Chapter 15 Summary PDF

CHAPTER 15 WHAT'S AHEAD FOR HEALTH PSYCHOLOGY? CHAPTER OUTLINE I. Goals for Health Psychology A. Section introduction 1. People are living longer and are more likely to develop chronic disease. a. chronic diseases are aggravated by lifestyle...

CHAPTER 15 WHAT'S AHEAD FOR HEALTH PSYCHOLOGY? CHAPTER OUTLINE I. Goals for Health Psychology A. Section introduction 1. People are living longer and are more likely to develop chronic disease. a. chronic diseases are aggravated by lifestyle i. medical professionals lack skills and time to address many of these issues ii. health psychologists have training and research to contribute B. Enhancing illness prevention and treatment 1. Section introduction a. efforts to prevent health problems should promote health- protective activity and reduction of unhealthful behaviors while the person is well b. health psychology has given much attention to health-related behaviors in peoples’ lifestyles i. unhealthful lifestyles are harder to change than prevent ii. cognitive behavioral approaches are effective in producing initial changes but relapse is common c. psychosocial issues also relate to behaviors once an individual has been diagnosed i. individuals often engage in sick-role behaviors ii. individuals may not seek medical attention because they are unaware of the symptoms of a serious illness iii. people are less likely to adhere to complex medical advice 2. Advances in research and theory a. health psychologists will continue to pursue research using new research methods i. ecological momentary assessment allows researchers to examine people’s everyday feelings and behaviors ii. stages of change model is an example of a theory regarding the changing of unhealthful behaviors b. research and theory need to be expanded in two ways i. need to incorporate more biological, psychological, and social factors that relate to health ii. need to give more attention to life-span changes in the nature of health threats  3. Advances in technology a. technology will play an increasing role in preventing and managing illness i. internet sites providing medical information ii. software designed to help drinkers reduce alcohol intake C. Improving efforts for helping patients cope 1. Major advances in use of psychosocial methods to help people cope. a. stress management and worksite wellness programs have reached nonpatient populations b. use of psychosocial interventions has increased in pain clinics, hospitals, and other medical settings c. psychologists' roles are expanding in hospitals and rehabilitation settings to include training and applying interventions D. Documenting the efficacy and cost-benefit ratio of care 1. Providing psychological services depends on the efficacy and cost-benefit ratio for the services. a. the bottom line is weighed heavily in decisions to offer programs 2. As researchers, psychologists aren't accustomed to analyzing costs & benefits of interventions. a. financial costs are often easily assessed but full range of benefits are not as clear-cut i. benefits could include reduced time in hospitals, less medication, faster recovery, better pain management ii. measuring benefits of psychosocial programs is easier in medical settings 3. Many psychosocial programs provide benefits that far outweigh the costs. a. hospital patients receiving help to cope during medical procedures recover more quickly and use less medication b. the benefits of workplace wellness programs outweigh costs c. health psychologists will give much more attention to cost/benefit analysis in the future E. Enhancing psychologists' acceptance in medical settings 1. Gaining acceptance by the medical professions continues to be a challenge. 2. Historical trends a. psychological services seen as tangential to medical needs b. psychologists not trained in physiological systems, medical illness and treatment, and organization of hospitals 3. Today health psychologists receive appropriate training to work in medical settings and more physicians recognize the psychosocial aspects of health and illness. 4. Strain can occur if one of the functions of a psychologist is to teach medical personnel "people skills."  a. stylistic differences between psychologists and medical personnel can lead to conflict, but can be resolved b. different ways of communicating about a patient's condition (i.e., charting) may contribute to conflict 5. In 2001, guidelines for medical education require including skills in teamwork and communication with non-medical professionals. 6. Psychologists need to be included as part of a standard team approach to be best accepted by patients. II. Careers and Training in Health Psychology A. Career opportunities 1. Career opportunities will probably continue to grow. a. psychologists working in health settings doubled from 20,000 in 1974 to 45,000 in 1985 b. some states have passed laws enabling psychologists full staff status in hospitals 2. Health psychologists practice in college and universities, medical schools, HMOs, rehabilitation centers, pain centers, and private practice. B. Training programs 1. Training is offered at undergraduate, graduate, and postdoctoral levels. 2. Graduate training may be specialized in research or service orientation, but involve a grounding in psychology and health-related courses. 