1
Q
– Perceiving Symptoms –
A
2
Q
Do we perceive symptoms accurately? Internal and/or external?
A
- We can notice strong sensations over weak ones, but we don’t assess internal nor external states very accurately
- People might not perceive a strong symptom, yet detect one that doesn’t have a physical basis
3
Q
Can some people detect internal symptoms better than others? What does this NOT indicate?
A
- Yes - people might have a heightened awareness. Sometimes paying too much attention
- Often know about the presence of a symptom, BUT are no more accurate
4
Q
What personality trait is associated with the tendency to notice/complain about symptoms?
A
Neuroticism
5
Q
Competing Environmental Stimuli in Perceiving Symptoms - athlete example
A
- Some athletes might get a bad injury, but downplay it in the moment. It hurts much more afterwards!
- The extent to which people pay attention to symptoms can depend on the degree of environmental stimuli present at the time
6
Q
Competing Environmental Stimuli in Perceiving Symptoms - when are people less likely to notice internal sensations?
A
When the environmental stimuli are noxious or exciting
7
Q
– Psychosocial Influences –
A
8
Q
What happens as a result of people not being accurate in assessing their internal/physical states?
A
Their bodily symptoms can be heavily influenced by cognitive, social, and emotional factors
9
Q
How have researchers demonstrated the role of cognitive factors in interpreting symptoms?
A
Through PLACEBOS
10
Q
What other cognitive factor can increase the symptoms people perceive?
what phenomenon do they experience?
A
- Expectations: e.g. patients who are taking an active medication sometimes show a nocebo phenomenon - perceiving side effects, such as dizziness or fatigue, that could not be the direct result of the drug
- They basically “manufactured” sensations based on their expectations
11
Q
What can worry do to the symptoms people perceive?
A
Can make people more vigilant, such as when individuals who worry a lot about their asthma are more accurate in noticing symptoms and attributing them to their asthma condition
12
Q
– Highlight: Understanding the Placebo Effect –
A
13
Q
When does the placebo effect occur?
A
When a medical procedure or treatment produces a response due to the user’s beliefs and experiences about the intervention or pill rather than its actual physical/chemical properties
14
Q
Important points about the placebo effect: often results from…
A
- …prescribed medications in addition to their pharmacological effects.
- This is why randomized clinical trials, which test the efficacy of drugs, utilize placebo control groups - by administering an inert substance to the control group, any placebo effect that may occur in the treatment group is equalized
15
Q
What factors can influence/contribute to the placebo effect?
A
- Color of the pill
- Simply describing an inert substance
- Verbal suggestions
16
Q
Key mechanisms/explainers for the placebo effect? (2)
A
- Expectation - that a belief in a response may result in an actual response
- Classical conditioning - that a physiological response occurs due to previous experiences and conditioning with a partciular feature of treatment
17
Q
Cognitive, Social, and Emotional Factors can create 2 phenomena: 1
A
Medical student’s disease: as med students learn more about diseases, many of them believe incorrectly that they have contracted one of these (self-diagnosing)
18
Q
Cognitive, Social, and Emotional Factors can create 2 phenomena: 2
A
- Mass psychogenic illness: involves widespread symptom perception across individuals
- Usually begins with an event, such as an unusual odour or someone fainting - then a chain reaction occurs with person after person feeling symptoms
19
Q
Cognitive, Social, and Emotional Factors can create 2 phenomena: WHY?
A
- People are already feeling negative emotions, such as high stress felt by the med students
- Symptoms involve common physical sensations, such as headache or dizziness, that are vague and very subjective in nature
- Expectations and other cognitive factors exaggerate the sensations
- Modelling of the symptoms
20
Q
Gender Differences in perceiving pain + why
A
- Women report feeling discomfort at lower stimulus intensities than men and request that a painful stimulus be terminated sooner
- Evidence suggests differences in sex hormones and gender role beliefs
21
Q
Sociological Differences in perceiving pain + why
A
- People of different cultural backgrounds seem to differ in their perceptions of and reactions to illness symptoms
- Might be due to cultural norms from reinforcing stoical versus distressed and disabled behaviours when in pain
22
Q
OVERALL: people’s perception of a symptom depends on…
A
- the strength of the underlying physical sensations
- tendency to pay attention to internal states
- degree to which external stimuli compete for their attention
- variety of social and emotional processes
23
Q
– Interpreting and Responding to Symptoms –
A
24
Q
How do people’s prior experiences affect their judgements of symptoms?
