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FCM 1: The Impact of Illness to the Family
Why Study Impact of Illness? Sickness of patient causes suffering and severe dysfunction for the patient s family Particular illness sets in motion processes that are disruptive of family life and hazardous to the health of family members ± Role reversal because one member of the family cannot fulfill his/her tasks anymore, there must be someone who will do his/her role for the patient (i.e., mother now becomes the breadwinner) ± Income loss Because of medicines, treatment, etc. Bawalmagkasakit ; Mahalmagkasakit ± Disruption of activities ± Danger of transmission because of close contact between the patient and the family members Patient s disease is embedded in a whole matrix of difficult family problems that contribute to the disease process itself. ± Poverty, ± Unemployment, ± Other sickness in the family ± Chronic family dispute Emotional burdens, stresses, etc. ± Poor nutritional habit Are the family members eating a balanced diet? ± Inadequate housing condition Key factor influencing sleep quality, indoor air, home safety, accessibility, mould growth, perception of crime, and residential quality. The interaction that takes place between the health care system and the patient & his family are dependent on: ± setting of care ± type of cure; ± ability to pay; and ± flexibility/responsiveness of the health care system Impact of illness minimized by personalized care that is highly responsive & flexible to the patient and the family members Illness, which is chronic and complicated, results in structural change within family system to the point that leads to different roles and functions Discovering the Meaning of Illness for the Family INVESTIGATE DISEASE Examining clinical and laboratory evidences of biologic and psychophysiologic dysfunction INVESTIGATE ILLNESS Exploring the meaning of illness to the patient and the patient s family
Impact of the Family on Chronic Illness Asthma, renal failure, heart disease, cancer, diabetes A significant correlation between the family and disease outcome ± Ex.An emotionally distant of disengaged family in which there is inadequate supervision and parental support may result in noncompliance with insulin and diet and, hence in poor diabetic control Clear family organization ± good diabetic control Dysfunctional psychosocial factors ± (such as absent fathers, poor living conditions, chronic family conflict, inadequate parental functioniong, and the lackfamily involvement) ± Increase the likelihood of poorly controlled diabetes Low family cohesion and high conflict ± Poor diabetic control Parental indifference ± Poor diabetic control and in the diabetic child
Major Illnesses Involving Loss of Body parts Ability to carry out normal and treasured activities Sense of self-esteem Dreams and plans for the future Sense of invulnerability of one s self and in love ones that keeps existential fears of impending death and separation at bay
The Family Illness Trajectory ² Passage thru Sufferings Normal course of the psychosocial aspects of disease for the patient and the family Knowledge of trajectory allows the physician to predict, anticipate and deal with a family s response to illness Indicates normal and pathologic response thus enabling family physicians to formulate special therapeutic plan
Studies have shown that: 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. DISEASE vs. ILLNESS The two represent one phenomenon but 2 aspects of sickness DISEASE Primary biologic psycho-physiologic disorder & ILLNESS Includes the sufferer s experience of the disease & 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
Stage in Family Illness Trajectory Stage I Stage II Onset of illness to diagnosis Impact Phase Reaction to diagnosis Major therapeutic efforts Recovery Phase Early Adjustment to outcome Adjustment to the Permanency of the outcome
Stage III Stage IV Stage V
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while aboard the ship. diagnosis & management.limiting his time in caring for Mae. 4. 32. her mother said that her husband. with an 18 month old child. father of three small children. given this level of anxiety or shock Disease and appropriate treatment are described according the patient s level of understanding and comprehension 2 Planes or Areas by which Family and Patient React and Adjust: EMOTIONAL PLANE ± Onset of Illness: denial. disbelief & anxiety Protest diffuse directly over unfairness (minutes to hours) ± Emotional upheaval: strong emotions Depends on disrupted roles and channels (period of weeks) Accommodation: accommodate and accept diagnosis Very important for the implementation of therapeutic plans ± As a physician 1. With inappropriate label of illness. Make clear about the nature of illness by helping the family maintain openness that allows sharing and support. 3. cough. 2. who is also the caregiver. Often with little support from within and outside the family. Explore aspects of pre-diagnostic phase of patients and families. 