Dra.Moderes
FCM 1: The Impact of Illness to the Family Why Study Impact of Illness?
Discovering
Sickness of patient causes suffering and severe dysfunction for the patients family
the Meaning of Illness for the Fam ily
INVESTIGATE DISEASE Examining
INVESTIGATE ILLNESS
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
the patients family
Role reversal
±
and
psycho-
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 Fam ily on Chronic Illness
patient (i.e., mother now becomes the breadwinner) Income
±
loss
Because of medicines, treatment, etc.
Bawalmagkasakit; Mahalmagkasakit
±
Disruption of activities
±
Danger
Asthma,
A
significant correlation between the family and disease outcome which there is i nadequate supervision and parental support may result i n noncomplia nce with i nsuli n and diet and, hence i n poor diabetic control
because of close contact between the
Clear
Dysfunctional psychosocial factors
problems that contribute to the disease process itself. Poverty,
±
Unemployment,
±
Other
±
hronic C hro
family con flict, i nadequate parental functioniong , and the lackfamily i nvolvement )
Emotional
Are
burdens, stresses, etc.
Low
Parental indifference
the family members eating a balanced
factor influencing sleep quality, indoor home
safety,
accessibility,
interaction that takes place between the health care system
and the patient & his family are dependent on: setti ng ng of care
Ability
Sense of self-esteem
Dreams
Sense of invulnerability of ones self and in love ones that keeps
T he he
Fam ily Illness
T rajectory rajectory
² Passage thru Suffer ings
of illness minimized by personalized care that is highly
which is chronic and complicated, results in structural
change within family system to the point that leads to different
Normal
course of the psychosocial aspects of disease for the
patient and the family
Knowledge
Indicates
roles and functions
of trajectory allows the physician to predict, anticipate
and deal with a familys response to illness
Studies have shown that: There
and plans for the future
ability to pay; a nd
responsive & flexible to the patient and the family members
to carry out normal and treasured activities
existential fears of impending death and separation at bay
flexibility/responsiveness of the health care system
±
Illness,
Body parts
type of cure;
±
Major Illnesses Involving Loss of
mould
quality.
Impact
Poor diabetic control and i n the diabetic child
±
growth, perception of crime, and residential
Poor diabetic control
housi ng ng condition
Key
air,
±
family cohesion and high conflict ±
diet? Inadequate
Increase the likelihood of poorly controlled diabetes
±
family dispute
Poor nutritional habit
±
ng conditions, chronic (such as absent fathers, poor livi ng
sick ness i n the family
The
good diabetic control
±
±
family organization ±
Patients disease is embedded in a whole matrix of difficult family
±
Ex. An emotionally distant of disengaged family i n
±
patient and the family members
±
renal failure, heart disease, cancer, diabetes
of transmission
normal and pathologic response thus enabling family
physicians to formulate special therapeutic plan
are psychological & social effects on the family of a patient
with chronic or life threatening illness;
There
Severe illness in parents place children of family at greater risk.
are effects on parents & sibling of the illness of a child;
DISEASE
Stage in Family Illness
vs. ILLNESS
Stage I Stage II
The
two represent one phenomenon but 2 aspects of sickness
Primary
DISEASE &
Includes
the
sufferers
psycho-physiologic
experience of the disease
disorder
& the broad range of dislocations felt by both the
sufferer
and
his
family
Deeply
embedded in the
social, cultural & family context & context of the person who is ill
Page | 1 2 Sept 2010
Onset of illness to diagnosis Impact
Phase
Reaction to diagnosis
ILLNESS biologic
rajectory T rajectory
CARPE DIEM
Stage III
Major
Stage IV
Recovery
Stage V
Adjustment
therapeutic efforts Phase Early Adjustment to outcome to the Permanency of the outcome
FAMILY AND COMMUNITY MEDICINE I | The Impact of Illness to the Family
Nature
TYPES OF ONSET OF ILLNESS AND ITS EFFECTS ON FAMILY Nature of Onset Characteristic of Experience Impact on Family
of Illness
Acute, rapid illness/ accident
Rapid,
clear onset
Provide little time for physical
Caught
Case
up in suddenness.
Roberto,
within and outside the family.
32, father of three small children, applied as a seaman one year ago. After six months of being away with his family, he died of fatal arrhythmia, while aboard the ship.
Vague apprehension & anxiety
Nilo,
and psychological adjustment. Deal
with immediate decision.
Short period between onset, diagnosis & management. Chronic, especially debilitating
Gradual onset
Suffer
from
state
Often with little support from of
uncertainty over meaning and symptom.
Fearful fantasies over denial of seriousness of symptoms and possible implications.
COGNITIVE PLANE
ST AGE I ² Onset of Illness
Phase I:
±
The
ex: malaise
±
Nature
tension & confusion w/ probable lack of
capacity for problem solving
stage experience prior to contact wit h medical care providers ±
26, father of 2, sole provider, worked as a messenger for 2 years. He encountered a motorcycle accident 1 year ago which left 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 Nilos needs and medications
threat sets in motion tension reduction mechanism
of onset play an important role on impact of
illness on a family and some meaning of experiences
Phase II: repeated failure in deriving the diagnosis may
±
are formulated here.
lead to exacerbation of tension & increas e distress
Onset ±
±
Acute/gradual
Family adaptation in acute illness requires:
Ability
resort to prayers; still earns capacity to problem solving
to tolerate highly charged situations,
rapid mobilization of family resources,
Case:
flexible role, problem solve efficiently, abut to together made of use of outside
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
resources
tried several faith healers and other therapeutic modalities to comfort Maes * see table above for the nature of illness, and the effects of its onset
symptoms.
As a physician
When asked about
1. 2. 3.