A
Most ofen, past experience probably helps people make correct judgements
25
We use information from past experiences/expectations about illneses to further construct _ of those illnesses
Cognitive representations or ***commonsense models***, which can affect our health-related behaviour
26
Commonsense Models - involve 4 basic components of how people think about disease: **1**
**Illness Identity:** consists of the name and symptoms of disease
27
Commonsense Models - involve 4 basic components of how people think about disease: **2**
**Causes and Underlying Pathology:** ideas concerning how one gets the disease ("I got a cold becaude someone sneezed in my face")and what physiological events occur with it
28
Commonsense Models - involve 4 basic components of how people think about disease: **3**
* **Timeline** or prognosis ideas: such as how long the disease takes to appear and lasts
* e.g. symptoms of salmonella take hours to first appear: some people know this, others don't
29
Commonsense Models - involve 4 basic components of how people think about disease: **4**
**Consequence:** involves ideas about the seriousness, effects, and outcomes of an illness
30
How do commonsense models of illness appear to affect future health and disability in at least 2 ways?
1. People with ***incorrect illness ideas* are less likely than others to adopt preventative behaviours** and when ill, less likely to seek treatment
2. **If an illness becomes *chronic*, people's expectations about their condition often worsen** - leading to negative emotions and a lessened sense of personal control
31
How can fear impact someone's approach to health behaviour?
1. Motivate a person **toward health behaviour**
2. Motivate **maladaptive avoidance behaviour**
32
Lay Referral Network?
* People tend to turn towards friends, family, loved ones for health advice before professionals
* These people base their knowledge on personal experience, preference, etc.
33
People within a lay referral network, **people can do 4 of the following:**
1. Interpret a symptom
2. Give advice about seeking medical attention
3. Recommend a remedy
4. Recommend consulting another lay referral person
34
Can laypersons give accurate advice?
Sometimes, but might also recommend things that worse the condition or delay the person's recovery
35
Why do people nowadays seek health advice from the internet?
With the goal of self-diagnosing
36
-- Using/Misusing Health Services --
37
Who uses health services more than others do? What might affect these rates?
* People with health risks
* Might be affected by demographic and sociocultural factors
38
Age: how often do children visit physicians?
More contacts with physicians per year than adolescents and young adults, the number of contacts increases consistently through old age
39
Gender: who has high rates of physician visits?
W > M
40
Possible explanations for women having more physician visits?
1. Women simply develop more illnesses that require attention
2. Men more hesistant to admit having symptoms and to seek medical care
41
Sociocultural Factors: rate of physician visits for Indigenous populations/immigrants
* Report significantly fewer doctor consultations each year compared with non-Indigenous Canadians
* Low for immigrants too
42
Frequently cited criticism of the Canadian Healthcare System?
Difficulty in securing a family doctor
43
Sociocultural Factors: reasons for gaps? **3**
* Individuals of lower classes **tend to view themselves as less susceptible to illness** than those of higher status; Thus, less likely to seek out preventative care
* People with low incomes and from minority groups are **less likely to have regular sources of healthcare**
* **Language barrier**
44
-- Why People Use, Don't Use, and Delay Using Health Services --
45
Sociocultural Factors: barriers for Indigenous peoples
* Language and culture
* Canada's healthcare is poorly equipped for addressing and accomodating cultural needs
46
Iatrogenic Conditions
* **Patients sometimes develop health problems *as a result of medical treatment* (e.g. a practitioner's error)**
* These experiences can influence our decisions to use medical services
47
2 issues of patient trust against practitioners?
1. Individuals may avoid getting care because they worry that their practitioners won't keep information confidential
2. Members of minority groups and individuals with certain diagnoses can encounter stigmas in a healthcare setting
48
Health Belief Model on perceiving symptoms?
