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36 Cards in this Set
- Front
- Back
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Factors that influence QoL |
-Demographics (example, age, culture) -The condition itself; for example, symptoms, presence, or absence of pain, functional disability, neurological damage with associated motor, emotional or cognitive impairment, sensory or communicative impairment. -Treatment; for example, its availability, nature, extent, toxicity, side-effects. -Psychosocial factors; for example, emotions (anxiety, depression), coping, social context, goals and support. |
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25 different facets of QoL grouped into 6 domains. |
- Physical Health - Psychological - Level of independence - Social relationship - Relation to environment - Spirituality,religion and personal beliefs |
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What are the main reasons suggested as to why QoL assessment is a useful clinical practice. |
-Measure to inform -Measure to evaluate alternatives -Measure to promote communication |
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Measure to inform |
a) Inform interventions and best practice & b) Inform patients about treatment outcomes or possible side effects in order that they are mentally 'prepared' for them or so that supportive resources can be put in place. Descriptive data from QoL studies can also be used to inform patients and their families about likely treatment experiences so that treatment choices can be made. |
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Measure to evaluate alternatives |
QoL measures may be used as a form of clinical 'audit' to identify which interventions have the 'best' outcomes - for the patient, but also often in relation to costs. |
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Measure to promote communication |
- Unlikely to be the primary motive for conducting a QoL assessment in a clinical setting, engaging patients in QoL assessment may require health professionals to address areas they may not otherwise have done. EXAMPLE - Treatment satisfaction, family interaction, hobbies, or sexual functioning. This will provide health professionals with a more holistic view of impact that illness or treatment has had upon their patient and may help future treatment decision making or healthcare. |
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Why is the QoL concept important |
- It encompasses a persons subjective belief about the quality of various life domains of importance to them |
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The main domains that are generally considered in QoL research |
-Physical functioning -Role functioning -Emotional functioning social functioning -environmental aspects and, increasingly, -Spiritual functioning |
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QoL aspects of an individual |
-age -ethnicity -mood -levels of social support |
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What are the methods of assessing the subjective construct of QoL? |
-Self-report interview -Self-report questionnaire completion -Proxy report (either interview or questionnaire) |
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Morse and Johnson (1991) Emotional and coping responses model. |
Onset of symptoms through to living with a chronic illness. Individuals facing illnesses are considered as having to deal with: - Uncertainty - Understanding the severity of the first symptoms. - Disruption - Becomes evident to the individual that they have a significant illness. - Striving for recovery - Individual attempt to try get control over their illness (Active coping). - Restoration of wellbeing - Individual achieves a new emotional equilibrium based on acceptance of the illness and its consequences. |
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Stages of response to diagnosis of cancer (Holland & Gooen-Piels, 2000) |
-Initial response (Disbelief, denial and shock) -Dysphoria (Individuals gradually coming to terms with the reality of their diagnosis.) -Adaption |
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Psychological model of adjustment (Shelly Taylor, 1983) |
She argued that the process of adjustment to threatening events, whether illness or not, centres around three themes: (no sequence) 1) Searching for meaning in the experience 2) attempting to gain a sense of control or mastery over the experience 3)making efforts to restore self esteem |
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Cognitive adaptational model |
Following a stressful event (challenge or threat), a person is motivated to face the challenge of their illness and be proactive in finding ways to deal with them in order to restore equilibrium in their life. |
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Two major killers in western society |
Heart disease and heart attacks |
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Key benefits of maintaining positive emotions (Fredrickson, 1998, 2001) |
- The promotion of psychological resilience and more effective problem solving - The dispelling of negative emotions - The triggering of an upward spiral of positive feelings |
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Five domains of positive change: (as a result of stress or trauma) |
1. enhanced personal relationships 2. greater appreciation for life 3. a sense of increased personal strength 4. greater spirituality 5. a valued change in life priorities and goals |
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Three processes that result from the crisis of illness.(Moos & Schaefer, 1984) |
1.Cognitive appraisal - accepts the illness in their lives
2.Adaptive tasks - specific tasks such as dealing with the symptoms, preserving emotional balance or relationships with others 3.Coping skills - Appraisal focused, problem focused or emotion focused coping |
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The adaptive tasks |
-Dealing with the symptoms of the disease -Maintaining control over the illness -Managing communicative relationships -Facing and preparing for uncertain future -Preserving self image and self esteem when challenged -Maintaining control and emotional balance over health and life in general. -dealing with changes in relationships with family and friends. |
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How i feel! |
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problem-focused coping |
Directed towards reducing or eliminating a stressor, adaptive behavioral |
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appraisal-focused coping |
Directed towards challenging one's own assumptions, adaptive cognitive |
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emotion-focused coping |
Directed towards changing one's own emotional reaction |
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Types of pain |
- Acute pain = Pain experienced for less than 3 - 6 months - Chronic pain = a pain that continues for more than 3 - 6 months |
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Nature of the pain |
Type of pain - Includes stabbing, throbbing, aching, piercing, sharp and hot The severity of pain - from mild discomfort to excruciating. The pattern of pain - including brief, continuous and intermittent. |
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What are the psychological and physical factors regarding how the experience of pain is moderated. |
- The degree of attention paid to pain. - The mood of the individual - The persons beliefs about the nature of the pain, including its cause and controllability. |
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The gate theory of pain. (Melzack and Wall) |
Suggests how Psychological factors affect the perception of pain. pg 556 for full details |
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What 2 interventions have proved to be affective in the treatment of both acute and more chronic pain. |
Behavioural and cognitive-behavioural intervention. |
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Biofeedback interventions (regards to acute and chronic pain.) |
Help reduce pain, but their overall effectiveness is no greater than more general relaxation procedures. |
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In regards to helping people reduce any distress they experience, to manage their disease and to prevent it developing further, what are the therapeutic approaches considered. |
- Providing relevant information - Stress management training - the use of social support - Self-management training - enhancing social support - the use of written emotional expression |
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In the study involving Spiegel (1989) what were the issues the health professionals, in the support group for the breast cancer patients, focus on . |
- building strong supportive bonds - expressing emotions - Dealing directly with fears of dying - improving relationships within the family - active involvement in decisions concerning treatment |
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Self management training (Lorig, 1996) |
Best know approach to helping patients to gain control over their illness. Arthritis example is on page 571 |
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Emotional expression (Pennebaker, 1980s) |
-Psychological effects of a writing test. -Writing about past events that have caused you to be upset or distressed. - A way to explore a individuals emotional reaction to an event. - Write for 15 - 20 mins on three consecutive days (Can be voice recorded if they don't want to write) |
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Negative and positive affects of emotional expression |
N= Following the process participants reported short-term increases in depression or distress. P= Medium to long term experienced better mood, and importantly better physical health. |
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What was the name of the study which is known to be the LARGEST trial of any form of cardiac rehabilitation ? |
ENRICHD (Enhancing Recovery in Coronary Heart Disease) intervention study with 2481patients. Study results were found to be disappointing. |
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Interventions that can impact long term health
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- Counselling - Stress management - Treatment of depression - Social suport |
