1 / 25

Module: Health Psychology Lecture: Preventive Medicine Date: 16 February 2009

Module: Health Psychology Lecture: Preventive Medicine Date: 16 February 2009. Chris Bridle, PhD, CPsychol Associate Professor (Reader) Warwick Medical School University of Warwick Tel: +44(24) 761 50222 Email: C.Bridle@warwick.ac.uk www.warwick.ac.uk/go/hpsych.

clark
Download Presentation

Module: Health Psychology Lecture: Preventive Medicine Date: 16 February 2009

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Module: Health PsychologyLecture: Preventive MedicineDate: 16 February 2009 Chris Bridle, PhD, CPsychol Associate Professor (Reader) Warwick Medical School University of Warwick Tel: +44(24) 761 50222 Email: C.Bridle@warwick.ac.ukwww.warwick.ac.uk/go/hpsych

  2. Aims and Objectives • Aim: To provide an overview of psychological issues relevant to screening and preventive intervention • Objectives: By the end of this session you should be able to describe … • the different types (levels) of screening • the psychological factors that contribute to variation in screening uptake • the ethics of screening in terms of the psychological and behavioural effects of screening • brief screening methods for two common presentations, i.e. depression and alcohol misuse • brief screening and preventive intervention for smoking

  3. Definitions Screening • Presumptive identification of unrecognised disease or defect by tests, examinations or other procedures • Early detection increases treatment effectiveness, with potential to delay mortality and reduce morbidity • Can not reduce, but may increase, incidence rate Preventive Medicine • Health care initiatives aiming to maintain and/or improve health among people who are currently free of symptoms • Preventing disease onset - delayed mortality, reduced morbidity and lowered incidence, e.g. heath promotion • Preventing disease progression, e.g. screening

  4. Types of Screening • Population Screening • Services aimed at identifying health problems, e.g. mammography and PAP smear • Self-Screening • Behaviours aimed at identifying health problems, e.g. breast and testicular self-examination • Opportunistic Screening • Adjunctive identification of (other) health problems, e.g. hepB in pregnancy and depression in primary care

  5. Screening Uptake • Much variation in the uptake of screening services • Disease • Mammography, 75% - HIV testing, 6% • Country • Mammography, 78% (England), 68% (Wales), 38% (Eire) • Geographical region • Mammography, 81% (South-East), 62% (North-East) • Sub-groups • Mammography, <50% in low S-E-S and minority groups Jepson et al (2000)

  6. What factors influence the uptakeof screening services? • Patient factors • Background demographic factors, stable individual differences, social network, and situational factors • Variation between people and within people • Provider factors • Provider beliefs and behaviour • Organisational factors • Invitation delivery, invitation response type, and screening location

  7. Why is there ethical controversy over screening? • A large number of people are tested in order to detect a small proportion of individuals who have preclinical disease. • Many people screened unnecessarily, and screening may have negative effects • Thus, a much larger number of people may experience harm from screening than those who experience the potential benefits from screening.

  8. Are there potential negative consequencesassociated with screening? • Four screening phases • Invited to participate • Complete the screening test • Wait for results • Receiving results and recommendations

  9. Breast Cancer (50-64 Years) Sensitivity (a/a+c) = 83% probability a case will screen positive Specificity (d/b+d) = 95% probability a non-case will screen negative

  10. Negative Effects of Test Result Result(per1000) Response / Effect • True + (50) Anxiety, fear, stress, guilt, etc. Patient, patient’s family, and provider Lower use of services by social group False + (500) Unnecessary treatment • True – (9450) Maintain health-damaging behaviours Initiate health-damaging behaviours Ignoring subsequent symptoms False – (10) Untreated progression of disease • Amended (510) Loss of trust in service, and provider Less and delayed use of health care

  11. Ethical Considerations • Informed uptake • Conflict between research/practice goals and ethical considerations – biased framing • Consent • Invitation to participate presupposes consent, and can not be withdrawn • Effect of screening on others • Relatives in the context of genetic screening • Confidentiality of medical information • How confidential are test results and patient data, not just now but also in the future?

