Assignment 1 – 1500 words (15% total mark)
Understanding how Lung cancer is caused using the Biopsychosocial Model
Use headings for each Task – Each task is distinct and does not require linking between tasks – content within tasks requires cohesion.
Task 1: The significance of lung cancer in New Zealand. (20pts, Maximum of 300 words) (327)
Lung cancer, as a high-volume cancer with large inequities and a relatively poor survival rate, continues to have the greatest impact on overall cancer morbidity and mortality rates in New Zealand and globally. Cancer is defined as a malignant disease, characterised by an uncontrolled and rapid growth of abnormal cells (REF). Lung cancer as per the New Zealand Ministry of Health is a specific disease caused by abnormal smooth muscle within the lining of the lungs that can invade neighbouring tissues, organs, blood and lymph (1). There are two major groups of lung cancer, each differentiated by which cells are affected. Small cell lung cancer (SCLC) affects alveolar lung tissue whilst non-small cell lung cancer (NSCLC) affects bronchial lung tissue (REF). Both cancers are attributable by biological (genetics, age, tissue health, poor sleep), psychological (motivation, stress, anxiety, sense of stability) and social (income, employment, social networks, education) risk factors, with those more socioeconomically deprived (income < NZD46,500) having the greatest incidence rates (6 + REF).
As the world’s leading cause of death, cancer, accounting for one in six fatalities in 2018 caused an estimated total of 9.6 million fatalities (2). Lung cancer, the most common cancer, accounted for 2.09 million deaths, followed closely by breast cancer with 2.08 million deaths, a stark contrast when compared to diabetes mellitus, another well-known and prevalent endocrine disease that only caused 1.6 million deaths in 2017 (2 + 4). A peer-reviewed literature examination revealed that these global incidence rates of mortality and other associated morbidities relevant to lung cancer, such as chronic obstructive pulmonary disease, were concentrated among lower socioeconomic groups (SEG) with incidence rates 50% higher than those in high SEGs (income > NZD68,800) (5 and 6). These findings reflect the 2017 Manatu Hauora New Zealand cancer statistics which identified the lung cancer mortality rate as 1 in 5.5 people diagnosed with cancer (6). Again, mortality and morbidity were observed more commonly in lower SEGs, such as those who were unemployed, chronically stressed and those who lacked social support, access to education and finances (6 + 2 + one more).
Task 2: Using the Biopsychosocial Model (Engel, 1977) for understanding the causes of health and illness. (30pts, Maximum 500 words)
Paragraph 1 – 150 words (199)
Medical conditions that cause ill-health are complex pathophysiological processes that are often influenced by the interplay of many social, biological and psychological factors that often detrimentally effect the quality of life of individuals and the societies in which they live (REF). Historically, models of health have attempted to understand these risk factors of disease, their influence on individuals and population groups and their pathophysiological significance in disease progression (REF). Some models such as the Biomedical Model, have attempted to achieve this, however, often failed as their application restricted the health practitioner’s foresight to no more than the diagnostic effort in finding the disease – a result, solely because of abnormal physiological processes (REF). Thus, to understand how social factors and individual subjectivity influence health states, the Biopsychosocial Model, a framework outlining the philosophy of interdisciplinary clinical care that encourages a holistic medical practice was proposed by George Engel in 1977 (REF – 1977). This model, in contrast to others, recognised that health status is a result of biological, social and psychological determinants, individually as well as through complex interactions – modifying and modernising the Biomedical Model to be all-inclusive (REF). The model explains that all three factors are equally important in the health and wellbeing of people, and that biological factors cannot be held solely and completely responsible for either health issues, or wellness (REF). Thus, the model broadens the scope of health providers to acknowledge the interplay of dynamics that may affect the expression of disease, coping methods, adherence to treatment, and recovery (REF).
Paragraphs 2-4 – 100 words each
– Write one paragraph describing each individual component of the model and also how the individual components are related to each other.
– Make sure you give examples of the kind of processes or factors that make up each component. What are the types of biological, psychological and social processes or factors that influence health? Don’t try to apply it to a specific health issue, just outline the general processes and factors involved.
Paragraph 2 – Biological characteristics (100 words)
Biological factors: genetic material, function and structure of physiology, immune responses, anatomical systems
The biological aspect of the Biopsychosocial model deals with the study and comprehension of the physiological causes of disease. It recognises that the human body is a complex interaction of sophisticated systems that can affect the psychology and physical functioning of human beings (REF). Biological risk factors of an individual’s health such as genetic makeup, chemical composition, blood flow, organ function, gastrointestinal process and the nervous system all contribute to an individual’s overall health, wellbeing, and level of functioning and that changes in either of these levels can have a profound impact on the body and thus, disease formation – a core concept of the biomedical model (REF). Although the biological concept is a core component of the BPS Model, it clearly states the non-biological factors also heavily influence the processes and expression of an individual’s disorder in those with pre-existing genetic risks.
