Family Medicine - Impact of Illness in the Family Dr.

Lerma Taylan

IMPACT OF ILLNESS IN THE FAMILY

Objectives:
Differentiate between Illness and Disease
Determine the reasons why the Impact of Illness on a family should be studied
Learn the Stages of the Family Illness Trajectory and the responsibility of the physician in each stage

Why study the Impact of Illness?

Sickness of a patients causes sufferings & severe disruption for the patient's family
Illness sets in motion processes that are disruptive and hazardous to health and family members
Role reversal, income loss
Prolonged and complicated illnesses result in structural changes within the family system to a point that leads to
different roles and functions
Minimize by personalized care tahtn is highly responsive & flexible to the patient and family member
The interaction that takes place between the health care system and the patient and his family are dependent on:
- Setting of Care
- Type of cure
- ability to pay
- Flexibility/responsiveness of the health care system
Patient's disease is imbedded in the whole matrix of difficult family problems that contributes to the disease process
itself:
- Poverty
- Unemployment
- other sickness in the family
- Chronic family dispute
- Poor nutritional habits
- Inadequate housing conditions

Disease VS Illness
DISEASE ILLNESS
- Primary biologic, - Includes sufferer's
psychophysiologic experience of the disease
disorder - deeply imbedded in the
- Examining clinical social, cultural and family
and laboratory context of the person who is
evidences of biologic ill
& psychophysiologic - Meaning of Illness to the
dysfunction patient and his family

Effects of Illness
1. PHYSICAL IMPACT
Increase utilization of medical services among family members
2. SOCIAL IMPACT
Need to care for the family member
Reorganization of task
social isolation
3. FINANCIAL IMPACT
Greatly felt among families with low socio-economic bracket
Emotional trauma
Social Dislocation
Economic catastrophe
4. PSYCHOEMOTIONAL IMPACT
Depression
Anxiety
Sleep problems

How is Investigation Done?

Explore the patient's explanatory model
Explore for patient's understanding on the following issues:
o Etiology
o Pathophysiology
o Trajectory and outcome of his illness
o Appropriate treatment
Explore patients patient's perception, reaction to symptoms, how and why he seeks medical advice and care, follow-up
regimen and care for himself
Consider that the popular concept of illness is by individual, family, ethnic group, social class & society
Investigate the broader set of experiences and concern that patient associate with their illness
o derived from past experience with therapy
o Meaning of illness to other members of the family and their vulnerability

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Family Medicine - Impact of Illness in the Family Dr. Lerma Taylan

o personal meaning associated with disease

Factors Influencing How Families Cope with

Illness:
FACTORS COMPONENTS
Intra familial Family Resources
Factors Family Life Cycle Stage
Degree of Family Functionality
External Factors Typology of Illness
Stigma associated with the
disease

COMPO-NENTS ENABLERS BARRIERS

Family Resources Adequate financial resources Limited financial resources

Good support system Lack of social support group
Strong spirituality Lack of access to community
Ability to tap community resources resources

Family Life Cycle Stages where family members are Stages that are suppose to launch
concentrated within the family members outside of the system

Degree of family Functional family that are flexible in Dysfunctional families

functionality adapting to changing roles Poor lines of communication
Healthy communication lines Poor emotional connectivity
Provide good emotional support

Typology of Illness Acute and self limiting Acute and life threatening disease
Non-fatal disease with no incapacitation Chronic and debilitating
Rapid progressive
Terminal illness

Stigma associated Diseases that do not carry social stigma Highly communicable disease that
with the disease carry stigma isolating patients and
family

FAMILY ILLNESS TRAJECTORY

STAGE DESCRIPTION

I Onset of Illness to Diagnosis

II Impact Phase - Reaction to Diagnosis

III Major Therapeutic Effort

IV Recovery Phase - Early Adjustment to Outcome

V Adjustment to the Permanency of the Outcome

The Family Illness Trajectory Passage Thru

Sufferings
Natural course of the psychosocial aspect of the disease
Knowledge of the trajectory allows the physician to predict, anticipate, and deal with the family's response to illness
Indicates normal and pathologic responses thus enabling physicians to formulate special therapeutic plan

