AC Wk 5 COping with Cardiovascular Diseases Life Threatening Illness Discussion

Ashworth College, Health & Medical

Question Description

Overview

Assignment Due Date Format Grading Percent
Coping Strategies for Chronic and Life Threatening Illness Day 3
(1st Post)

Discussion

5
Transtheoretical and Health Belief Models in Chronic Illness Day 7

Assignment

 20

Learning Outcomes

This week students will:

  1. Evaluate biopsychosocial factors associated with chronic, serious, and disabling illness.
  2. Explain biopsychosocial aspects of coping with chronic, serious and disabling illness.
  3. Identify common serious illness syndromes and available support interventions designed to maximize adaptive coping strategies.

Introduction

Welcome to Week Five of PSY361! Unfortunately, not all illnesses are minor or temporary. Many disease syndromes are serious and even life-threatening. Some of these conditions are also chronic, meaning that the individual cannot look forward to a resolution of symptoms. To compound the impact of these illnesses on the individual’s life, symptoms or body damage from the disease process may result in functional loss. This can reduce enjoyment of life, impair productivity, and diminish self-esteem. Even in the face of such serious challenges, health-related behaviors can be adaptive and maximize successful outcomes. This week we will explore how the integration of mental health services into care delivery systems can assist individuals in understanding the options available in these circumstances.


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Required Resources

Required Text

  1. Sarafino, E.P., & Smith, T.W. (2016). Health psychology: Biopsychosocial interactions (9th ed.). Retrieved from https://vitalsource.com
  1. Chapter 13: Serious and Disabling Chronic Illnesses: Causes, Management, and Coping
  2. Chapter 14: Heart Disease, Stroke, Cancer, and AIDS: Causes, Management, and Coping

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PSY 361 Week 5 Overview:

While the course is in session, there will be Announcements in the online course to remind you of our current subject content and reading, discussion board activities, assignments, and other important or relevant information. Please be sure to check the course for current Announcements frequently. As always, email with ANY questions or concerns, or post public comments/questions on the “Ask Your Instructor” forum.

Topics this week:

  • Evaluate biopsychosocial factors associated with chronic, serious, and disabling illness.
  • Explain biopsychosocial aspects of coping with chronic, serious and disabling illness.
  • Identify common serious illness syndromes and available support interventions designed to maximize adaptive coping strategies.

Reading in Text Chapters 13 & 14:

  • Impact of chronic illness
  • Adjusting to chronic illness
  • Psychosocial interventions for chronic illness
  • Coping with and adapting to high-mortality illness
  • Information on selected chronic illnesses

Focus of topics in this Guidance:

  • Risk factors for chronic illness
  • Patient-centered care
  • Psychosocial factors in the development of chronic illness

RISK FACTORS FOR DEVELOPING CHRONIC ILLNESS:

What are Risk Factors? What is Relative Risk (RR)?

  • A risk factor is an indentifiable characteristic that has been shown to raise the risk of developing an illness
  • We compare the rate of development of illness in those with and without the factor, and this allows us to determine the “relative risk” (RR) contributed by the risk factor
  • Relative Risk (RR) as a “number line” continuum:
    • A Relative Risk of one (RR = 1) means that this characteristic neither raises nor lowers the risk of developing the illness
    • A Relative Risk of a positive number above one (RR >1) means that this characteristic raises the risk of developing the illness
    • A Relative Risk of a fractional number (between zero and one) (0< RR <1) means that this characteristic reduces the risk of developing the illness (i.e., may be protective; for example, an RR=0.8 means this is associated with reduced risk of developing the illness)
  • Example of A1C lab test with eye damage (retinopathy) in diabetes

Known association of A1C elevations with damag to the eyes (retinopathy)

A1C retinopathy

  • Example of high blood pressure (hypertension) creating increased relative risk for premature mortality from cardiovascular disease: this occurs at blood pressure values above 130 systolic and 80 diastolic – BP values above 130/80 create an RR >1 on the graph (see white dotted line)

BP relative risk

What is a “major” risk factor? What is a “minor” risk factor?

  • Major risk factor:
    • The presence of this risk factor alone will contribute to development of the illness
    • No other risk factors need to be present – it is a “stand-alone” characteristic that will increase the risk of developing the illness
    • Example of major risk factors in the development of cardiovascular disease:
      • Elevated blood levels of “bad” cholesterol (LDL-Cholesterol), high blood pressure (hypertension), family history of heart disease at an early age (male relative diagnosed before age 55, female relative diagnosed before age 65), person’s own age (male 45 years old or older, female 55 years old or older), current cigarette smoking (having smoked within the past two weeks), insufficient blood levels of “good” (protective) cholesterol (HDL-Cholesterol < 40 mg/dL)

LDL relative risk

  • Minor risk factor:
    • This risk factor has often been associated with the development of the illness
    • Either we don’t as yet have sufficiently robust research evidence of its definite effect, or the risk factor may need to be combined with other risk factors in order to have an effect
    • Sometimes these are called non-traditional risk factors
    • Examples of minor risk factors in the development of cardiovascular disease:
      • Elevated values of blood hs-CRP (a measure of inflammation), obesity, sedentary lifestyle, diet low in phytochemicals (these are found in fruits and vegetables)

What are “positive” risk factors? What are “negative” risk factors?

