Southern Philippines Medical Center

August 18, 2011

Impact of Illness On the Family
Dr. Amor I. Guinmapang
FM resident

‡ Differentiate between illness and disease ‡ Determine the reasons why study the impact of disease on family ‡ Learn the stages of the family illness trajectory and the responsibilities of the physician on each stage

Why study impact of Illness?
‡ Sickness causes suffering and severe disruption of the patients family ‡ Role reversal, income loss

Interaction are dependent on: ‡ Setting of care ‡ Type of cure ‡ Ability to pay ‡ Responsiveness of health care system

‡ Illness (prolonged and complicated) results in structural change within family system to the point that leads to different roles and functions

Studies shown that
‡ There are psychological and social effects on the family of a patient with chronic or life threatening illness

Disease vs Illness
Disease Primary biologic and psycho physiological dso Illness
‡Includes sufferers experience of the dse ‡Deeply embedded in the social, cultural and family context of the person who is ill

Discovering the Meaning of illness for the Family

Investigate Dse ‡ Examining clinical and laboratory evidences of biologic and psycho-physiologic dysfunction

Investigate Illness ‡ Exploring the meaning of illness to the patient and the patient¶s family

How is investigation done?
PHYSICIAN: ‡ Explore for patients understanding of the ff issues: *etiology of his illness *its pathophysiology *trajectory and outcome of his illness *appropriate treatment

‡ Explores the patient¶s perception, reaction to symptom« ‡ Investigate the broader set of experiences and concerns that patients associate with their illness

Stages in the family Illness Trajectory
Stage I ± onset of Illness to Diagnosis Stage II ± Impact phase- Reaction to Diagnosis Stage III- Major Therapeutic Efforts Stage IV ± Recovery Phase- Early Adjustment to Outcome Stage V- Adjustment to the Permanency of the Outcome

Stage I ± onset of Illness
‡ Stage experienced prior to contact with medical care provider

‡ Arnold, 35, father of 3 small children, worked as OFW 1 year ago. After 6months of being far away from his family, he died of fatal arrythmia while on his work.

Nature of illness Acute, rapid illness/ accident

Nature of onset Rapid, clear

Characteristics of illness ‡Provide little time for physical and psychological adjustment ‡Short period between onset, dx and mx thereby leaving little time to remain in state of uncertainty

Impact on family

‡Caught up in suddenness ‡Deal with immediate decision ‡Often with little support from within and outside the family unit

Chronic, especially debilitating

Gradual onset

‡Suffer from state of uncertainty over meaning and symptom

Vague apprehension and anxiety Fearful fantasies over denial of seriousness of symptoms and possible implications

Case #1
‡ Nature of illness ‡ Nature of onset ‡ Characteristic of experience ‡ Impact on family ‡ Acute, rapid ‡ Rapid, clear onset ‡ Provide little time for physical and psychological adjustments ‡ Caught up in suddenness ‡ Immediate decision

Responsibilities of the Physician ‡ Explore routinely the explanatory model and fear that patients bring to the clinic set up ‡ With inappropriate label of illness, acknowledge and explore conflict the patient maybe experiencing ‡ Explore several aspects of pre-diagnostics phase of patients and families

Stage II ± Reaction to Diagnosis: Impact Phase ‡ Disease can be described accdg to the patients level of comprehension and understanding ‡ Give small doses of information over time

If diagnosing is confusing
‡ Provide support, and continuity of care ‡ Interpret findings which are misunderstood ‡ Offer advice and encouragement ‡ And clarify meaning of specialist¶s message & outcome of illness and operation

2 planes that a patient/family react and adjust
‡ Emotional plane ‡ Cognitive plane

Emotional Plane
‡ Denial, disbelief, anxiety (mins to hrs) ‡ Emotional upheaval such as anger, anxiety, and depression (weeks) ‡ Accomodation and acceptance

Cognitive Plane
‡ Phase 1 ±tension and confusion, ;ack of capacity for problem solving ‡ Phase 2 ± repeated failure to deriving the diagnosis leading to increased distress

‡ Phase 3 ± receptivity of the family to new approach for relief of distress ‡ Phase 4 ± eventual acceptance of diagnosis

Case #2
‡ Lyn, 22, with an 18month old child was diagnosed with lymphoma 6months ago. Due to lack of funds, her mother who is also the caregiver, has tried several faith healers to comfort Lyn¶s syndrome.