3. Explore the fear that the patients/ family bring up in the clinic. father of 2. Also.FAMILY AND COMMUNITY MEDICINE I | The Impact of Illness to the Family TYPES OF ONSET OF ILLNESS AND ITS EFFECTS ON FAMILY Nature of Onset Characteristic of Experience Impact on Family Rapid. paralyzed. Mae sfather. Anxiety and Depression Phase 2 to 3 Failure to derive the diagnosis Trial of different approaches to relieve stress. Emotional Plane where the patient is now Phase in the cognitive plane where the patient is now. Caught up in suddenness. Vague apprehension & anxiety Fearful fantasies over denial of seriousness of symptoms and possible implications. he died of fatal arrhythmia. After six months of being away with his family. was diagnosed with lymphoma 6 months ago. Page | 2 2 Sept 2010 CARPE DIEM . still earns capacity to problem solving Case: Mae. Nature of Illness Acute. Mae continued to have anorexiaand vomiting. 7. anddifficulty of breathing. 21. she has been depressed forthe last three months because aside from her illness. Offer alternative interpretation of proposed therapeutics. When asked about Mae s family history ofcancer. rapid mobilization of family resources. * see table above for the nature of illness. 2. His wife accepts laundry work from neighbors in order to feed their family and take care of Nilo s needs and medications STAGE I ² Onset of Illness The stage experience prior to contact with medical care providers ± ex: malaise ± Nature of onset play an important role on impact of illness on a family and some meaning of experiences are formulated here. worked as a messenger for 2 years. from the waist down. back pain. 5. rapid illness/ accident Case Roberto. anticipate such feelings. Chronic. and the effects of its onset As a physician 1. her husband wasrumored to be having another girl. clear onset Provide little time for physical and psychological adjustment. acknowledge and explore conflicts the patient and family may be experiencing. sole provider. 6. 26. Know that the feeling of guilt is a natural response to stress of grief and loss. abut to together made of use of outside resources COGNITIVE PLANE ± Phase I: tension & confusion w/ probable lack of capacity for problem solving threat sets in motion tension reduction mechanism ± Phase II: repeated failure in deriving the diagnosis may lead to exacerbation of tension & increase distress resort to prayers. problem solve efficiently. She expressedher fearsregarding the management and theappropriateness of care in the hospital. STAGE II² Reaction to Diagnosis: IMPACT PHASE Information on the diagnosis is given in a way the patient can absorb. especially debilitating Gradual onset Suffer from state of uncertainty over meaning and symptom. died of liver CA in the hospital where Maewas diagnosed with Lymphoma. and make realistic goals to correct the feeling. applied as a seaman one year ago. Describe disease and treatment according to patient s level of comprehension and understanding. Help the family assess the likely effect of the illness on the family. He encountered a motorcycle accident 1 year ago which left half of his body. Assess the capability of the family to cope with stress. has tried several faith healers and other therapeutic modalities to comfort Mae s symptoms. Short period between onset. Nilo. Due to lack of funds. Anticipate problems and help family cope and adapt through family meetings/ discussion. flexible role. Deal with immediate decision. Onset ± Acute/gradual ± Family adaptation in acute illness requires: Ability to tolerate highly charged situations. her mother.
FAMILY AND COMMUNITY MEDICINE I | The Impact of Illness to the Family STAGE III: Major Therapeutic Efforts Have multiple variables.fear. 2. frustrated or hurt Geriatric . HOW WILL YOU TELL THIS PATIENT THAT HE HAS PTB AND CONVINCE HIM TO TAKE HIS MEDICATIONS? As a physician 1. and reinforcement of care. social dislocation. came in due to cough for 1 month.premorbid pattern of behavior(anger. Deal with immediate effects of trauma. 3. give reassurance.helpless. behavior or resource. Ang nagpagulo sa atin noong September 1 and 2. Alleviate anxiety and assure adequate rest. & 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 . 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 . 4.special economic burden Mother .poses high risk of family dysfunction Children . depression. Psychological support. STAGE IV: Early Adjustment to Outcomes ² Recovery Initiates a period of gradual movement from the role of being sick to some form of recovery or adaptation with corresponding 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 PHOTO MEMORIES As a physician 1. 4 months HR. helplessness 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. Remain open and work in harmony with the patient and his family. 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.few days to weeks ± If prolonged . 5. consider all factors when planning. loneliness. When illness is perceived as threat to its equilibrium Case: 56/M married with three children.reactionafter prolonged illness and adaptation ± Stage of Denial. Explore level of understanding of patient and family. It is the right of the patient to know about their disease. Anticipate pathologic responses and be able to deal with them. 4. CXR: Cavitary lesion at right apex Diagnosis: Pulmonary Tuberculosis Tx: 2 months HRZE. 3. 2010 Masayang ber months starter to! Page | 3 2 Sept 2010 CARPE DIEM . Deal with multiple variables. Coordinate all aspects of therapy.special syndrome of emotional problems Parents . guilt. full. 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. responsible person For Acute Illness ± potential for crisis especially when family routines are suspended ± Physician can facilitate acceptance for diagnosis. 2. 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.
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