* Symptoms initiate a decision-making process about seeking medical care
* Involves assessing the **perceived threat** suggested by the symptoms, and the **pros and cons** of taking action
49
How much threat individuals perceive **depends mainly on 3 factors:** **recap**
1. Perceived seriousness
2. Perceived susceptibility
3. Cues to action
50
Emotional Effects: Depression
51
Emotional Effects: Fear
People frightened by their symptoms are more likely to seek care quickly opposed to people with little fear
52
Emotional Effects: Embarassment
Leads to avoidance of medical care
53
Social Factors? men ex
Many men believe getting medical care is a sign of weakness
54
Social Factors: social triggering
* **Social factors that encourage people to seek care**
* EX: sanctioning - someone asks or insists that an ill person have symptoms treated
55
-- Stages in Delaying Medical Care --
56
Treatment Delay
the time that elapses **between when a person *first notices a symptom* and when the person *enters medical care***
57
Treatment delay occurs in **3 stages:**
1. **Appraisal Delay:** time it takes to *interpret a symptom as an indication of illness*
2. **Illness delay:** time taken between *recognizing one is ill and deciding to seek medical attention*
3. **Utilization delay:** time after *deciding to seek medical care until actually going in to use that health service*
58
Different factors important at different stages of delay? (for delaying treatment)
1. Appraisal delay - **sensory experience** of the symptom
2. Illness delay - **thoughts** about the symptom
3. Utilization delay - **perceptions** of benefits and barriers
59
Why is it bad that when people don't feel physical pain, they don't seek help?
Many major, serious diseases don't feature pain as a main symptom (e.g. cancer)
60
-- Using Complementary and Alternative Medicine --
61
Complementary and Alternative Medicine (CAM)
* **Prevention of illness with practices/products not currently considered a part of conventional medicine**
* A method is complementary is used along with conventional treatments, and alternative if used in place of them
62
Examples of CAM practices?
1. Manipulative and body-based methods
2. Natural products
3. Mind-body interventions
63
Who uses CAM?
* People around the world
* Normally educated, have aligned beliefs and values
* White, in Western provinces
64
Issues for CAM methods + when can they be adopted into conventional healthcare?
* Little or no scientific evidence of their effectiveness, let alone safety
* Adopted once sufficient evidence is found
65
-- Problematic Health Service Usage --
66
When can healthcare usage become problematic?
* Overusing it when there is no medical need
* Often hypochondriacs
67
Hypochondriasis
* **Tendency of individuals to worry excessively about their health, monitor their bodily sensations closely**
* Known as a psychiatric disorder, now formally called illness anxiety disorder
* Factitious disorder is also another condition that involves repeatedly and intentionally acting if one is sick
68
Link between hypochondriasis and emotional maladjustment/neuroticism?
* Involves a high degree of self-consciousness and "vulnerability to stress as well as the tendency to experience anxiety
* Thus leads to health complains
* Even future development of a variety of illnesses
69
-- Patient-Practitioner Relationship --
70
Negative patient stories regarding practitioners?
* Many patients have stories about negative experiences, involving insensitivity, lack of responsiveness
* Lead to others being skeptical
71
How do people differ in the participation they want?
Some might want more details than others - and practitioners might underestimate/not understand this
72
Research has revealed 3 associations with clients' participation preferences
1. Gender, age, sociocultural differences exist
2. Those who receive their desired type of participation show overall better adjustment and satisfaction with medical treatment
3. Patients who want more of an active role tend to adjust their recovery periods better and recover faster
73
Patient participation - practioner side of things?
Sometimes practitioners differ in the participation they are inclined to provide
74
Patient participation - mismatch between the patient wants and practitioner willingness?
1. Patients experience more stress
2. Clients less likely to follow advice
3. Dissatisfaction and interpersonal discomfort can lead to a switch in doctors
75
-- Practitioner's Behaviour and Style --
76
Doctor-centered style?
* Physician asks questions that only require brief answers ("yes" or "no"), focused mainly on the first problem the person mentioned
* Intent on establishing a link between the initial problem + a disorder, without getting sidetracked
77
Patient-centered style?
* Less controlling; asks open-ended questions like that allow a patient to relate more information and introduce new facts that may be pertinent
* Avoid using medical jargon, allow clients to take part in decision-making
78
Medical jargon - issue for patients, particularly those of lower-class backgrounds?
Many fail to understand the terms their physicians use
79
Why would physicians use terms with a patient when they do not expect the person to understand?