‡ Lyn¶s father was died due to liver cancer in the hospital where Lyn was diagnosed lymphoma. She expressed her fears regarding the management and the appropriateness in the hospital.

‡ Lyn continued to have anorexia, vomiting, cough, back pain, and difficulty breathing. Also she has been depressed for the last three months because aside from her illness, her husband has a rumored to be having another girl, limiting his time for Lyn.

Emotional plane where the patient is now

Anxiety and depression

Phase of cognitive where the patient is now

Phase 2 to 3 Failure to derive the diagnosis Trial of different approaches to relieve stress

Responsibilities of Physician
‡ Anticipate problems and help family cope and adapt thru family meetings ‡ Assess the capability of the family to cope with stress

‡ Make clear about the nature of illness by helping the family maintain openness that allows sharing and support.

Stage III- Major Therapeutic Efforts

Critical Issues in Choosing Therapeutic Plan 1. Psychological state and preparedness of the patient and family determine the choice of therapeutic plans as well as the alternative choices

2. Assumption of responsibility for care of very early in the treatment plan. 3. Economy of Therapeutic plan 4. Life style and cultural characteristics of a family are important in choosing a therapeutic plan

5. Effects of hospitalization are emotionally stressful for the patient¶s family

Responsibilities of the Physician
‡ Remain open to the family ‡ Work in harmony with patient and family ‡ Deal with multiple variables ‡ Coordinate all aspects of therapy ‡ Anticipate pathologic response

Stage IV- Early adjustment to outcomes
Experience of recovery or adjustment to the illness outcome ‡ Simplest outcome is return to full health ‡ Partial recovery ‡ Recovery is quite different (permanent disability)

Stage V- Adjustment to the permanency of the outcome ‡ Points to the family¶s adjustment to crisis ‡ 2nd crisis occurs as family realizes that they must accept and adjust to a permanent disability ‡ Coping mechanism is developed during earlier stage of family adjustment

For acute illness: ‡ Emotions are high and can lead to anger especially if the family perceives that the care given by the doctor is not satisfactory

What can physician can do?
‡ Facilitate healthy response or acceptance to diagnosis and recognize danger signals such as delayed or prolonged reaction

For chronic illness:
‡ Because of prolonged fear and anxiety, there is higher incidence of illness in other members of the family What physician can do? ‡ Encourage ventilation of feelings, give reassurance and reinforcement for care

For terminal illness;
‡ Highly emotional and potentially devastating ‡ The initial response in diagnosis of terminal illness is that of shock and overwhelming anxiety

The physician can ‡ Assist the patient and family in relating to health care system ‡ Aid the patient and the family in efficient and functional readjustment

‡ Provide quality care. ‡ Home care is the best and most accepted and the last demanding thus it should be facilitated

Family reaction to death
‡ In after prolonged severe illness and adaptation and reaction are already accomplished ‡ Death comes swiftly and MD to assist to cope ‡ Stage of denial

‡ If prolonged ± premorbid pattern of abnormal behaviour

Emotional Plane

Cognitive Plane

‡During onset of illness, initially there is denial, disbelief and anxiety

‡Emotional upheaval charac by strong emotions such as anger, anxiety and depression

‡Accommodation during which the patient and the family learn to accommodate and accept the diagnosis

‡Phase l : Initially there is tension & confusion with probable lack of capacity for problem solving ‡Phase II : repeated failure in deriving the diagnosis may lead to exacerbation of tension & increased distress ‡Phase III: increasing assessment and receptivity of family to new approach for relief of distress ‡Phase IV: eventual acceptance of diagnosis will enable them to mobilize resources and recognize the family