STAGE I ONSET OF SYMPTOMS OR ILLNESS

Patient demonstrate physical symptoms to period of consultation
health beliefs and previous experiences help shape what the family will do
nature of onset may play an important role

Nature of Illness Nature of Onset Characteristics of Experience Impact on Family

Acute/ Rapid illness/ Rapid, clear onset Provide little time for physical
accident and psychological adjustment
Short period between onset,
diagnosis and management
thereby leaving little time to
remain in state of uncertainty
Caught up in suddenness
Deal with immediate decision
Often with little support from
within and outside the family
unit
If less threatening, may be

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Family Medicine - Impact of Illness in the Family Dr. Lerma Taylan

dramatic but less crisis

oriented problem for the
family

Chronic especially Gradual onset Suffer from state of uncertainty Vague apprehension and
debilitating over meaning and symptom anxiety
Fearful fantasies over denial
of seriousness of symptoms
and possible implication

Responsibility of the Physician:

Explore the explanatory model and fear that the patient brings
Explore conflict that the patient maybe experiencing
Explore several aspect of pre-diagnostic phase of patients and families

STAGE II IMPACT PHASE OR REACTION TO DIAGNOSIS

Physicians should explore first what they already know & ask what they want to know
family should be given small doses of truthful information
to tell or not to tell

2 plane or areas by which family and patient

react and adjust:
EMOTIONAL PLANE COGNITIVE PLANE
PHASE I PHASE I-
Denial, disbelief and Tension and confusion with
anxiety probable lack of capacity
protest diffuse directly for problem solving
over unfairness threat sets in motion
(minutes to hours) tension reduction
mechanism
PHASE II PHASE II- repeated failure
Emotional upheaval in deriving the diagnosis
-characterized by may lead to exacerbation
strong emotions such of tension and increase
as anxiety, anger and distress
depression depends on -resort to prayers
disrupted roles & -still earn capacity to
channels (period of problem solve
weeks)
PHASE III PHASE III- increasing
accommodation assessment and receptivity
- the patient and the of family to new approach
family learn to for relief of distress
accommodate and *some go doctor
accept the diagnosis shopping
- this is very important *some are willing and
for the implementation capable for active
of therapeutic plans participation
*time for real
opportunity for the
physician and other health
workers to assist family in
realigning roles and
expectations, learn new
skills and make adjustment
*willing to accept
responsibility
PHASE IV-
Acceptance of diagnosis
- enable them to mobilize
resources and recognize
the family
*quality of family
reorganization
*if there is no
movement towards this
phase, family will be
inefficient in achieving
healthy adaptation to the
crisis and reorganize at

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Family Medicine - Impact of Illness in the Family Dr. Lerma Taylan

more dysfunctional level

Physicians Responsibility
Anticipate problems and help families to cope and adapt
Know that the feeling of guilt is a natural response to stress of grief and loss
Help the family to assess the likely effects of illness in the family
Offer alternative interpretation to proposed therapeutic- bolsters family's denial and inability to accept reality

Stage III Major Therapeutic Effort

Management/ therapy
One of the most challenging and rewarding part of clinical practice
period of great mobilization

CRITICAL ISSUES IN CHOOSING THERAPEUTIC

PLAN
1. Psychological state and preparedness of the patient and family
-belief system and trust
physician should investigate for signs of non-compliance
-not emotionally equipped to undertake some form of therapy so other professional help should be obtained
2. Assumption of responsibility for care very early in the treatment plan.
Establish and define responsibilities of each party
Give realistic role to everyone.
3. Economy of therapeutic plan
-Diligence on the part of physician in keeping costs down
involve the family in all major decisions which affect the patient
-request for tests/referrals which are really necessary
4. Lifestyle and cultural characteristics of a family
5. Effects of hospitalization, surgery and other major therapeutic method
Emotionally stressful for the patients family.
Fear and concern in the families who are still essentially helpless
Unable to participate in the suffering or need to relieve the constant discomfort or anguish