3. Some professionals have recommended greater standardization of health psychologist training. III. Issues and Controversies for the Future A. Environment, health, and psychology 1. Health psychologists may help assess the effects of exposure to toxic substance, pollutants, or to stress. a. efforts may also be directed toward changing behaviors that produce these problems B. Quality of life 1. Why the focus on quality of life? a. QOL is reduced by becoming and staying sick b. QOL important in prevention efforts i. maintaining good health affects QOL c. life-or-death decisions often come down to judgement of QOL 2. Psychologists and medical personnel will need to make better quality of life assessments. a. quality-adjusted life years i. computed by assessing how long a person is likely to live after receiving treatment, multiplying by treatment QOL and adding together ii. can be used to assess and rank different treatments  C. Ethical decisions in medical care 1. Section introduction a. bioethics committees have developed in hospitals i. discuss ethical issues in health care ii. make policy iii. recommend action regarding specific cases b. types of issues discussed i. patient's right to choose treatments ii. patient's right to withhold or withdraw treatment iii. patient's right to die 2. Technology and medical decisions a. use of technology and data has raised ethical questions i. example – computer program which gives odds that patient will die in intensive care or after leaving it ii. how will data be used? iii. will these numbers be weighed too heavily by physicians and families? iv. what if insurance companies want the data? b. ethical dilemmas in organ transplants. i. who are the best candidates to cope with stress and behave appropriately to maintain health with a new organ? c. ethical dilemmas in genetics technology. i. since technology now can identify people who may develop genetic diseases, who should be tested and who should have access to results? 3. Assisted dying: suicide and euthanasia a. ending life is a controversial issue in general and in the medical community i. some physicians believe life is sacred and shouldn't be involved in trying to end life ii. others believe if a person is beyond all help and the decision isn't due to depression, they should help b. assisted suicide i. the patient takes the final action with a physician's cooperation c. euthanasia i. the physician ends the life d. legal issues i. some countries and states permit both assisted suicide and/or euthanasia e. role of the psychologist i. could assess the person's emotional status, ability to make sound decisions, likelihood of benefiting from psychosocial interventions IV. Future Focuses in Health Psychology A. Section introduction. 1. Early studies produced narrow view of biopsychosocial influences due to limited subject pool.  a. subjects were readily available. b. researchers believed results would generalize. b. recent studies have increased the representativeness of samples. B. Life-span health and illness 1. From conception to adolescence a. prenatal environments have an effect on health i. health psychologists are studying ways to improve prenatal environments by educating parents b. health beliefs and habits form in childhood and adolescence. i. little research has been done on how these beliefs actually develop ii. efforts to promote healthy behavior such as proper diet, exercise, dental care, and seat belt use needs to begin early iii. later childhood should focus on accident prevention, cigarette and drug use, and unsafe sex 2. Adulthood and old age a. by the time adulthood has been reached, health behaviors are ingrained and difficult to change i. affects chances of developing chronic diseases ii. prolonged emotional difficulties influence future illness b. worldwide aging of the population presents health care challenges i. how will health care system respond to added load? ii. critical to find ways to prevent or change risky lifestyles iii. need to improve ways families cope with caring of elderly relatives C. Sociocultural factors in health 1. We don't exactly know how cultural customs and socioeconomic factors shape lives. 2. Health psychology needs to address understanding and reducing poor health habits of minority groups. 3. Cross-cultural research needs more emphasis. a. few studies examine differences across countries b. countries whose citizens most affected by behavioral risks don't yet recognize principles of health psychology i. research is needed on how to adapt health psychology principles to other cultures D. Gender differences and women's health issues 1. Health psychology has neglected women's and gender issues until the 1980s. 2. Current research emphasizes the uniqueness of men and women. a. women and men differ in stress reaction, type A and B behavior patterns, risk of AIDS and heart disease, weight regulation, and tobacco and alcohol use b. special interventions are likely needed to promote health V. Factors Affecting Health Psychology's Future A. Factors influencing amount of research, clinical intervention and health promotion activities. 1. Economic and financial pressures. a. cutbacks in government and private funding may influence financial support b. increasing health care costs may create pressure to increase funding in health psychology areas c. funding may also depend on insurance structuring 2. Education and training a. field of health psychology may influence students in other nonpsychology disciplines and promote importance of research, and psychological interventions 3. Developments in medicine a. new health problems may require psychosocial interventions