patients become overwhelmed by potential changes in their lives and/or the prospect of death Interferes with treatment 5

6. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Depression: Complicates treatment adherence and medical decision making Assessing it in the chronically ill can be complicated People who get depressed Experience pain and disability Experience negative life events Lack social support 6

7. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Self-concept: Stable set of beliefs about one’s personal qualities Evaluated by self-esteem Body image: Perception and evaluation of one’s physical functioning and appearance Poor body image raises the risk of depression and anxiety Influences a person’s adherence to treatment and willingness to adopt a comanagement role 7

8. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Achievement - Important to self-esteem and self-concept Social functioning - Provide information, help, and emotional support Private self - Patient’s identity can be affected by chronic illness 8

9. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Strategies Social support/direct problem-solving Distancing Positive focus Cognitive escape/avoidance Behavioral escape/avoidance Strategies that work - Active coping and coping with positive responses 9

10. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Nature of the illness - Patients adopt an inappropriate model for their disorder Cause of the illness Patients blame stress, physical injury, disease- causing bacteria, and God’s will for their illness Self-blame can lead to guilt, self- recrimination, or depression 10

11. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Controllability of the illness Belief in control and a sense of self-efficacy with respect to the disease and its treatment are adaptive Experience of control or self-efficacy may prolong life 11

12. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Physical rehabilitation: Learning: How to use one’s body as much as possible How to sense environmental changes to make appropriate accommodations New physical management skills Necessary treatment regimen How to control the expenditure of energy 12

13. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Developing a comprehensive rehabilitation program Patients need a pain management program There is a need for assistive technologies Factors that contribute to the recurrence or that exacerbate the disease should be identified Chronic illness leads to a decrease in sexual activity 13

14. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Adherence Increased by appropriate education Predicted by high expectations for controlling one’s health and self-efficacy and knowledge of the treatment regimen Vocational issues in chronic illness Discrimination against the chronically ill Financial problems arise when patients have to cut back on work 14

15. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Social interaction problems Negative responses from others Impact on family Caregiving role Gender and the impact of chronic illness Women have more deficits in social support Married women are more likely to be institutionalized than the husbands 15

16. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Positive changes in response to chronic illness Experiencing positive reactions and optimism Inspiration to act now instead of postponing it Acquiring more empathy and compassion Feeling stronger and more self-assured 16

17. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Confused because they do not understand the diagnosis and treatment Cannot follow the treatment regimen without help from family Exposed to isolating and terrifying procedures Exhibits a variety of behavioral problems May develop maladaptive coping styles 17

18. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Improving coping Parents can soothe children emotionally and provide an informed basis for care Children should be encouraged to take care of themselves Regular school attendance Physical activities Family therapy and training the family in the treatment regimen will help 18

19. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pharmacological interventions - Prescription of antidepressants Individual therapy Can be episodic Collaboration with patient’s physician and family is critical Requires respect for patient’s defenses 19

20. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Comprehensive understanding of the illness and its modes of treatment are required Guided by cognitive behavioral therapy 20

21. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coping skills training can improve functioning for chronic diseases Increases knowledge about the disease Reduces anxiety Increases patients’ feelings of purpose and meaning in life 21

22. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Relaxation, stress management, and exercise Relaxation training and acceptance and commitment therapy (ACT) are widely used Mindfulness-based stress reduction (MBSR) - Improves adjustment to medical illness Exercise can improve quality of life 22

23. Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Social support interventions Family support Enhances patient's physical/emotional functioning Promotes adherence to treatment Improves course of illness Support groups: Discuss issues of mutual concern that arise as a consequence of illness Low-cost, convenient treatment option 23