Dra.

Moderes

FCM 1: The Impact of Illness to the Family

Why Study Impact of Illness? Discovering the Meaning of Illness for the Family

• Sickness of patient causes suffering and severe dysfunction for the INVESTIGATE DISEASE INVESTIGATE ILLNESS
patient’s family • Examining clinical and • Exploring the meaning of
• Particular illness sets in motion processes that are disruptive of laboratory evidences of illness to the patient and
family life and hazardous to the health of family members biologic and psycho- the patient’s family
– Role reversal physiologic dysfunction
• because one member of the family cannot
fulfill his/her tasks anymore, there must be
someone who will do his/her role for the Impact of the Family on Chronic Illness
patient (i.e., mother now becomes the
breadwinner)
• Asthma, renal failure, heart disease, cancer, diabetes
– Income loss
• A significant correlation between the family and disease outcome
• Because of medicines, treatment, etc.
– Ex. An emotionally distant of disengaged family in
• “Bawal magkasakit”; “Mahal magkasakit”
which there is inadequate supervision and parental
– Disruption of activities
support may result in noncompliance with insulin and
– Danger of transmission
diet and, hence in poor diabetic control
• because of close contact between the
• Clear family organization
patient and the family members
– good diabetic control
• Patient’s disease is embedded in a whole matrix of difficult family
• Dysfunctional psychosocial factors
problems that contribute to the disease process itself.
– (such as absent fathers, poor living conditions, chronic
– Poverty,
family conflict, inadequate parental functioniong, and
– Unemployment,
the lack family involvement)
– Other sickness in the family
– Increase the likelihood of poorly controlled diabetes
– Chronic family dispute
• Low family cohesion and high conflict
• Emotional burdens, stresses, etc.
– Poor diabetic control
– Poor nutritional habit
• Parental indifference
• Are the family members eating a balanced
– Poor diabetic control and in the diabetic child
diet?
– Inadequate housing condition
Major Illnesses Involving Loss of…
• Key factor influencing sleep quality, indoor
air, home safety, accessibility, mould
• Body parts
growth, perception of crime, and residential
• Ability to carry out normal and treasured activities
quality.
• Sense of self-esteem
• The interaction that takes place between the health care system
• Dreams and plans for the future
and the patient & his family are dependent on:
• Sense of invulnerability of one’s self and in love ones that keeps
– setting of care
existential fears of impending death and separation at bay
– type of cure;
– ability to pay; and
– flexibility/responsiveness of the health care system The Family Illness Trajectory – Passage thru Sufferings
• Impact of illness minimized by personalized care that is highly
responsive & flexible to the patient and the family members • Normal course of the psychosocial aspects of disease for the
• Illness, which is chronic and complicated, results in structural patient and the family
change within family system to the point that leads to different • Knowledge of trajectory allows the physician to predict, anticipate
roles and functions and deal with a family’s response to illness
• Indicates normal and pathologic response thus enabling family
Studies have shown that: physicians to formulate special therapeutic plan
• There are psychological & social effects on the family of a patient
with chronic or life threatening illness;
• There are effects on parents & sibling of the illness of a child;
• Severe illness in parents place children of family at greater risk. Stage in Family Illness Trajectory

DISEASE vs. ILLNESS Stage I Onset of illness to diagnosis

Stage II Impact Phase
• The two represent one phenomenon but 2 aspects of sickness Reaction to diagnosis

DISEASE ILLNESS Stage III Major therapeutic efforts

Stage IV Recovery Phase Early Adjustment to outcome
• Primary biologic & • Includes the sufferer’s
psycho-physiologic experience of the disease
disorder & the broad range of Stage V Adjustment to the Permanency of the outcome
dislocations felt by both
the sufferer and his family
• Deeply embedded in the
social, cultural & family
context & context of the
person who is ill

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 FAMILY AND COMMUNITY MEDICINE I | The Impact of Illness to the
Family

TYPES OF ONSET OF ILLNESS AND ITS EFFECTS ON FAMILY

Nature of Illness
Acute, rapid illness/ accident
Chronic, especially debilitating
Nature of Onset Characteristic of Experience Impact on Family Case
Rapid, clear onset Provide little time for physical Caught up in suddenness. Roberto, 32, father of three
and psychological adjustment. small children, applied as a
Deal with immediate decision. seaman one year ago. After six
months of being away with his
Short period between onset,
family, he died of fatal
diagnosis & management. Often with little support from arrhythmia, while aboard the
within and outside the family. ship.
Gradual onset Suffer from state of Vague apprehension & anxiety Nilo, 26, father of 2, sole
uncertainty over meaning and provider, worked as a
symptom. Fearful fantasies over denial of messenger for 2 years. He
encountered a motorcycle
seriousness of symptoms and
accident 1 year ago which left
possible implications. half of his body, from the waist
down, paralyzed. His wife
accepts laundry work from
neighbors in order to feed their
family and take care of Nilo’s
needs and medications

