Colon cancer in elderly


SW 613: Behavioral, Psychosocial and Ecological Aspects of Health and Disease
Winter 2010
Instructor: Brad Zebrack

Final Paper Assignment: Overview

Purpose of the project. The purpose of the Final Paper assignment is to gain an understanding of the nature and distribution of a particular health problem, the etiology of the health condition, its prognosis and treatment, and noted social determinants and health disparities in these dimensions. The assignment examines issues of the behavioral, psychosocial and ecological aspects of the health problem, with focused attention on the role of social work approaches (Interpersonal Practice, Community Organizing, Management of Human Services, and Social Policy and Evaluation) in addressing micro and macro features of the health problem.

Learning Objectives. The student will be able to understand, use and apply acquired perspectives, knowledge and skills about the health problem and the role of social work to the analysis of a diverse range of health conditions and problems.

Skill Development. The student will acquire skills in the areas of research, analysis, synthesis of health information and data, and health literacy. The student will develop skills in critically evaluating written products, identifying stresses associated with disease, and targeting individual, community-level and society-level processes for intervention and change.

Relation of final assignment to course content. The final assignment is focused on the major elements of course content with respect to the distribution, determinants, and psychological and behavioral aspects of health and disease. The assignment involves the examination of the behavioral, psychological, social, economic, environmental, and cultural variations in and determinants of the health problem. The influence of social determinants such as race, gender, and socioeconomic position are examined and inform the discussion of the existence of potential health disparities in disease prevalence, treatment, and/or outcomes. The discussion of social work roles addresses issues of professional ethics and PODS content.

Format for the final project. A written paper divided into 2 sections, totaling no more than 10-12 pages, double-spaced (not including references). 12-point font with 1” margins is required. Use APA style for in-text citations and references. All students will complete Section 1 of the assignment and opt to complete either Section 2A or 2B.

Main project components and their relation to one another. In Section 1 of the assignment, the student will provide an overview of the nature and course of an identified health problem, including its associated distribution patterns in the US across sub-groups defined by race/ethnicity, age, gender, socioeconomic status and/or sexual orientation (epidemiology, rates of excess risk). Section 2A of the assignment continues with an elaboration of how environmental, psychosocial, behavioral and/or ecological factors contribute to the onset and exacerbation of a particular health problem, and the potential for social work involvement. Alternatively, Section 2B elaborates on individual and family experiences of the course of illness, and the potential role for social work involvement. All sections should provide appropriate citations and references substantiating presentation of data.

Grading. See separate hand-out for grading rubric.

Please upload an electronic version of your paper into the CTools Drop Box by 5pm on April 23rd. Please also deliver a hard copy to Dr. Zebrack’s office or else attach an electronic copy to an email sent directly to Dr. Zebrack.

Possible Health Problems. The list of health problems listed below can be selected for the final assignment. You must select a topic that you did NOT cover in your mid-term narrative assignment. If there is a health problem that is not listed here that you would like to use for the final assignment, please contact the instructor to discuss.


 Alzheimer’s Disease
 Asthma
 Cancer (specify type)
 Cerebral Palsy
 Congestive Heart Failure
 COPD (Chronic Obstructive Pulmonary Disease)
 Crohn’s Disease
 Cystic Fibrosis  Cardiovascular Disease (CVD)
 Diabetes
 Eating Disorders
 Heart Attack
 Hepatitis B
 Hepatitis C
 HIV and AIDS
 Hypertension (High Blood Pressure)  Infertility
 Lupus
 Multiple Sclerosis
 Parkinson’s Disease
 Rheumatoid Arthritis
 Stroke
 Tuberculosis



Guidelines and Outline:

Section 1: Health Problem Description (3-4 pages): Describe a specific health problem or condition and its associated distribution patterns in the US. Answer the following questions.

1. What is the common name of the health problem and scientific name, if it differs from the common one?

o Describe the incidence, prevalence, mortality and survival rates associated with this health problem in the United States.
o What are common physical and psychological symptoms associated with the disorder?
o Is there a typical age or age range of onset? If so, what is it?
o What diagnostic and/or screening procedures are used to assess this condition?
o What organs and body systems are involved in this health problem?
o What is the etiology of the disorder?
o What are the usual treatments for the disorder?
o What is the prognosis with and without treatment?

Section 2A (7-8 pages): Select two (2) social determinants from the following list. Answer each of the questions listed below in relation to each social determinant you have selected.
1. Gender 8. Marital status
2. Age 9. “Race”
3. Ethnicity 10. Cultural group
4. Income and assets 11. Education
5. Occupation 12. Insurance status
6. Geographical region, U.S. or internationally 13. Other relevant social characteristic
7. Population density

1. What are the identifiable differences in the distribution (e.g., rates of incidence, prevalence, morbidity or mortality, survival) of your health problem?
2. Are there identifiable differences in the timing of diagnosis by the social determinants you selected?
3. Are there differences in treatments offered based on these social determinants?
4. Are there differences in outcomes or appropriate referral and follow-up for treatment based on these determinants?
5. What known behavioral risk factors are associated with the social determinants and this disease? For example, persons of lower socioeconomic status are more likely to smoke than persons of higher socioeconomic levels, thus putting persons of low income at greater risk for cardiovascular events (e.g., stroke, heart attack).
6. What known social factors are related to the behavioral factors you will have identified? For example, one reason that obesity is on the rise is the increased portion size in restaurants. Coupled with increased portion sizes, more people rely on more meals out of the home and thus become accustomed to eating larger meals.)
7. What other important psychosocial and/or environmental factors are associated with the social determinant and this disease?
8. Social Work Roles: Discuss how a social worker, through two social work practice methods (Community Organization, Interpersonal Practice, Management of Human Services, and Social Policy and Evaluation), could intervene and influence the effects of social determinants on the health problem. Specify actual activities, programs, therapies or policies a social worker might initiate at interpersonal, community or societal levels to address your selected health issue. Cite existing evidence-based approaches reported in the literature.



