discussion #2

ì   Biopsychosocial  View  of  Chronic  Illness   Incorpora)ng  Psychological,  Social,  &  Cultural  Factors  in  Chronic  Illness  Management    

ì   The  Biopsychosocial  Model  

Incorpora)ng  Psychological,  Social,  &  Cultural  Factors  in  Chronic  Illness  Management  

• Preven)on   • Help-­‐Seeking   • Illness   Management  

• Self-­‐efficacy  

• Stressors   • Cause,  experience,  &   expression  of  chronic   illness  

• Rela)onships   • Spirituality   • Cultural  Expecta)ons  

• Personality/Iden)ty   • Psychological  Func)oning   • Appraisal   • Coping   • Self-­‐conscious   • Processing   • Communica)on  

• Systems  Func)on:   • Peripheral  Organ   • Immune     • Neuroendocrine     • Central  Nervous  

• Automa)c   • Outside  Consciousness  &   Awareness  

Biology   Psychology  

Behavioral   Protec)ve   &  Risk   Factors    

Social/ Cultural  

Chronic  Illness  Defined    

ì  Chronic  illnesses  are  among  the  most  prevalent,  costly,  and   preventable  health  problems  

ì  Poses  incredible  treatment  challenges  

ì  Chronic  Illness:  The  subjec)ve  experience  of  a  chronic  medical   condi)on  which  does  not  usually  have  a  single  cause,  specific   onset,  stability  in  its  presenta)on  (i.e.,  there  is  waxing  and   waning  of  the  symptom  presenta)on),  and/or  iden)fiable  cure   leading  to  the  definite  end  of  the  disease  process.    

Onset    Abrupt  vs.  Gradual  

Dura+on    Limited  vs.  Indefinite  

Cause    Usually  Single  vs.  Mul)ple  &  Dynamic  

Diagnosis  &  Prognosis    Usually  Accurate  vs.  OXen  Uncertain  

Technological  Interven+ons    Usually  Effec)ve  vs.  OXen  Indicise/Side  Effects  Common  

Outcome    Curable  vs.  No  Cure/High  Risk  of  Remission  

Uncertainty    Minimal  vs.  Pervasive  

Knowledge    Knowledgeable  Professionals  vs.  Pa)ent  &  Professional  complementary  knowledge  

Differences  between  Acute  &  Chronic  Illness    

The  Chronic  Illness  Experience    

• Disease  onset   • Diagnosis   &Treatment  

Crisis  

• Symptom   plateau   • Illness   familiarity   • A[empt  at   pre-­‐illness   func)oning  

Stabiliza)on  

• Acceptance   • Development   of  new   iden)ty  in  the   context  of  the   illness    

Resolu)on  

Experience   the  illness   as  one  life   aspect  

Integra)on  

Not  every  individual  manages  to  journey  through  the  four  stages.  The  most  frequent  recurrent  loop  occurs  between  phase  1  and  2,  where   each  new  crisis  produces  de-­‐stabiliza)on  of  the  individual’s  biopsychosocial  system  followed  by  a  period  of  brief  stabiliza)on.  

Clinical  Considerations  in  Chronic  Illness   Management      

ì  Healing  &  Curing   ì  Curing  is  the  eradica)on  of  the  disease  while  healing  is  the  experience  of  improvement  in  

health  status  despite  the  presence  of  a  disease  process   ì  Chronic  illnesses  are  not  commonly  cured;  acknowledging  that  healing  without  curing  is  a  

reality  can  help  pa)ents  cope  and  have  an  improved  quality  of  life  

ì  Health  &  Wellness   ì  Wellness  in  the  experience  of  func)oning  at  level  where  an  individual’s  poten)al  is  

maximized  (capable);  wellness  can  coexist  with  chronic  illness  

ì  Pain,  Suffering,  &  S)gma   ì  Suffering  goes  beyond  the  conscious  experience  of  pain  (physical,  emo)onal,  or  spiritual  discomfort)  to  

include  the  knowledge  of  and  actude  towards  the  influence  of  pain  on  one’s  life.  Such  actudes  can  be   ones  of  acceptance,  indifference,  or  rejec)on  of  the  pain/discomfort.    