  • Positive Risk Factor:
    • This is NOT a “positive” (good) thing! This is a BADthing!
    • A “positive” risk factor means it will CONTRIBUTE to development of the disease or illness
  • Negative Risk Factor:
    • This is a GOOD thing!
    • A “negative” risk factor means it will PROTECT against the development of the disease or illness
  • Often the layperson is confused by the terminology:
    • Positive here really means: bad
    • Negative here really means: good

Modifiable and non-modifiable risk factors:

  • Modifiable:
    • This type of risk factor can be treated or otherwise controlled through some form of intervention
    • Clinical interventions to modify risk factors: drug therapy (medication), surgery, therapy (psychotherapy, occupational therapy, physical therapy, recreational therapy, other rehabilitation therapy)
    • Lifestyle interventions to modify risk factors: physical activity, diet, behavioral choices (e.g., tobacco use)
    • Adherence and compliance are terms that are often used interchangeably, but actually have different meanings – as follows:
      • Compliance – the individual follows recommendations for medications to treat or prevent illness
      • Adherence – the individual follows recommendations for overall (holistic) therapeutics (think: diet, exercise, environment, etc.)
    • Examples of modifiable risk factors in Type 2 diabetes:
      • See American Diabetes Association: http://www.heart.org/HEARTORG/Conditions/Diabetes/UnderstandYourRiskforDiabetes/Understand-Your-Risk-for-Diabetes_UCM_002034_Article.jsp
      • Overweight and obesity – can be modified with lifestyle interventions, medication, surgery
      • Elevated blood glucose – can be lowered with medication & lifestyle interventions
      • High Blood Pressure (HBP)(also called Hypertension) – can be modified with lifestyle interventions, medication
      • Abnormal blood cholesterol – can be modified with lifestyle interventions, medication
      • Physical inactivity – can be modified with lifestyle interventions
      • Smoking – can be modified by lifestyle interventions (smoking cessation)

— AND/OR —

    • reduce adverse outcomes if the disease has already been
  • Recognition of non-modifiable risk factors – patient adherence:
    • Individuals can receive counseling about the contribution of such risk factors to illness or adverse outcomes in diagnosed illness
    • This guidance may help the individual realize how important it is to adhere to other interventions for modifiable risk factors

How do we use these risk factors?

AHA stages of HBP

  • Calculating risk of disease/illness development:
    • Example – using risk factor data to calculate risk using information from the research evidence base
    • See the American Heart Association website that calculates short-term and long-term risk of cardiovascular illness: http://tools.acc.org/ASCVD-Risk-Estimator/
      • Data needed: age, sex, total cholesterol, HDL cholesterol, race, if treated for hypertension, if smoker, if diagnosed with diabetes
      • The risk calculator will automatically give the risk of developing cardiovascular disease – see what happens if you change the data!
  • Screening:
  • Health promotion:
    • Example – making recommendations for lifestyle changes to improve health outcomes
    • See the American Heart Association 2013 guidelines on lifestyle management to reduce cardiovascular risk: http://content.onlinejacc.org/article.aspx?articleid=1770218#tab1 (see table 5)
      • Diet for Lipids (cholesterol):
        • Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats.a.Adapt this dietary pattern to appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other medical conditions (including diabetes).b.Achieve this pattern by following plans such as the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet.
        • Aim for a dietary pattern that achieves 5%–6% of calories from saturated fat.
        • Reduce percent of calories from saturated fat.
        • Reduce percent of calories from trans-fat.
    • Diet for Blood Pressure (BP):
      • Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats.a.Adapt this dietary pattern to appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other medical conditions (including diabetes).b.Achieve this pattern by following plans such as the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet.
      • Lower sodium intake.
      • Consume no more than 2,400 mg of sodium. Further reduction of sodium intake to 1,500 mg/d can result in even greater reduction in BP. Even without achieving these goals, reducing sodium intake by at least 1,000 mg/d lowers BP.
      • Combine the DASH dietary pattern with lower sodium intake.
    • Exercise (physical Activity):
      • For lipids (cholesterol): In general, advise adults to engage in aerobic physical activity to reduce LDL-C and non–HDL-C: 3–4 sessions per wk, lasting on average 40 min per session, and involving moderate- to vigorous-intensity physical activity.
      • For blood pressure (BP): In general, advise adults to engage in aerobic physical activity to lower BP: 3–4 sessions per wk, lasting on average 40 min per session, and involving moderate- to vigorous-intensity physical activity.
  • Treating illness:
    • Example – a laboratory test called the A1C is associated with increased risk of complications of diabetes, and the A1C can be used as a guide to determining initial treatment of newly diagnosed diabetes
    • Example – based on the “stage” of high blood pressure (hypertension), clinicians determine what type of initial medical treatment is needed From: An Effective Approach to High Blood Pressure Control (Science Advisory). Go AS, et al., 15 November 2013. Retrieved from http://hyper.ahajournals.org/content/early/2013/11/14/HYP.0000000000000003

AHA HBP algorithm 2013

Image of a chart regarding the poor, intermediate and ideal numbers for blood pressure, physical activity, cholesterol, healthy diet, healthy weight, smoking status and blood glucose

PATIENT-CENTERED CARE:

What is patient-centered care?