Explore
the fear that the pa tients/ family bring up in the clinic.
husband,
Diagnosis:
IMPACT PHASE
Information
on the diagnosis is given in a way the patient can
absorb, given this level of anxiety or shock
continued to have anorexiaand vomiting, back pain, cough, anddifficulty
of breathing. she has been depressed forthe last three months because aside
from her illness, her husband wasrumored to be having another girl,limiting
Emotional Plane where the patient is now
Anxiety
Phase in the cognitive plane where the patient is now.
Phase 2 to 3 Failure to derive the diagnosis Trial of different approaches to relieve stress.
EMOTIONAL PLANE Onset of Illness: denial, disbelief & anxiety
As a physician 1.
Emotional
Depends
on disrupted roles and channels
2.
V ery
problems and help family cope and adapt through
Make
clear about the nature of illness by helping the family
maintain openness that allows sharing and s upport. 3.
Accommodation:
Anticipate
family meetings/ discussion.
upheaval: strong emotions (period of weeks)
±
and Depression
Protest diffuse directly over unfairness (minutes to hours)
±
Know
that the feeling of guilt is a natural response to stress of
grief and loss, anticipate such feelings, and make realistic goals to
accommodate and accept diagnosis
correct the feeling.
important for the implementation of
therapeutic plans
4.
Help the family assess the likely effect of the illness on the family.
5.
Assess
6.
Offer alternative interpretation of proposed therapeutics.
7.
Describe
the capability of the family to cope with stress. disease and treatment according to patients level of
comprehension and understanding.
Page | 2 2 Sept 2010
the
his time in caring for Mae.
Planes or Areas by which Family and Patient React and Adjust:
±
Maewas
fearsregarding
and appropriate treatment are described according the
patients level of understanding and comprehension
expressedher
aspects of pre-diagnostic phase of patients and families.
Also,
2
She
in the hospital where
conflicts the patient and family may be experiencing.
Disease
L ymphoma.
CA
management and theappropriateness of care in the hospital.
Explore
with
died of liver
With inappropriate label of illness, acknowledge and explore
ST AGE II² Reaction to
Maesfather,
family history ofcancer, her mother said that her
diagnosed
Mae
Maes
CARPE DIEM
FAMILY AND COMMUNITY MEDICINE I | The Impact of Illness to the Family ST AGE III: Major
T herapeut i c
Efforts
ST AGE V: Adjustment to the Permanency of the Outcome
Have multiple variables, works in harmony with the wishes of the
Family adjustment to crisis
patient and family
Acceptance
Critical issues:
Coping
±
Psychological state an d prepared ness of the patient &
adjustment:
ne the choice of therapeutic plans as family determi
±
well as the alter n ative choices Assumption
±
& adjustment to permanent disability -> second crisis
mechanism developed during the earlier stage of family Person who is sick conti nued to be treated as sick & he is treated as patient and not i ntegrated i n the family
of responsibility for are very early i n the
±
T reat
patient as recovered, full, responsible person
treatment plan E conomy
±
of therapeutic plan Economic
Impact
of Illness:
emotional
For Acute Illness ±
trauma, social dislocation, & economic
suspended
catastrophe ±
Life
±
E motionally
potential for crisis especially when family routi nes are
±
Physician can facilitate acceptance for diagnosis.
style & cultural characteristics of family stressful effects of hospitalization , sur gery
and other major therapeutic method for the patients
For Chronic Illness ±
family
hi gher i ncidence of ill ness i n other members of the family due to prolonged fear and an xiety
Father - special economic burden
Mother
-
poses
high
risk
±
of
family
Physician should encourage ve ntilation of feeli ngs, give reassurance, and rei n forcement of care.
dysfunction Children - special syndrome of emotional
For Terminal Illness
problems
±
hi ghly emotional & potentially devastati ng
Parents - helpless, guilt, frustrated or hurt
±
F unctional:
Geriatric - fear, loneliness, helplessness
±
Dysfunctional:
Case:
members will be draw n together seed for future family discord &
breakdow n ±
Physician should provide quality home care
56/M married with three children, came in du e to cough for 1 m onth. CXR: Cavitary
lesion at right apex
Diagnosis: Pulmonary Tuberculosis Tx:
Family reaction to death ±
2 months HRZE, 4 months HR.
Already
accomplished - reactionafter prolonged illness
and adaptation
HOW WILL YOU TELL THIS PATIENT THAT HE HAS PTB AND CONVINCE HIM TO TAKE HIS MEDICATIONS?
of Denial - few days to weeks
±
Stage
±
f prolonged - premorbid pattern of behavior(anger, I depression, bargaining acceptance)
As a physician
Family in Crisis
1.
It
is the right of the patient to know about their disease.
2.
Remain
3.
Deal
4.
Coordinate
5.
Anticipate
open and work in harmony with the patient and his family.
with multiple variables; consider all factors w hen planning.
When family moves into a state of dis-equilibrium in response to any situation or event that it cannot resolve by use of available
all aspects of therapy.
problem-solving skills, behavior or resource;
pathologic responses and be able to deal with them.
When illness is perceived as threat to its equilibrium
ST AGE IV: Early Adjustment to Outcomes ² Recovery
Initiates
a period of gradual movement from the role of being sick
PHOTO MEMORIES
to some form of recovery or adaptation with corresponding adjustments
Illness
Type
outcome is an important phase for patients and family
of outcome: Retur n
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
2.
Alleviate
with immediate effects of trauma.
3.
Psychological support.
4.
Explore
Page | 3 2 Sept 2010
anxiety and assure adequate rest. Ang
level of understanding of patient a nd family.
nagpagulo sa atin noong September 1 and 2, 2010
Masayang ber
CARPE DIEM
months starter to!