PROVIDERS  NEED  TO  ADDRESS    SUFFERING  AS  THE  ATTITUDINAL  DIMENSION  OF  THE  PAIN   EXPERIENCE    WHEN  IMPLEMENTING  EVIDENCE-­‐BASED  TREATMENT  PROTOCOLS.    

The  Biopsychosocial  Model  as  a  Lens  for   Chronic  Illness  Perception  

ì  The  Biopsychosocial  model  is  an  extension  of  the  biomedical   and  psychosocial  models   ì  It  allows  us  to  conceptualize  the  rela)onship  between  

biological,  psychological,  social,  and  cultural  factors  in  chronic   illness  

ì  It  is  a  comprehensive  and  systemic  perspec)ve  for   understanding  the  pa)ent  and  their  rela)onship  to  the  inner   and  outer  systems  that  impact  health  and  illness    

ì  The  interface  of  these  factors  is  COMPLEX,  with  dynamic  and   reciprocal  associa)ons  

Cultural  Factors  that  Influence     Chronic  Illness  Perception  

FACTOR   DESCRIPTION  

Intolerance  of  Suffering   Suffering  is  perceived  as  having  no  value.  The  expression  of  grief  and  sorrow  is   frowned  upon;  gender  biases  in  expression  of  suffering  (i.e.,  men  don’t  cry).  

Intolerance  of  Ambiguity   There  is  fear  of  the  unknown.  Irra)onal  fears  (e.g.,  chronic  illness  is   contagious)  lead  to  placement  of  guilt/responsibility  on  the  chronically  ill.  

Intolerance  of  Chronic   Illness  

Percep)on  than  the  non-­‐treatability  of  chronic  illness  represents  a  failure  of   modern  medicine  (unlike  acute  diseases  which  are  iden)fiable  and  treatable).  

Cultural  Fear  of  Disease   Fear  of  new/unknown  diseases  leads  to  some  diseases  being  “unacceptable”.   Pa)ents  with  “acceptable”  diseases  are  s)ll  viewed  as  “outsiders”.  

Disease  Encultura)on   The  definable  process  by  which  a  new  disease  en)ty    is  recognized.  It  begins   with  fear,  followed  by  disease  iden)fica)on  (naming),  treatment  op)ons   research,  treatment,  and  acceptance.    Process  may  take  several  years,   detrimentally  affec)ng  pa)ents  with  the  disease  in  the  early  stages  due  to   s)gma  and  discrimina)on.      

Media  Influence   Media  can  influence  and  reinforce  social  stereotypes  and  cultural  biases.   Certain  aspects  of  the  disease  may  be  overrepresented  or  drama)zed,   affec)ng  society’s  percep)on  of  the  disease  process.    

Adapted  from:  Fennell,  P.  (2003).  Managing  chronic  illness  using  the  four-­‐phase  treatment  approach.  Hoboken,  NJ:  Wiley.    

Concluding  Thoughts  

ì  The  treatment  of  pa)ents  with  chronic  illness  requires  a   comprehensive  biopsychosocial  perspec)ve  under  which  an   individual’s  biological,  psychological,  social,  cultural,  and   behavioral  protec)ve  and  risk  factors  shed  light  on  the   conceptualiza)on  and  treatment  of  their  medical  condi)on.  

ì  Acute  and  chronic  illnesses  affect  pa)ents  in  fundamentally   different  ways.  Psychosocial  responses  to  chronic  illness   correlate  highly  with  disease  severity  and  quality  of  life.  For  this   reason,  the  use  of  a  comprehensive  treatment  approach  is   impera)ve  if  providers  are  to  understand  and  facilitate  coping   processes  in  chronically  ill  pa)ents.