STAGE I – Onset of Illness

• COGNITIVE PLANE
• The stage experience prior to contact with medical care providers
– Phase I: tension & confusion w/ probable lack of
– ex: malaise
capacity for problem solving
– Nature of onset play an important role on impact of
• threat sets in motion tension reduction
illness on a family and some meaning of experiences
mechanism
are formulated here.
• Onset
– Phase II: repeated failure in deriving the diagnosis may
– Acute/gradual
lead to exacerbation of tension & increase distress
– Family adaptation in acute illness requires:
• resort to prayers; still earns capacity to
• Ability to tolerate highly charged
problem solving
situations, rapid mobilization of family
resources, flexible role, problem solve
Case:
efficiently, abut to together made of use of
outside resources
Mae, 21, with an 18 month old child, was diagnosed with lymphoma 6
months ago. Due to lack of funds, her mother, who is also the caregiver, has
* see table above for the nature of illness, and the effects of its onset
tried several faith healers and other therapeutic modalities to comfort Mae’s
symptoms.
As a physician…
1. Explore the fear that the patients/ family bring up in the clinic.
When asked about Mae’s family history of cancer, her mother said that her
2. With inappropriate label of illness, acknowledge and explore
husband, Mae’s father, died of liver CA in the hospital where Mae was
conflicts the patient and family may be experiencing.
diagnosed with Lymphoma. She expressed her fears regarding the
3. Explore aspects of pre-diagnostic phase of patients and families.
management and the appropriateness of care in the hospital.

STAGE II– Reaction to Diagnosis: IMPACT PHASE

• Information on the diagnosis is given in a way the patient can
absorb, given this level of anxiety or shock
• Disease and appropriate treatment are described according the
patient’s level of understanding and comprehension
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.

2 Planes or Areas by which Family and Patient React and Adjust: Emotional Plane where the Anxiety and Depression
patient is now
• EMOTIONAL PLANE Phase in the cognitive plane Phase 2 to 3
– Onset of Illness: denial, disbelief & anxiety where the patient is now. Failure to derive the diagnosis
• Protest diffuse directly over unfairness Trial of different approaches to relieve stress.
(minutes to hours)
As a physician…
– Emotional upheaval: strong emotions 1. Anticipate problems and help family cope and adapt through
• Depends on disrupted roles and channels family meetings/ discussion.
(period of weeks) 2. Make clear about the nature of illness by helping the family
maintain openness that allows sharing and support.
– Accommodation: accommodate and accept diagnosis 3. Know that the feeling of guilt is a natural response to stress of
• Very important for the implementation of grief and loss, anticipate such feelings, and make realistic goals to
therapeutic plans correct the feeling.
4. Help the family assess the likely effect of the illness on the family.
5. Assess the capability of the family to cope with stress.
6. Offer alternative interpretation of proposed therapeutics.

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7. Describe disease and treatment according to patient’s level of 3. Psychological support.
comprehension and understanding. 4. Explore level of understanding of patient and family.

STAGE III: Major Therapeutic Efforts

• Have multiple variables, works in harmony with the wishes of the
patient and family
• Critical issues:
– Psychological state and preparedness of the patient &
family determine the choice of therapeutic plans as
well as the alternative choices
– Assumption of responsibility for are very early in the
treatment plan
– Economy of therapeutic plan
• Economic Impact of Illness: emotional
trauma, social dislocation, & economic
catastrophe
– Life style & cultural characteristics of family
– Emotionally stressful effects of hospitalization, surgery
and other major therapeutic method for the patient’s
family
• Father - special economic burden
• Mother - poses high risk of family
dysfunction
• Children - special syndrome of emotional
problems
• Parents - helpless, guilt, frustrated or hurt
• Geriatric - fear, loneliness, helplessness
Case:
56/M married with three 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 TELL THIS PATIENT THAT HE HAS PTB AND CONVINCE HIM
TO TAKE HIS MEDICATIONS?
As a physician…
1. It is the right of the patient to know about their disease.
2. Remain open and work in harmony with the patient and his
family.
3. Deal with multiple variables; consider all factors when planning.
4. Coordinate all aspects of therapy.
5. Anticipate pathologic responses and be able to deal with them.
STAGE IV: Early Adjustment to Outcomes – Recovery
STAGE V: Adjustment to the Permanency of the Outcome
• Family adjustment to crisis
• Acceptance & adjustment to permanent disability -> second crisis
• Coping mechanism developed during the earlier stage of family
adjustment:
– Person who is sick continued to be treated as sick & he
is treated as patient and not integrated in the family
– Treat patient as recovered, full, responsible person
• For Acute Illness
– potential for crisis especially when family routines are
suspended
– Physician can facilitate acceptance for diagnosis.
• For Chronic Illness
– higher incidence of illness in other members of the
family due to prolonged fear and anxiety
– Physician should encourage ventilation of feelings, give
reassurance, and reinforcement of care.
• For Terminal Illness
– highly emotional & potentially devastating
– Functional: members will be drawn together
– Dysfunctional: seed for future family discord &
breakdown
– Physician should provide quality home care
• Family reaction to death
– Already accomplished - reaction after prolonged illness
and adaptation
– Stage of Denial - few days to weeks
– If prolonged - premorbid pattern of behavior (anger,
depression, bargaining acceptance)
Family in Crisis
• When family moves into a state of dis-equilibrium in response to
any situation or event that it cannot resolve by use of available
problem-solving skills, behavior or resource;
• When illness is perceived as threat to its equilibrium

• Initiates a period of gradual movement from the role of being sick

to some form of recovery or adaptation with corresponding
PHOTO MEMORIES…
adjustments
• Illness outcome is an important phase for patients and family
• Type of outcome:
• Return to full health
• gains from illness experience
• nurture & allowed to take over the
abandoned obligation

• Partial Recovery
• followed by a period of waiting to learn if
disease will return or fear of death because
of long period of waiting

• Permanent disability
• requires acceptance of condition

As a physician…
1. Deal with immediate effects of trauma.
2. Alleviate anxiety and assure adequate rest.

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Ang nagpagulo sa atin noong September 1 and 2, 2010…

Masayang “–ber” months starter to!

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