* Out of habit
* Feels, in a patronizing way, that the person doesn't need to know
80
Priorities for patients in a practitioner?
* Competence
* Warms
* Sensitivity
* Concern
81
Other important aspects of physicians' styles relates to...
The diagnostic information they receive from their patients
82
-- Patient's Behavioural Style --
83
What are some things that patients do that could be unsettling for a doctor?
1. Not following the prescribed treatment
2. Waiting too long with symptoms before contacting the study
3. Making sexually suggestive remarks
84
Do patients do things that impair parient-practitioner communication?
People who are high in neuroticism may convey too much concern about their conitions (seeming less credible and less in need of medical care)
85
Why do patients give unclear descriptions of their symptoms?
1. **Might be the way they perceive symptoms**
2. Individuals form **different commonsense models**
3. People might try to **emphasize or downplay a symptom they think might reflect a serious illness**
4. Person could be young or an immigrant, lacking a good sense of the practitioner's primary language
86
What can be done to improve communication between patients and practitioners?
* Training programs to improve physician's interview styles
* Interventions can improve pateint's communication too (ex: fill out a form that has them list any symptoms and q's they have)
87
Important thing to keep in mind about patient-practitioner communication?
Often, practitioners fail to change as they lack feedback for their work
88
-- Compliance: Adhering to Medical Advice --
89
Adherence and Compliance
Both terms that refer to **the degree to which patients carry out the behaviours and treatments** their practitioners recommend
90
Why is it difficult to answer the question, "how widespread is the problem of nonadherence?"
1. Failures to adhere may occur for many different types of medical advice
2. People can violate each doctor's orders in many ways (omit doses, using a drug for the wrong purpose, taking medication in wrong amount/at wrong time)
91
How to assess patient's adherence to medical recommendations?
* Ask a practitioner who works with the client to estimate it
* Ask the patient themselves (however, they tend to overreport adherence)
92
How widespread is noncompliance?
About 40%, aka 2/5 patients
93
3 more factors regarding patient adherance to medical advice
1. The average adherence rate for taking medicine for chronic illness drops (more than acute)
2. Adherence to taking medicine is higher in the date before/after visiting a doctor than at other time
3. Advice that requires changes in lifestyle is generally variable often
94
3 further considerations about the general trends in adherence?
1. Percentages stated might overestimate adherence
2. Adherence rates don't reflect the *range* of noncompliance
3. Nonadherence can have serious health effects
95
-- Why/Why Don't People Adhere to Medical Advice? --
96
What impacts patients' adherence? Depends on characteristics of...
1. The illness of regimen
2. The person
3. The interactions between the practitioner and patient
97
Advice that requires changes to life habits?
People often are less likely to adhere to medical advice for changes in personal habits
98
Advice that requires many steps or a strict schedule?
The greater the number of drugs and the more complex the medication schedule and dosage, the greater likelihood the person will make an error
99
What else can impact adherence to medical advice?
* Side effects
* Expense
* Duration
100
Are individuals with serious illness more likely to adhere than those with milder health problems? Why?
* NO
* Might be because many very serious health problems have no symptoms that worry people greatly or interfere with their functioning
101
Can specific characteristics/demographics affect adherence? EX social class, race, religion
* Not so much individually
* However when combined, can show a stronger correlation to compliance
* Some may be relevant to compliance in some situation sover others
102
Responsibility for medical compliance over lifetime
* Children: become more responsible as they get older
* Adolescents: may be less likely to comply with long-term treatments (peer pressure, social influence)
* Older adults: more likely to suffer from visual, hearing, and cognitive impairments that affect carrying out a regimen
103
What other characteristics/demographic factors might be at play?
1. Some cultural groups may have beliefs or customs that undermine adherence
2. Some minority groups may have lower literacy rates and higher health risks
104
-- Psychosocial Aspects of the Patients --
105
Rational Nonadherence
Sometimes not adhering to a treatment regimen may be **deliberate** and based on **valid** reasons
106
Rational Nonadherence - valid reasons?
1. Have a reason to believe that medication isn't helping
2. Confused about when to take it
3. Don't have the money to take the next refill
107
Most common reason for non-compliance?
FORGETTING
108
Two other psychosocial factors associated with adherence?
