SAN BEDA COLLEGE OF MEDICINE Batch 2011

Topic: Impact of Illness on the Family FCM I

Lecturer: Mek Villafuerte-Solana, MD, CFP
December 2007

Objectives of the Session

• Differentiate between disease and illness

• Determine reasons why impact of illness on a
family should be studied
• Learn the stages of the family illness trajectory
and the responsibilities of the physician in each
stage

Why study impact of illness?

• Sickness of a patient causes suffering and How is investigation done?

severe disruption for the patient’s family
• Explore the patient’s explanatory models
• Illness sets in motion processes that are
• Explore for patient’s understanding of the following
disruptive and hazardous to health of family
issues:
members
o Etiology
• Role reversal, income loss
o Pathophysiology
• Prolonged and complicated illnesses result in
o Trajectory and outcome of his illness
structural change within the family system to a
o Appropriate treatment
point that leads to different roles and functions
o

Problems Contributing to the Disease

Process
The Family
Sufferings
Illness
• Prim
Trajectory-Passage Thru

psyc
• Poverty
• Unemployment • Natural course of the psychosocial aspects of
• Other sickness in disease
• the family • Knowledge of the trajectory allows the physician to

disor
• Chronic family predict, anticipate, and deal with a family’s
• dispute response to illness
• Poor nutritional habit • Indicates normal and pathologic responses thus
• Inadequate housing condition enabling physicians to formulate special
therapeutic plans

• Labo
Major Illnesses Involves Loss of the Following

• Body parts
• Ability to carry out normal and treasured activities
• Sense of self-esteem

Trans Com: TEODOSIO, MARCELO

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• Dreams and plans for the future wife accepts laundry work from neighbors in order
• Sense of invulnerability of one’s self and in love to feed their family and take care of Nilo’s needs
ones that keep existential fears of impending and medications.
death and separation at bay

Stage I- ONSET OF ILLNESS

Stages in Fa
What will your responsibilities as a physician be?
• Warning sign of malaise which initiates
preliminary stage of the illness trajectory • Explore fear that the patients/ family bring up in the
• Stage experienced prior to contact with medical clinic
care providers • With inappropriate label of illness, acknowledge
• Nature of illness may play an important role on and explore conflicts the patient and family may be
impact of illness

Case # 1
• Stage I • OnN
experiencing
• Explore aspects
patients and families
of pre-diagnostic phase of

• Stage II • Im
• Roberto, 32, father of 3 small children, applied Stage II- REACTION TO DIAGNOSIS:

N
as a seaman 1 year ago. After 6 months of being IMPACT PHASE
away from his family, he died of fatal arrhythmia
while aboard his ship. • Describe disease and treatment according to
patient’s level of comprehension and

Di
• C
understanding
• Make a clinical judgment about the amount of
information to give and be absorbed by the patient
• Give small doses of information over time

• Stage III Mae

C
• If diagnosis is confusing or stressful
o Provide support and continuity of
care
o Interpret findings
Offer advise and encouragement

• Stage IV Re
o

Case # 2

2 PLANES OR AREAS BY WHICH A

• Nilo, 26, father of 2, sole provider, worked as a PATIENT/FAMILY REACT AND ADJUST

• Ad
Im
messenger for 2 years. He encountered a
motorcycle accident 1 year ago which left half of EMOTIONAL PLANE
his body, from the waist down, paralyzed. His • Denial, disbelief, anxiety (min to hrs)

Trans Com: TEODOSIO, MARCELO

• • Nature
Stage of
V illn
Ad
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• Emotional upheaval such as anger, anxiety and • Make clear about the nature of illness by helping
depression (wks) the family maintain openness that allows sharing
• Accommodation and acceptance and support
• Know that the feeling of guilt is a natural response
COGNITIVE PLANE to stress of grief and loss, anticipate such feelings,
• Phase 1: Tension and confusion, lack of capacity and make realistic goals to correct the feeling
for problem solving • Help the family assess the likely effect of the
• Phase 2: Repeated failure in deriving the illness on the family
diagnosis leading to increased distress • Assess the capability of the family to cope with
• Phase 3: Receptivity of family to new approach stress
for relief of distress • Offer alternative interpretation of proposed
• Phase 4: Eventual acceptance of diagnosis therapeutics

Case # 3
Mae, 21, with a 18 month old old child, was
diagnosed with Lymphoma 6 months ago. Due to
lack of funds, her mother, who is also the Stage III- Major Therapeutic Efforts
caregiver, has tried several faith healers and other
therapeutic modalities to comfort Mae’s symptoms. • Represents one of the most challenging and
When asked about Mae’s family history of rewarding part of medical practice
cancer, her mother said that her husband, Mae’s • Physician should deal with multiple variables
father, died of liver CA in the hospital where Mae o work in harmony with the wishes of
was diagnosed with Lymphoma. She expressed the patient and family
her fears regarding the management and the o Coordinate all aspect of the therapy
appropriateness of care in the hospital.
Mae continued to have anorexia and
vomiting, back pain, cough, and difficulty of
breathing.
Also, she has been depressed for the last
three months because aside from her illness, her
husband was rumored to be having another girl,
limiting his time in caring for Mae.

