1. Chapter Eleven: Management of Chronic Illness

2. Chapter Outline 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

3. Quality of Life
Assessments measure the extent to which a patient’s normal life activities have been compromised by disease and treatment
Domains to evaluate:
Physical functioning
Psychological status
Social functioning
Disease- or treatment-related symptoms

4. Why Study Quality of Life?
Provides basis for interventions
Helps identify the problems likely to emerge for patients
Assesses the impact of treatments
Used to compare therapies
Can inform decision-makers about care

5. Emotional Responses to Chronic Illness
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

6. Emotional Responses to Chronic Illness
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

7. Personal Issues in Chronic Disease
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 co-management role

8. Personal Issues in Chronic Disease
Achievement - Important to self-esteem and self-concept
Social functioning – quality of relationships, emotional support
Private self - Patient’s identity can be affected by chronic illness
How has Curt’s private self changed?
How has Laura’s private self changed?

9. Coping with Chronic Illness
Strategies people use:
Social support/direct problem-solving
Distancing
Positive focus
Cognitive escape/avoidance
Behavioral escape/avoidance
Strategies that work - Active coping and coping with positive responses

10. Patients’ Beliefs about Chronic Illness
Nature of the illness - Patients can adopt an inappropriate model for their disorder
Examples: Cause of the illness
Patients blame stress, physical injury, disease- causing bacteria, and God’s will for their illness
Consequence: Self-blame can lead to guilt, self-recrimination, or depression, lack of belief in treatment

11. Patients’ Beliefs about Chronic Illness
Controllability
Belief in control and a sense of self-efficacy with respect to the disease and its treatment improves outcome
Experience of control or self-efficacy may prolong life

12. Comanagement of Chronic Illness
Physical rehabilitation: Adapting to limits
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
May be resisted, denial of need

13. Comanagement of Chronic Illness
Developing a comprehensive rehabilitation program
pain management program
assistive technologies
Chronic illness leads to a decrease in sexual activity
Learn triggers to exacerbation of Sx

14. Comanagement of Chronic Illness
Adherence to treatment: key to outcome
Increased by education about illness
Predicted by perception of control over one’s health and self-efficacy
Vocational issues in chronic illness
Discrimination against the chronically ill
Financial problems arise when patients have to cut back on work

15. Comanagement of Chronic Illness
Social interaction problems
Negative responses from others
Impact on family
Caregiving role: guilt at reduced 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

16. Comanagement of Chronic Illness
Resilience in face of 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

17. When the Chronically Ill Patient is a Child
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 (MRI, Surgery)
Exhibits a variety of behavioral problems
May develop maladaptive coping styles
Trauma Sx : repetitive play

18. When the Chronically Ill Patient is a Child
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

19. Psychological Interventions and Chronic Illness
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

20. Psychological Interventions and Chronic Illness
Coping skills training can improve functioning
Evaluate what behaviors do not work
Increases knowledge about the disease
Reduces anxiety
Increases patients’ feelings of purpose and meaning in life

21. Psychological Interventions and Chronic Illness
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. Psychological Interventions and Chronic Illness
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