Hospitalization gives rise to stressful logistic

problem
a. Father- special economic burden
b. Mother- greatest impact on the family members.
c. Children
special syndrome of emotional problems of families
Hostility, abandonment
d. Parents
helpless, guilt, frustrated, or hurt
e. Geriatric
vulnerable to fears of death, rejection, abandonment, loneliness, & helplessness

Physician's Responsibility
Pphysicians should offer the family options that are effective at a cost they can afford and are acceptable to the
patient and familys belief system
Physicians should explore the familys reaction to therapy and how it is proceeding
Remain Open to the family, indicate that they will not be abandoned
Deal with variables
Work in harmony with patient and family
Coordinate all aspect of therapy

STAGE IV EARLY ADJUSTMENT TO OUTCOME

Return from the hospital
Types of Outcome
o Return to full health
o Partial Recovery
o Permanent Disability

Physician's Responsibility
Deal with immediate effect of trauma
Alleviate anxiety and assure adequate rest
Psychological support
Explore level of understanding of patient and family

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STAGE V - ADJUSTMENT TO THE PERMANENCY OF THE OUTCOME

Family's adjustment to crisis
The second crisis occurs as family realizes that they must accept and adjust a permanent disability
Coping mechanism is develop during the early stage
person who is sick will continue to be treated as sick & not reintegrated into family
treat patient as recovered, full responsible person

Acute Illness:
potential for crisis specially when family routine is suspended
Emotions are High
Family may find it difficult to face the stress
Physicians can facilitate healthy response or acceptance of diagnosis and recognize danger signals such
as delayed or prolong reaction

Chronic Illness
Prolonged fear and anxiety
Higher incidence of illness in other members of the family
Can be seen as additional burden
Feeling of guilt
Physicians can encourage ventilation of feelings, give reassurance and reinforcement for care

Terminal Illness
Highly emotional
Potentially devastating
Single most difficult time of the entire illness experience
Patient and family anticipate grief reaction
if functional: drawn closer together to provide support
if dysfunctional: seed for future family discord and breakdown

Physician's Responsibility
Aid the patient and the family in efficient and functional readjustments
Provide quality care

Family In Crisis:
when the family moves in a state of disequilibrium in response to any situation or event that can not be resolve by any
problem-solving skills, behavior or resource

Evaluating Family In Crisis

1. Assess family history of coping with problem or stressor
Boiling point at which crisis response is set in motion
o affected by uniqueness of internal and external factors
o stress is sufficient in number or intensity to disturb family equilibrium
o family psychosocial history provides information regarding capacity of family to cope with illness
o quality of family life
2. Determine style of Family Development
o Anticipatory Guidance
o Timeliness of illness or problem
3. Role of Patient in the Family
o member providing financial support
o member plays critical role in family emotional life
o child
4. Monitoring Role Disruption
o assess and monitor effect of role disruption
o identify gaps in family role that exist
o sick role as perceived by patient and family

SMILKSTEIN CYCLE OF FAMILY FUNCTION

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 FAMILY IN
EQUILIBRIUM

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Family Medicine - Impact of Illness in the Family Dr. Lerma Taylan

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 Exploringboth the Understandingthe FindingCommon
Disease & Illness Whole Person Ground
Experience

History, Physical
PROBLEMS
Exam, Lab

DISEASE
Person Mutual
Patient
Presents GOALS Decisions
Cues
DiseaseIllness
ILLNESS
ROLES
Ideas, Expectations
Feelings,
Effect on Functions

EnhancingPatient- Incorporating BeingRealistic

Family Medicine - Impact of Illness in the Family Dr. Lerma Taylan

Doctor Relationship Prevention and Health

Promotion

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