  • Initially, health care was focused on disease, often called a “disease-centered model”
    • Physicians or other healthcare providers make treatment decisions
    • Patient non-medical needs and preferences are not taken into account
  • In recent years, most healthcare delivery has moved towards a “patient-centered model”
    • Patients are active participants in their care
    • Deliver of care is more of a partner-based relationship, including attention to patient non-medical needs and preferences
  • Tools to support patient-centered care:
    • Patient questionnaires on preferences
    • Patient questionnaires on functional outcomes
    • Example – the International Prostate Symptom Score (IPSS), see: http://www.urospec.com/uro/Forms/ipss.pdf helps guide urologists in delivery care to men with chronic prostate enlargement (benign prostatic hyperplasia)
  • Treatment strategies can be influenced by patient preferences
  • Patient-Centered Medical Home (PCMH):
  • Self-management of chronic disease:
    • Recognition that for most chronic illnesses, patient education and self-management will improve outcomes
    • Tools developed to help patients manage their own illness
    • Example – asthma action plan with Green/Yellow/Red Light recommendations individualized for the patient

asthma action plan.bmp

PSYCHOSOCIAL FACTORS IN CHRONIC ILLNESS:

Stress and cardiovascular disease:

  • For at least the past decade, there has been a recognition that many chronic diseases are influenced by stress
  • Stress has been shown to be a psychosocial factor that contributes to the development of cardiovascular disease
  • Job Stress:
    • The 2004 Whitehall II Study on Work Stress and Cardiovascular Diseasedemonstrated increased cardiovascular disease (CVD) with lack of control in the workplace and Effort-Reward Imbalance in the workplace

Whitehall Job Control CVD.bmp
Whitehall effort reward imbalance CVD.bmp

What about the famous “Type A” personality and heart disease?

Anger, acute emotional stress, and heart disease – “Broken Heart Syndrome”:

Depression and chronic illness:

What about race and ethnicity?

What about where you live?

CDC hypertension southern states.bmp

Social determinants of health:

  • What are these? Include economic and social conditions that influence the health of people and communities:
    • Food security (having enough to eat)
    • Housing
    • Education
    • Getting and keeping a job
    • Earnings
    • Health services access and quality
    • Discrimination
    • Social Support
    • Early childhood development
  • Centers for Disease Control (CDC) FAQ sheet: http://www.cdc.gov/nchhstp/socialdeterminants/faq.html

CDC determinants of population health.bmp

Additional Resources:

Risk Factors in Chronic Disease:

Preventing chronic diseases and reducing health risk factors. (2013, October 25). Retrieved from http://www.cdc.gov/nccdphp/dch/programs/healthycom…

Centers for Disease Control (CDC) website on Risk Factors in Chronic Disease.

World Health Organization. (2005). Chronic diseases and their common risk factors. Retrieved from http://www.who.int/chp/chronic_disease_report/medi…

World Health Organization (WHO) Brochure on Risk Factors for Chronic Disease

Patient-Centered Care:

Joint principles of the patient-centered medical home. (2007, March). Retrieved from http://www.aafp.org/dam/AAFP/documents/practice_ma…

Journal of the American Geriatrics Society. (2012). Patient-centered care for older adults with multiple chronic conditions: A stepwise approach from the American Geriatrics Society. Retrieved from http://www.americangeriatrics.org/files/documents/…

Patient-Centered Medical Home. (http://pcmh.ahrq.gov/)

The patient-centered medical home (PCMH). (http://www.aafp.org/practice-management/pcmh/patient-care.html)

Stress and Chronic Disease:

Hughes, J. W., Fresco, D. M., Myerscough, R. van Dulmen, M. H., Carlson, L. E., & Josephson, R. (2013, October). Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Journal of Psychosomatic Medicine October, 75(8), 721-728. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24127622

Rosengren A, Hawken S, Ounpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W.A.,…Yusuf, S. (2004, September 3). Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): Case-control study. The Lancet, 364(9438), 953-962. http://dx.doi.org/10.1016/S0140-6736(04)17019-0

The whitehall studies. (2004). Retrieved from https://sheffieldequality.files.wordpress.com/2012…

Whooley, M. A., & Wong, J. (2011). Hostility and cardiovascular disease. J Am Coll Cardiol. 58(12), 1229-1230. doi:10.1016/j.jacc.2011.06.018

Course Text:

Sarafino, E. P., & Smith, T. W. (2014). Health psychology: Biopsychosocial interactions (8th ed.). New York, NY: John Wiley & Sons, Inc.

The focus of this discussion activity is on research regarding the coping strategies utilized by those diagnosed with a chronic illness. Analyze one (or more) peer-review

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