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Health Psych – Module 9

Resources

The Breakdown

Important

  • Components of Quality of Life – Quality of life has several key components: physical functioning, psychological status, social functioning, and disease or treatment-related symptomology. This structure mirrors the biopsychosocial (BPS) model of health.
  • Criteria to qualify for Medical Assistance in Dying (MAID) – To qualify for MAID in Canada, individuals must be eligible for government-funded health insurance in Canada, be 18 years of age or older, have a grievous and irremediable condition as defined by the Criminal Code, make a voluntary request for MAID without external pressure, and provide informed consent after being informed of all available means to relieve suffering, including palliative care. A “grievous and irremediable medical condition” means having a serious and incurable illness, disease, or disability; being in an advanced state of irreversible decline in capability; enduring physical and psychological suffering that is intolerable; and natural death being reasonably foreseeable.

Core concepts

  • Chronic Illness: This refers to diseases or illnesses that are long-term, lasting more than a few weeks at a minimum, and have a long-term effect on the body and mind. Chronic illnesses can range from relatively mild (e.g., psoriasis) to severe and life-threatening. They can be present at birth or develop later in life due to factors such as genetics (e.g., Alzheimer’s, MS), environment (e.g., living in a home of smokers, working in certain occupations), and lifestyle (e.g., poor diet, lack of exercise, unprotected sex). Previous injury or prolonged strain can also lead to chronic pain later in life, such as lower back pain or osteoarthritis of the knee.
  • Prevalence and Impact of Chronic Illness: A significant portion of the population lives with chronic conditions, with almost 60% of the general population and 81% of the elderly subpopulation affected. Chronic conditions disproportionately affect women, lower-income individuals, seniors, and certain ethnic subpopulations (e.g., Indigenous peoples). Chronic conditions account for two-thirds of Canada’s health spending and are linked to over 63% of deaths globally and 88% of deaths annually in Canada. These conditions have substantial economic consequences, costing billions annually for diseases like diabetes, cancer, arthritis, and cardiovascular disease.
  • Quality of Life (QoL): QoL is distinct from “standard of living” and refers to an individual’s overall health experience. It is directly impacted by the severity of chronic illness, with more severe diseases leading to a lower QoL. QoL influences a patient’s interpretation of their illness and helps determine psychological contributions such as depression, anxiety, and distress. QoL assessments gauge how much normal life activities have been compromised. Population norms can be established, allowing for comparative analysis across conditions and between countries. QoL can fluctuate based on illness characteristics (e.g., acute vs. managed phases), acute changes in symptoms, age-related changes, and culture.
  • Importance of Studying Quality of Life: Studying QoL allows for the documentation of history and trends between illness and QoL factors, helping to target research and treatment. It helps gauge the impact of treatment on QoL and compare the effectiveness of different treatments, especially those that improve patients’ ability to engage in valued activities. QoL data is increasingly used to inform decision and policy makers regarding drug reimbursement and healthcare strategies.
  • Emotion and Chronic Illness: A chronic illness often requires long-term dramatic change. Patients typically experience emotional phases, including denial (which helps control emotional reactions but may interfere with treatment), anxiety (leading to increased self-vigilance and potential interference with treatment), and depression (which can potentiate symptoms, increase suicide risk, and is often difficult to diagnose). The severity of the illness often increases the likelihood and intensity of depression.
  • Chronic Disease and Self: Chronic illness impacts an individual’s self-concept (stable beliefs about one’s qualities and attributes) and self-esteem (general evaluation of self-concept). Self-concept is a composite of the physical self (body image), achieving self (job and hobbies), social self (social interaction and support), and private self (alone time and loss of unrealised dreams). Poor body image is linked to low self-esteem and higher rates of depression and anxiety.
  • Coping with Chronic Illness: Chronic illness is considered a chronic stressor. Coping strategies include avoidant coping (which can cause psychological distress) and active coping (leading to less psychological distress and better outcomes). Social support can provide positive reinforcement, and multiple coping strategies are most effective. Physical rehabilitation aims to help patients use their bodies as much as possible, sense environmental changes, learn new physical management skills and treatment regimens, and control energy expenditure.
  • Positive Changes with Chronic Illness: Despite the challenges, positive emotions can arise from chronic illness. This includes benefit finding, where individuals acknowledge positive effects such as a re-evaluation of priorities, strengthening of relationships, realisation of one’s abilities, and lifestyle changes. The type of chronic illness can influence the ability to rebound positively.
  • Psychological Interventions for Chronic Illness: Interventions include individual therapy (often episodic, requiring familial collaboration and therapist understanding of the illness), brief psychotherapeutic interventions (to calm over-reactions), and patient education (providing control and knowledge through credible sources). Other beneficial interventions are relaxation, stress management, and exercise, including mindfulness-based stress reduction (MBSR). Social support interventions (like support groups) foster commitment to change and provide emotional support. Family support is crucial for treatment adherence.
  • Death Across the Lifespan: Today, death from infectious diseases is much lower, with the average lifespan in Canada being 81 years. Death usually stems from chronic, not acute, illness. Death in infancy or childhood (e.g., SIDS, accidents, cancer) is tragic, with children having a poor understanding of death until age 9-10. Death in young adulthood is seen as tragic, robbing individuals of a future. Death in middle age becomes more realistic and fearful, often triggered by the death of peers or parents, and can be considered premature if before age 81. Death in old age is typically from degenerative diseases.
  • Psychological Issues in Advancing Illness: Continued treatment can cause significant psychological distress, leading patients to question if treatment is “worth it”. Patients hope for a “good death”, which means being free from avoidable suffering for themselves and caregivers, effective pain and symptom management, clear decision-making (e.g., DNR orders), time for preparation for death, and a good completion.
  • Medical Assistance in Dying (MAID): Euthanasia (ending the life of a person suffering from painful terminal illness) and Physician-Assisted Dying (PAD) are contentious issues. Patients may request MAID due to distress/fatigue, pain/suffering, or feeling like a burden to family. This creates a polarized view against a doctor’s oath to prolong life. MAID became legal in Canada in June 2016 with Bill C-14, allowing a physician/nurse practitioner to directly administer a substance or prescribe one for self-administration. Two independent healthcare professionals must evaluate to qualify for MAID. Living wills (advanced care directives) indicate that extraordinary measures should not be taken, though they are not always followed.
  • Stages in Adjustment to Dying (Kübler-Ross’s Five-Stage Theory): Patients typically go through five stages: denial (provides initial emotional control, but may affect therapy), anger (“why me?”, difficult for family), bargaining (unrealistic deals for good health), depression (realising lack of control, anticipatory grief), and acceptance (a calm state where necessary preparations are made).
  • Alternatives to Hospital Care for Terminal Illness: Historically, hospitals were primary settings. Now, two prominent alternatives are hospice care and home care. Hospice care focuses on accepting death positively, improving QoL through pain management and emotional support, and offering a personalised setting with unrestricted familial visits, rather than curing the illness. Home care allows patients to pass in their own homes, offering psychological benefits, but places increased responsibility on family members while still requiring regular contact with medical staff.