Developing strategies to improve the management of chronic illness: a focus on disability and psychosocial aspects in an illness with an organic cause (cancer) and an illness with a non-organic cause (IBS).
Year: 2008
Type: dissertation
Study design: Observational Study
Abstract: Models of health care concentrate on acute conditions yet the major cause of disease burden is \nchronic illness. An emphasis on biomedical, as opposed to bio-psychosocial models, \nunderestimates psychological disability and fails to explain burdens resulting from illnesses \nwith no known organic cause. Topics explored were: quality of life, chronic and acute stress, \nemotion regulation, communication, support services, patient expectations, satisfaction with \nmedical treatment, and health care seeking. Using grounded theory (Glaser, 1992) and active \npatient participation (Susman & Evered, 1978), the major objective was to develop strategies \nto improve the management of chronic illness. \nTwo groups were studied: 20 patients with an organic cause (cancer) and 21 patients with a \nnon-organic cause (Irritable Bowel Syndrome). Using quantitative and qualitative measures, \nobservational studies (N=29), interviews (N=41), focus groups (N=12), and a case study \n(N=10) were conducted. IBS patients reported greater disability (increased distress and \nreduced quality of life) than the cancer group and other chronic illnesses. Cancer patients \nshowed impaired quality of life but they reported levels of distress up to 50% lower than the \ngeneral population and 75% lower than another chronic illness group. Some cancer patients \nappeared to under-report levels of distress; however, when applying Pennebaker’s (1997) \nwritten disclosure method, emotional expression was not uniformly associated with beneficial \noutcomes. \nInterviews with IBS patients revealed that determinants of dissatisfaction involved a lack of \nacceptance and/or understanding of an IBS diagnosis and an expectation that consultants \nwould find an organic cause. Cancer participants reported no need for participation in \ndecisions concerning treatment. Evaluations of the quality of health services received were \ndistinct from evaluations of the quality of care received by specialists. Fighting spirit and positivity were linked with emotional inhibition and a lack of uptake of support services. \nPatients became more pro-active in seeking emotional and social support later in their illness \nexperience. These findings were interpreted within the Conservation of Resources Theory \n(COR; Hobfoll, 2001; 1999; 1998). \nResults in this study challenge public policy recommendations that focus on encouraging \nconsumer participation in health care. Recommendations for intervention and future research \nwith cancer patients focus on application of the COR theory. In IBS, patient education, \nimprovements in communication and the adoption of Drossman’s (1998) bio-psychosocial \nmodel are advocated. Finally, recommendations for improvements in methodology involve \nsuggestions to incorporate quantitative and qualitative measures using longitudinal \nassessments with the grounded theory (Glaser, 1992) approach being an excellent \nmethodological template.
Author: Vikki Knott
Language: English
Topic: Cancer survivorship and care
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2286165296