Module 3 Overview: Chronic Illnesses, Quality of Life, and Palliative Care Resources image of puzzle pieces with the last puzzle piece being put into the puzzleImage from Pixabay uploaded by wilhei Module Objectives By the end of this module, you will be able to: Examine how the diagnosis of a chronic illness can influence one’s quality of life. (*co 4) Evaluate patient’s quality of life (QOL) using the QOL Model. (*co 4) *tied to course objective (co) Instructor Commentary Illness and Disease According to Lubkin and Larsen (2016) disease refers to the pathophysiology of a condition (p. 4). The term illness is the human experience of a disease and refers to how the disease is perceived, lived with and responded by individuals, their families and healthcare professionals (p.4). In order for physicians to manage a disease they need to determine if it is acute or chronic. Acute means a sudden onset of symptoms that are short term in nature and affect functional capacity on a temporary basis (Falvo, 2014, p.10). Chronic refers to symptoms that last indefinitely and are attributed to a cause that may or may not be able to be identified (p.10). Facts about Chronic Illness Chronic illness is becoming an epidemic as 75% of the $2 trillion are spent in healthcare costs annually in the United States. For individuals with chronic illnesses enhancing or maintaining quality of life has received very little attention (Institute of Medicine, 2012). Around 25 million Americans report receiving unwanted treatment. In a 2014 compassion and choices poll, Americans wanted adequate information about treatment for advanced illness and wanted physicians to be forthcoming about the potential downsides of treatment (Compassion and Choices, 2014). When someone is faced with a chronic disease, for example Chronic Obstructive Pulmonary Disease (COPD), we need to ask what the illness trajectory could possibly look like. According to Falvo (2014), the term Trajectory is the course of a health condition over time, plus actions taken by individuals and families to manage or shape the course of the condition (p. 10). Some illnesses are classified by stages, for example COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2016) use the following stages to describe where a person is within an illness trajectory: Stage 0: at risk, Stage I: mild, Stage II: moderate, Stage III: severe, and Stage IV: very severe. With any chronic illness there can be periods of stability where needs are managed and illness remains the same. Eventually the disease will progress, possibly with episodes of flare ups that could be degenerative causing a continuation of the breakdown of structure or function. It is during these times of instability, progression, flare ups and degeneration where management of ones quality of life (QOL) and needs can make a huge difference. Quality of Life Model/Palliative Care Resources Palliative care is a comprehensive treatment of the discomfort, symptoms and stress of serious illness. The goal is to prevent and ease suffering and improve QOL (NINR, 2009, p.1). The term QOL is a subjective concept that can only be observed and ultimately defined by the patient. It incorporates a multitude of components including the patients past experiences, cognitive abilities, and perception of self as they relate to the disease process (Connor, 2009). Many tools have been developed to evaluate ones QOL focusing on management of disease signs and symptoms and side effects of treatment. The City of Hope Quality of Life Model was developed grounded on the assessment of forces. These forces include assessment of an individual patients physical, psychological, social and spiritual well-being and measures how they define levels of satisfaction with the facets of life that they feel are most important (Lavdaniti & Tsitsis, 2015). Measuring QOL in palliative care provides information to evaluate the effectiveness of the care provided and the areas that need further attention according to the patients perspective (Lawerence & Clancy, 2003). Image of the Quality of Life Model explaining four dimensions of care Physical (Functional Ability, Strength/Fatigue, Sleep and Rest, Nausea, Appetite, Constipation, Pain), Psychological (Anxiety, Depression, Enjoyment/Leisure, Pain Distress, Happiness, Fear, Cognition/Attention), Social (Financial Burden, Caregiver Burden, Roles and Relationships, Affection/Sexual Function, Appearance), Spirtual (Hope, Suffering, Meaning of Pain, Religiosity, Transcendence)Image courtesy of American Association of Colleges of Nursing with permission to embed within this course. This QOL Model is used to evaluate a patients QOL for all diagnoses at all stages of disease. References Compassion & Choices. (2014). 25 million older Americans have experienced unwanted or excessive medical treatment, survey suggests. Retrieved from https://www.compassionandchoices.org/25-million-older-americans-have-experienced-unwanted-or-excessive-medical-treatment-survey-suggests/. End of Life Nursing Education Consortium (ELNEC). (2015). Core Curriculum. Train the Trainer Program. Falvo, R, D. (2014). Medical and psychosocial aspects of chronic illness and disability (5 ed.). Sudbury, MA; Jones and Bartlett Publishers. Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2016). Global strategy for the diagnosis, management, and prevention of COPD. Retrieved from https://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/ Institute of Medicine (IOM) (2012). Living well with chronic illness: A call for public health action. Washington, DC; The National Academies Press. Lawerence, W., & Clancy, C. (2003). Health outcomes assessment in cancer. Disease Management & Health Outcomes, 11(11), 709-721. Lavdaniti, M., & Tsitsis,N. (2015). Definitions and conceptual models of quality of life in cancer patients. Health Science Journal, 9(2:6), 1-5. Lubkin, M. I., & Larsen, P. D. (Eds.). (2016). Chronic illness: Impact and interventions (9th ed.). Sudbury, MA; Jones and Bartlett Publishers. National Institute of Nursing Research (NINR). (2009). Palliative care: Improving quality of life when you are seriously ill. Retrieved from https://cancer.ucsf.edu/_docs/sms/PalliativeCare.pdf The QOL Model can be incorporated into the care of all patients with any diagnosis at any point during their illness. Develop a case study discussing a patient with a disease process, of interest to you (i.e. oncology, cardiac, renal, respiratory, etc), who would benefit from instituting palliative care at the time of diagnosis. Incorporate the City of Hope/ELNEC QOL Model (introduced in the Module 3 overview) as a tool for evaluating your patient. Provide explanations of the patients perspectives of QOL related to the physical, psychological, social and spiritual forces in their life. Discuss aspects of care that could be offered to the patient that would provide them with better QOL from their perspective (i.e. information related to disease process, ability to talk about their fears, adequate pain control, financial strain, etc). Discuss any additional outcomes that you feel are important and should be attained. Support the information with the palliative care resources provided and at least two additional scholarly articles from the scholarly healthcare literature. Paper should to be 3-5 pages not including title page and reference page. Follow APA formatting and the guidelines of the Written Assignment Rubric.
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