Responsibilities of the Physician

• Anticipate problems and help family cope and

adapt through family meetings/ discussion
WO
• Emotional
Trans Com: TEODOSIO, MARCELO
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Involving Family Members in Routine Office
Visits • Information Exchange- Ask what the family knows

• One or more family members are present about the patient’s illness; Educate family about
the illness
• Common medical Situation: Well-child and
• Establishing a Plan- develop a mutually agreed
prenatal care, diagnosis of a chronic illness
upon treatment plan and clarify each person’s role
• Length of visit: 15-20 min
in carrying it out
• How scheduled: Request family member
attendance
• Family Interviewing

CRITICAL ISSUES IN CHOOSING

THE THERAPEUTIC PLAN

Involving F
• Psychological state and preparedness of the
patient and family
• Assume responsibility of care very early in the
treatment plan. Define roles
• Economic status
o Economic impact of illness

Routin
 Emotional trauma
 Social dislocation
 Economic catastrophe
• Lifestyle and cultural characteristics of the family

Involving F
• Effects of hospitalization, surgery, and other
therapeutic methods are emotionally stressful to
the family

DO’s
• Hospitalization gives rise to stressful logistic
problems
o Father- special economic burden

Routin
o Mother- greatest impact on other
family members; high risk of family

Family Conferences • Greet each family o

dysfunction
Children- syndrome of emotional
problems; hostility, abandonment

member
• A specially arranged meeting requested by the o Parents- helpless, guilt, frustrated, or
physician, patient or family to discuss the hurt
patient’s health problem in more depth than can o Geriatric- vulnerable to fears of
be addressed during a routine office visit death, rejection, abandonment;

• Acknowledge any
• Medical Situation: Terminal Illness loneliness and helplessness

DO’s
o Institutionalization
• Length of visit: 30-40min RESPONSIBILITIES OF THE PHYSICIAN

emotions express
• Joining Phase- develop rapport with family
• create a sense of trust • Remain open and work in harmony with the patient

• Goal Setting- why the family has been convened and his family

•• Emphasize indiv
• Deal with multiple variables; consider all factors

Phases of Family Conferences when planning

Encourage family
Trans Com: TEODOSIO, MARCELO
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• Coordinate all aspects of therapy
• Anticipate pathologic responses and be able to
deal with them
Case # 4
56/M, married with 3 children, came in due to
cough for 1 month.
CXR: Cavitary lesion at right apex
Diagnosis: Pulmonary Tuberculosis
Tx: 2 months HRZE, 4 months HR
How will you present your diagnosis, and
educate the patient about the disease?
How will you present your management and
convince the patient to adhere to
prescribed medicines?
Case# 5
49/M, married with 4 children, works as a seaman.
He was supposed to board back to his ship when
his agency did not allow him him due to high blood
sugar
FBS: 235mg/dl
History:polyuria, polydipsia, polyphagia
Family History of DM
How will you present your diagnosis, and
educate the patient about the disease?
o Followed by a period of waiting to
see if illness will return
o Fear of death
o Constant sense of vulnerability
• Permanent disability
RESPONSIBILITIES OF THE PHYSICIAN
• Deal with immediate effects of trauma
• Alleviate anxiety and assure adequate rest
• Psychological support
• Explore level of understanding of patient and
family
Stage V- Adjustment to the Permanency of the
the
Outcome
• Family’s adjustment to crisis
• Second crisis occurs as family realizes that they
must accept and adjust to a permanent disability
• FOR ACUTE ILLNESS: Potential for crisis when
routines are suspended
o Physician can facilitate acceptance
of diagnosis
• FOR CHRONIC ILLNESS: Prolonged fear and
anxiety leads to higher incidence of illness in other
members of the family
o Feeling of guilt brings about anger
and resentment
o Physician should encourage

How will you present your management and ventilation of feelings, give

convince the patient to adhere to the reassurance and reinforcement of

prescribed medicines? care

• FOR TERMINAL ILLNESS: Highly emotional and

Stage IV-Early Adjustment to Outcomes- potentially devastating

Recovery o Single most difficult time of the entire

illness experience

• Return from the hospital or major therapy o If family is functional: members are

• Gradual movement from the role of being sick to drawn close together
some form of recovery or adaptation o If family is dysfunctional: seed for
• Adjustment of relation within the family future family discord and breakdown
o Physician should provide quality
Types of Outcomes home care
• Return to full health
o Gains from illness experience
o Patient allowed to take over
abandoned obligation
• Partial recovery

Trans Com: TEODOSIO, MARCELO

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Something to think about!!!!

“Practice makes perfect”

“Nobody is perferct”
therefore why practice….. hehehehe!!!!

Trans Com: TEODOSIO, MARCELO

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