Paragraph 3 – Psychological factors (100 Words)
The psychological component of the BPS Model seeks to find a psychological foundation for a particular symptom or array of symptoms (impulsivity, irritability, overwhelming sadness etc.) that contribute to disease processes. It also recognises that underlying mental health issues contribute to the manifestation of an illness. Engels Model recognises that a person’s internal reality can have a significant impact on disease and that personal beliefs about illness can affect how a person responds to a diagnosis as well as how the person follows through on treatments. Individuals with a genetic vulnerability may be more likely to display aspects of negative thinking that puts them at risk for depression; alternatively, psychological factors may exacerbate a biological predisposition by putting a genetically vulnerable person at risk for other risk behaviours. Increased risk-taking behaviours lead to an increased likelihood of disease. An individual’s coping strategies, including thoughts and feeling about one’s health, have been shown to affect the severity of an illness with individuals feeling hopeless and powerless more likely to experience sever symptoms than those who maintain positive perspectives. Psychological factors can also impact on whether a person is even aware of their illness, as well as the persons motivation to adhere to treatment recommendations. Thus, the medical expert prescribing treatment based on the principals of the BPS Model must identify any psychological problems that may be affecting the patient’s health directly or indirectly
Psychological factors: Behaviour, lifestyle, choices, decision-making, cognition, beliefs, knowledge, emotion/affect, mental health, personality, motivation
Engel’s Model recognises that a person’s internal reality can have a significant impact on disease and that personal beliefs about illness can affect how a disease manifests
Paragraph 4 – Social conditions (100 Words)
The social component of the BPS Model refers to the environment in which the individual exists. This aspect analyses the disease from a sociological point of view and determines the external factors that may have influenced the manifestation of the illness in the patient. These external factors may be anything from religion, economic background, financial stability, social support networks and cultural environments. The social and cultural components are conceptualised as a particular set of stressful events that may differently impact the mental health of people from different social environments and histories. Such life events may predispose an individual to developing psychological risk factors or alter the biological composition of the individual, which may, in turn, contribute to physical health disorders. Cultural factors such as the differences in circumstances, expectations and belief systems of different cultural groups can contribute to different prevalence rates and symptom expression of disorders. Culture can change biology, as research in epigenetics suggests that the environment can alter an individual’s genetic makeup. For example, those exposed to overcrowding and poverty are more at risk for developing depression with actual genetic mutations forming over a single generation.
Cultural norms and societal expectations can contribute to health or illness significantly. Ones culture provides values as to whether it is acceptable to seek treatment for a problem or whether the condition is seen as the persons own doing. Other cultural or social standards such as the acceptance or rejection of medication, reliance on communal rather than medical support, emphasis on physical symptoms rather than psychological factors. Cultural and social factors can impact a persons diet, exercise levels, religious practices, and other behaviours. Social connections can also impact on an individual’s ability to cope with health or illness. Studies have shown that the existence of strong social supports can speed up recovery and contribute to longer life expectancies. Individuals with strong social support often show better adherence to treatment because family and friends are motivators during the process. Each of the previous concepts can contribute significantly to both the development and the treatment of a condition; therefore, integration of all these areas is a key feature of the biopsychosocial model. The knowledge of when and where to refer a client for additional support is also an important part of integrated care and requires cross-disciplinary relationships.
Social factors: relationships, support, families, community, environment, availability of resources, SES, gender, ethnicity/race, age.
Summary 3 sentences.
Task 3: The relevance of the Biopsychosocial Model for understanding the causes of lung cancer. (30pts, Maximum 500 words)
Paragraph 1:
o Your first paragraph should focus on describing the way in which the model has been used to understand the causes of different health issues.
o Give some evidence for the effectiveness of the model for understanding different health issues. Don’t look at the effectiveness and/or relevance of each component and just focus on the overall effectiveness of the model.
Paragraphs 2-4:
o Write one paragraph for each component in the model explaining the relevance for understanding the causes of lung cancer. Focus specifically on the types of processes and factors within the components of the model for understanding the causes of lung cancer. Provide an example and evidence from the literature to show the relationship between each component and lung cancer.
Task 4: Summary and Conclusions. (10pts, Maximum 200 words)
Paragraph 1:
o Write a sentence or two summarising what you have written for tasks 1-3.
Paragraph 2:
o Write a couple of concluding sentences about the usefulness of the Biopsychosocial Model for understanding the causes of lung cancer.
Address the broader determinants of health, reduce social inequities, empower individuals and communities and promote interprofessional collaboration.
10 pts will be allocated to writing style, referencing, evidence and finding two new quality resources.
*Indent the first line of each paragraph – Size 12 font – No spaces between paragraphs
*Reference List – Hanging indent
1. https://www.health.govt.nz/publication/selected-cancers-2015-2016-2017
2. https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2018/vol-131-no-147927-july-2018/7641
3. https://bpac.org.nz/BPJ/2012/November/upfront.aspx
4. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
5. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192999
6. file:///C:/Users/eddie/Downloads/nzsei-2013%20(1).pdf
7. https://www.health.govt.nz/publication/cancer-new-registrations-and-deaths-2013
8. file:///C:/Users/eddie/Desktop/The_SAGE_Encyclopedia_BioPsychoSocial_Model___(Pg_164–169).pdf
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