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Treating the psychological and social needs of the chronically ill

Kalliopi Megari

- Healthcare

- Dec 17 2014

Kalliopi Megari

Professor and clinical neuropsychologist, Aristotle University of Thessaloniki,

Kalliopi Megari, professor and clinical neuropsychologist at Aristotle University of Thessaloniki in Greece, stresses the importance of a holistic approach to caring for the chronically ill as a means to improve their chances of living - not only longer, but more importantly, living better.

In 2012 the World Health Organization reported that chronic conditions are the leading cause (60%) of mortality worldwide. What is the universal definition of chronic disease?

Kalliopi Megari: Generally speaking, a chronic disease is permanent and results in residual disability caused by irreversible pathological alterations in the body. While the majority of chronic conditions are found in people aged 18 to 64, at the same time, 80% of older adults

in the U.S. have at least one chronic condition and at least 50% of this population suffers from two or more. Chronic diseases are usually slow to progress and require medical treatment. Cultural differences and beliefs as well as lifestyle, diet and approach to stress can largely shape

the way individuals behave and perceive their illnesses, symptoms and emotional states. The majority of chronic diseases can limit a patient’s capacity to function physically, psychologically and socially, profoundly impacting a patient’s well-being.

Given the vast scope of chronic diseases, what is being done today to effectively treat chronically ill patients?

K.M.: Typically a chronic disease patient is pulled into a vicious cycle. First the patient experiences physical pain, among other symptoms, which usually leads to feelings of anxiety, depression, anger, isolation, or uncertainty about the future. Cancer patients are especially concerned with body image and often fear a recurrence. This can cause mood swings, diminished self-esteem and a heightened sense of vulnerability. All these feelings can actually increase a patient’s physical pain while also putting significant strain on family members, friends and colleagues. Indeed, physical, psychological, and social stressors are often intertwined, both resulting from and contributing to each other.

How do medical and research communities evaluate a patient’s quality of life?

K.M.: As I mentioned, it is important to keep in mind that the patient’s physical, psychological and social experiences and needs are all interconnected. In 1993 two scientists (Patrick & Erickson) defined the term Health Related Quality of Life (HRQoL), as a multidimensional construct that consists of measuring the functioning of these three broad domains: physical functioning, which is usually defined as the ability to perform a range of daily activities; psychological functioning ranges from severe psychological distress to a positive sense of well-being; and social functioning refers to all aspects of social relationships, interactions and integration.

HRQoL is measured through personal interviews or questionnaires, usually within a university research setting. The study is designed to evaluate a patient’s life expectancy, taking into account any impairments, functional states, or perceptions as they are influenced by disease, injury, treatment or even health policy. The most important aspect of HRQoL is how patients perceive their experience with illness and the discrepancy that exists between this reality and patients’ hopes or expectations.

Are there shortfalls in services in terms of care?

K.M.: While there have been remarkable advances in biomedical care, sadly there have not been equal advances in providing patients with high quality care for the psychological and social effects of chronic diseases. Numerous cancer patients, for example, report that medical providers fail to recognize and adequately address depression and other symptoms of stress, and generally do not consider psychosocial support to be an integral part of quality care.

How can chronic disease patients experience a longer and better life, despite their illness ?

K.M.: The majority of chronic diseases may worsen the overall health of patients by limiting their functional status. So, treatment of these limitations has become extremely important in ensuring a better Quality Of Life. But for a chronically ill patient, these qualities must be re-acquired or relearned. In this respect, it’s important to design intervention programs that promote skills that cover: physical training and exercise, relaxation, health education (including smoking cessation, healthy eating and limiting weight gain), stress management, active self-management and employment support. Programs can also incorporate psychosocial counseling to reduce anxiety and depression and build greater autonomy and ease. In order to be efficient, these programs must have the buy-in of the entire medical team.

The heightened vulnerability of chronically ill patients makes patient-doctor relationships and communication extremely important. Psychologists therefore occupy a pivotal role in clinical settings because they can provide training for doctors and nurses to learn how to communicate with patients and their caregivers in a way that promotes both physical and psychological health.

If you could describe a model for future care of the chronically ill, what would it be?

K.M.: An integrated framework for healthcare would be built on a single guiding principle: addressing the physical, social and psychological aspects of chronic disease helps patients and the entire population to live better. This holds true regardless of the type of chronic disease or an individual’s own state of health. Within this model, the medically-driven decision making process would of course include the patient’s voice and point of view. It’s vital that we listen to and hear what the patient has to say!

Contact Kalliopi Megari at kmegari@psy.auth.gr

To learn more, consult the global healthcare magazine Quality of Life Experiences


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Treating the psychological and social needs of the chronically ill

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  • Mon
    02 Feb

    Dr Pavlides

    Very good. All medical doctors must watch this interview carefully.

  • Mon
    26 Jan


    Very interesting interview. The holistic approach is the best approach for chronic diseases.Professor seems very qualified. Well done!

  • Mon
    19 Jan


    Excellent work and point of view. Can you publish more of her work?


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