Section 2B: Course of Illness, Lifespan and Family-focused Intervention (7-8 pages): This section distinguishes an individual’s or family’s experience of illness from the physiologic disease process. Using the chapter by Rolland and Werner-Lin (as well as other resources) as a guide:

1. Delineate and describe crisis, chronic, recovery and/or terminal phases associated with your identified health problem, the transitions between phases, and the psychosocial developmental tasks (for individuals or families) associated with these phases.

2. Describe the psychosocial demands of the illness/health problem based on its pattern of onset, course, outcome, incapacitation, and level of uncertainty. Discuss stresses and coping behaviors experienced by the individual or family when the health issue occurs, particularly when these stresses occur “out of time.” Discuss culturally-based attributions of meaning to illness and provide 2 specific examples.

3. Discuss the role of social work in influencing this health problem, its course of illness, and individuals’ or families’ abilities to cope across a continuum of care.

1. Discuss how a social worker, through two social work practice methods (Community Organization, Interpersonal Practice, Management of Human Services, and Social Policy and Evaluation), could intervene and improve an individual’s and/or family’s experience of, and ability to cope with, this health problem. Specify actual activities, programs, therapies or policies a social worker might initiate at interpersonal, community or societal levels and at different points along a continuum of care to address your selected health issue. Cite evidence-based approaches to involvement with patients and families.


Additional Information

What is an appropriate balance between using Internet-based resources vs. journal articles in researching your health topic?

This is an important consideration given the vast amount of information that is available using the Internet. I would ask you to be an informed consumer of Internet information. That is to say, that all information that is available on the Internet is not equally reputable, valid or reliable.

Information from official government websites (the various National Institutes of Health and other federal government agencies) are reliable sources of information.

Information from national organizations (National Cancer Institute, Juvenile Diabetes Association, American Heart Association) are similarly very reliable sources of information.

Similarly, websites that are associated with major medical institutions (the Mayo Clinic, Harvard Medical School) are reputable sources of information on health matters.

Websites from special interest and advocacy groups can be very useful. However, be aware that in their role as special interest and advocacy groups, the developers of these websites may be particularly motivated to provide a specific perspective in their presentation of materials, information and data. This, in and of itself, is not necessarily problematic. However, it may be the case that aspects of a particular topic may not be as thoroughly examined as is needed for your purposes.

DO NOT use Wikipedia or other similar websites as a source of information for either portion of this assignment.

As in using any information from the Internet, it is wise to be a CRITICAL AND AWARE CONSUMER.

I do expect you to be aware of and to have researched the non-Internet resources that are available on your topic (journal articles, in some cases, books). Given that most professional/scientific journals are available online, the issue of accessibility (having to go to the library) should not be a barrier in using these sources of information.

You should work towards obtaining a balance between journal articles and Internet resources. This will be particularly critical when you move into Section 2 (examining the social determinants) in which much of the current research related to the social determinants of disease is available in newly published journal articles or in books that specifically examine issues of social determinants and health. In addition to the online resources and information that are available, explore other resources and information by searching through online databases like PubMed and MedLine for appropriate journal articles and books.

Medline Interactive Health Tutorials

Helpful Definitions

etiology: The cause or causes of a disease or abnormal condition <some types of cancer have a viral etiology> <a multiple etiology in which biological, psychological, and sociocultural factors all play a role — M. E. Jackson et al> 2 : a branch of medical science dealing with the causes and origin of diseases
prognosis: 1 : the act or art of foretelling the course of a disease 2 : the prospect of survival and recovery from a disease as anticipated from the usual course of that disease or indicated by special features of the case <the prognosis is grave; death usually occurs within one year>
incidence: a : an act or the fact or manner of occurring or affecting <diseases of domestic incidence — Science> b : rate of occurrence or influence; especially : the rate of occurrence of new cases of a particular disease in a population being studied
prevalence: the percentage of a population that is affected with a particular disease at a given time
risk factors: something which increases risk or susceptibility <a fatty diet is a risk factor for heart disease
excess risk: The difference between two proportions, signifying a disparity. In epidemiology it’s typically defined to be the difference between the proportion of subjects in a population with a particular disease who have a specified risk factor (e.g., being over age 65) and the proportion of subjects with that same disease who do not have the risk factor (under age 65). Suggests that the incidence or prevalence of a condition in a certain sub-population is greater than what would be expected for the population as a whole. For example, if the incidence of condition X in the general population is 1 in 100 and the incidence of the same condition in a specific non-Caucasian racial group is 2 in 100, the “excess risk” among non-Caucasians with the condition is twice that of everyone else with the same condition.


Cancer is one of the most threatening health conditions in the world. In the last few decades, case of patients who are diagnosed with cancer has been on the rise, which is attributed to changing lifestyle patterns that increases exposure to cancerous materials. Apart from rising case of cancer, it has been noted that new forms of cancers have been recorded.  Colon cancer is one type of cancers that cause more than 655,000 deaths in the world every year. Colon cancer is the fifth most common type of cancer in United States (Weitzel, 2009). It has also been ranked as the third largest cause of cancer related deaths in developed world. Colon cancers are cancer growths in colon, rectum, or in the appendix. It is more prevalent in old people. Colon cancer can have negative effects on the elderly patients unless they get necessary treatment and social assistance (Baron et al., (2005).  Social work can play a grater role in alleviation of effects of colon cancers among elderly.