  12. Depression • Depression is the largest source of morbidity in the world (WHO) • Easy and quick to screen patients - questions based on affect and motivation within a specified time period • Two questions: • During the past month have you often been bothered by feeling down, depressed or hopeless? • During the past month have you been bothered by having less interest or pleasure in doing things? (Arroll et al., 2005)

  13. Alcohol • Hazadous alcohol use V Alcohol misuse • Easy and quick to screen patients with many different mnemonics, e.g. CAGE • Have you ever felt the need to Cut down your drinking? • Have you ever felt Annoyed by criticism of your drinking? • Have you had Guilty feelings about your drinking? • Did you ever need a morning Eye-opener? (Ewing, 1984)

  14. Smoking • Proportion of smokers abstaining from smoking long term, by cessation intervention 6-Month Intervention Abstinence (%) No intervention (self-help/willpower) 2 (30% try) Brief, opportunistic screening 5 and BPI from doctor to stop + NRT 10 Intensive support from specialist 10 + NRT 18 (West et al, 2000)

  15. The 5 A’s • For every patient at every consultation • ASK the patient if he or she uses tobacco • ADVISE him or her to quit • ASSESS willingness to make a quit attempt • ASSIST him or her in making a quit attempt • ARRANGE for follow-up to prevent relapse

  16. The 5 R’s • For smokers unwilling to make a quit attempt • RELEVANCE: Tailor advice & discussion to each patient • RISKS: Outline the risks of continuing smoking • REWARDS: Outline the benefits of quitting • ROADBLOCKS: Identify barriers to quitting • REPETITION: Repeat message at every visit

  17. The 5 Stages Stage of change • Precontemplation • Contemplation • Preparation • Action • Maintenance Motivation • Not thinking about stopping • Thinking about stopping • Planning to stop • Trying to stop • Stopped for some time

  18. Assessing Motivation • Simple test of motivation to stop smoking • Do you want to stop smoking for good? • Are you interested in making a serious attempt to stop in the near future? • Are you interested in receiving help with your quit attempt? • A “yes” response to all questions suggests high motivation to quit • Used to allocate resources • High: behavioural support and/or medication • Low: BPI to increase motivation, i.e. stage progression

  19. Once a decision to quit has been made, success is determined more by level of dependence than level of motivation

  20. Assessing Nicotine Dependence • Important to assess dependence • Guide choice of nicotine-based pharmacotherapy, i.e. nicotine dose should reflect dependence level • Two question screen: • How many cigarettes do you smoke a day? (15+ = high) • How soon after you wake up do you smoke your first cigarette? (within 30 minutes reflects high dependence)

  21. Your patient (Ask about smoking) Smoker Never smoked Ex-Smoker (>1 year) Advise: As your Doctor I must advise you that … Assess motivation: Do you want to quit for good? Assessment & BPI Algorithm Ready to quit Thinking about quitting Not thinking of quitting Assist: NRT, cessation support Assist: Enhance motivation to trigger quit attempt Assist: Enhance motivation - raise awareness - 5 Rs Arrange follow-up

  22. Smoking Summary • Smoking cessation integrated into routine clinical practice - the 5A’s • Don’t give up on smokers not yet ready to quit – the 5R’s • Motivational messages are effective if tailored / personalised – the 5 stages • Choice of NRT should be guided by level of nicotine dependence

  23. Conclusions • Preventive medicine is a integral part of clinical practice • Screening has many important health benefits • Screening uptake is variable • Individual screening behaviours are disease-specific • Screening has potentially negative consequences • Ethical considerations must be acknowledged

  24. Summary • This session would have helped you to understand … • the different types (levels) of screening • the psychological factors that contribute to variation in screening uptake • the ethics of screening in terms of the psychological and behavioural effects of screening • brief screening methods for two common presentations, i.e. depression and alcohol misuse • brief screening and preventive intervention for smoking

  25. Any questions? • What now? • Obtain / download one of the recommended readings • In your small groups consider today’s lecture in relation to next week’s tutorial tasks: a) integrated template b) ESA question

More Related