* Self efficacy: ppl who feel they can carry out the regimne and receive proper support are more likely
* Social support
109
OCEAN trait associated with good adherence?
Conscientiousness - ppl who plan when, where, form ways to avoid lapses
110
-- Patient-Pracitioner Interactions --
111
Why is clear communication to patients important?
* Increases likelihood of adherence
* Yet this isn't always clear
112
Good communication involves...
* Patience
* Patient-centered approaches
113
-- Increasing Patient Adherence --
114
What happens when people don't adhere to regimens suggested by their physicians?
* Risks their health and possibly develops problems they don't already have
* Can prolong/worsen existing symptoms
115
What happens when people don't adhere to regimens suggested by their physicians? **Is this always detrimental?**
* No - only greater for serious and chronic illnesses than for less serious conditions
* Physicians sometimes prescribe things with non-medical goals in mind (i.e. avoiding malpractice)
116
Methods to Promote Adherence - **#1**
Orienting patients to the disease process and the reason for the treatment in terms that they can understand
117
Methods to Promote Adherence - **#2**
Using straightforward language without being condescending
118
Methods to Promote Adherence - **#3**
Use written instructions, even breaking down into smaller segments
119
Methods to Promote Adherence - **#4**
Have patient repeat the regimen in their own words
120
Behavioural Methods to Enhance Motivation? **4**
1. Tailor the regimen to the person
2. Provide reminders
3. Self-monitoring/recording
4. Behavoiural contracting (specifying rewards for success)
121
-- Focusing on Prevention --
122
Chronic Care Model
Healthcare systems focus on secondary and tertiary prevention (ie slowing/reversing progress) and have developed processes for managing chronic diseases
123
Chronic Care Model: **Organization of Care**
Health admin give explicit and obvious priority to primary prevention, and provide incentives for staff to engage in these efforts
124
Chronic Care Model: **Clinical Information Systems**
Organization requires regularly updates, easily accessed data in client files regarding the need for and status of preventitive services so staff can receive feedback
125
Chronic Care Model: **Delivery-System Design**
Physicians initiate preventative interventions, such as mailings and counselling for stopping smoking
126
Chronic Care Model: **Decision Support**
Providing staff with training to identify clients who need intervention and to carrry it out
127
Chronic Care Model: **Self-Management Support**
The healthcare system provides information and referrals to clients and their families to help them recognize the need for preventative services and for change in unhealthful behaviours
128
Chronic Care Model: **Community Resources**
The healthcare system extends its prevention efforts into the community by making use of self-help organizations, such as for quitting smoking and losing weight, and supporting public health programs/laws
PSYC 314
flashcards
Decks in class (36)
# Cards
-
Lecture 1-224
-
Lecture 329
-
Lecture 428
-
Lecture 530
-
Lecture 639
-
Lecture 727
-
Lecture 825
-
Chapter 1105
-
Chapter 3101
-
Chapter 4117
-
Chapter 588
-
-------------------------- MIDTERM 1 --------------------------0
-
Lecture 9 - Health Behaviours and Promotions23
-
Lecture 10 - Health Behaviours and Promotions28
-
Lecture 11 - Health Behaviours and Promotions, Substance Use11
-
Chapter 6158
-
Lecture 12 - Substance Use & Addiction32
-
Chapter 70
-
Lecture 13 - Diet, Exercise, & Weight Control19
-
Chapter 8140
-
Lecture 14 - Using Health Services & Patient-Practitioner Interaction27
-
Chapter 9128
-
Lecture 1520
-
Chapter 1068
-
-------------------------- MIDTERM 2 --------------------------0
-
Lecture 16 - Pain and its Symptoms and Management22
-
Chapter 11 lol119
-
Lecture 17 - Pain and its Symptoms and Management29
-
Chapter 12107
-
Lecture 18 - Managing Chronic Illness and Family Involvement0
-
Chapter 130
-
Lecture 19 - Managing Chronic Illness and Family Involvement0
-
Chapter 140
-
Lecture 20 - Psychosocial Aspects of Chronic Illness and Aging; End-of-Life Care and Bereavement0
-
Lecture 21 - Psychosocial Aspects of Chronic Illness and Aging; End-of-Life Care and Bereavement0
-
Chapter 150
