IMPACT OF ILLNESS/FAMILY, ILLNESS ‘ TRAJECTORY Gretchel Carbonell, M.D Community and Family Medicine OBJECTIVES + Know the importance of being aware of the impact of illness on the family - Enumerate the different stages and describe the characteristics of each stage of family illness trajectory¥ | @ + Disease + Iliness Primary biologic © feeling, an experience &psycho-physiologic of unhealthy which is disorder entirely personal, interior to the person Deeply embedded in social, cultural & family context @ ea STUDY IMPACT OF ILLNESS BIOPSYCHOSOCIAL approach to care - Understand and respond adequately to suffering + Provide empathy HOLISTIC CARE e| oan STUDY IMPACT OF ILLNESS © Stress, illness and the family are linked + Stress frequently follows illness + Family support protects from stress « Illness has an effect on the family + Family has an impact on illness ® we STUDY IMPACT OF ILLNESS - Disease is embedded in a whole matrix of difficult family problems that contribute to the disease process itself Poverty, poor nutritional habit, poor education, poor health habits, etc-> poor health outcomesFitness affects the patient and the family - Assessment of the impact of illness can help physicians... plan interventions that can mobilize the family help the family cope and adapt lessen the burden brought about by the disease support the patient ® | Family IlIness Trajectory © ~ The natural history of an illness episode or the normal course of the psychosocial aspects of sickness for the patient and family + Allows to predict, anticipate and deal with the family's response to illness » Enable the physician to formulate specific @ therapeutic plans ’| Of Family Illness Trajectory © Stage! Onset of Illness Stage II Reaction to Diagnosis ( Impact phase) Stage III Major therapeutic efforts Stage IV Adjustment to outcomes of Disease e Stage V Adjustment to permanency of the cxtcot ie Stage 1- ONSET OF ILLNESS © - Prior to contact with medical care providers influence to meaning of illness Nature of onset may play an important role on 1 | \ | | \ Health beliefs and previous experiences provide I \ | | impact of illness on family | \NATURE OF NATURE OF IMPACT TO FAMILY ILLNESS ONSET Acute/ Rapid, clear Potential crisis when resources are © Rapid onset limited lliness/ -Anxiety Accident -No time to remain in uncertainty -No time to adjust or react Chronic Gradualonset -Burden >long term need for especially resources debilitating -Anxiety Drained resources Uncertain of meaning of symptoms.) outcome of Treatment Denial of seriousness of possible Complication; | a Stage 1- ONSET OF ILLNESS Responsibility of Physician: Physicians are not actively involved Explore routinely the explanatory model and fear that patients bring to the clinical set up Illness perception ‘Awareness/understanding of what is happening Explore how the patient and family perceive the illness e a aniaEXPLANATORY MODELS OF ILLNESS (DISEASE TRAJECTORIES) © Sudden death- acute life »»|_sssou» threatening illness require family to act quickly. ' Its easier to deal with i this type of illness if resources can support treatment. seal Potential crisis if Toe resources are limited -..t~« EXPLANATORY MODELS OF ILLNESS (DISEASE TRAJECTORIES) © - Frailty- Chronic nonprogressive illness fon poses a burden in terms of furnishing resources for long haul. But since disease is stable it is not marked by many crisis situationsEXPLANATORY MODELS OF ILLNESS (DISEASE TRAJECTORIE* © Chronic debilitating and \ terminal illness cause greatest degrees of anxiety because they drain resources and leave the Operate family uncertain as to the M potential outcome of the treatment j N= @ | Pitace 2-IMPACT PHASE REACTION TO DIAGNOSIS © - Initial contact with physician » Reaction/impact depend on Understanding Awareness Perceptions Outcome Readiness/preparedness ®PLANE OR AREAS BY WHICH FAMILY AND PATIENT REACT AND ADJUST EMOTIONAL PLANE initial: denial, disbelief and anxiety -strong emotional upheaval --anxiety, anger and depression COGNITIVE PLANE - Phase |:tension and confusion with probable lack of capacity for problem solving -Phase |I- failure to. diagnosis may lead to exacerbation of tension and increase distress >Resort to prayers @ >eamn capacity to problem-solve PLANE OR AREAS BY WHICH FAMILY AND PATIENT REACT AND ADJUST EMOTIONAL PLANE Accommodation >Patient and the family learn to accommodate and accept the diagnosis and can proceed to therapeutic management( or palliative management) COGNITIVE PLANE -Phase IIl- increased assessment and receptivity of family new approach for relieve of distress >doctor shopping >wiling and capable for active participation >realigning roles and expectation, learn new skills and make adjustment >Wiling to accept responsibilty _ —nlasstage 2- IMPACT PHASE REACTION TO DIAGNOSIS @ + Anticipate number of problems and help families to cope and adapt more through family conference, discussion with parents + Specifically: Encourage to elucidate clearly to each other the nature of the lliness = Maintains Openness = Allows sharing and support Non-sharing and silence @ « Limit openness and spontaneity «Isolation and Abandonment Aaa Stage 2- IMPACT PHASE REACTION TO DIAGNOSIS © Responsibility of Physician: + Explore patient and family illness understanding> what they already know, what they want to know, what they should know (CEA) Assess likely effect/impact of the illness Assess capabilities to deal with stress Proper disclosure e abyTO DIAGNOSIS © Responsibility of Physician: + Interpret findings . Disclose properly, with empathy and compassion . Offer advise & encouragement « Provide support & continuity of care kept at reasonable level Economics status - Economic impact of illness 8 CRITICAL ISSUES IN CHOOSING THERAPEUTIC PLAN e 4 Lifestyle and cultural characteristics of a family 5. Effects of hospitalization, surgery and other major therapeutic method - Emotionally and/or financially stressful for the patient’s family consider all factors e@ when planning Brovnce Ill- MAJOR THERAPEUTIC EFFORTS @ RESPONSIBILITIES OF THE PHYSICIAN « Coordinate all aspects of therapy - View the patient and family as therapeutic ally >not merely as recipient of care « Explore reactions to therapy (elicit ECM about treatment) a dé‘Jerace IV- ADJUSTMENT TO OUTCOMES © « Return role of being sick to some form of recovery or adaptation « Varies according to the type of outcome anticipated. Non-fatal, possibly fatal, fatal Acute with complete resolution Chronic, debilitating, relapsing 6 Jsrace IV- ADJUSTMENT TO OUTCOMES ©. CHRONIC ILLNESS: Prolonged fear and anxiety leads to higher incidence of illness in other members of the family Encourage ventilation of feelings, give reassurance and reinforcement of care @stance IV- ADJUSTMENT TO OUTCOMES » TERMINAL ILLNESS: Highly emotional and potentially devastating Single most difficult time of the entire illness experience If family is functional -- members are drawn closer together If family is dysfunctional-- seed for future family @ discord and breakdown Jerace IV- ADJUSTMENT TO OUTCOMES + TERMINAL ILLNESS: Highly emotional and potentially devastating Single most difficult time of the entire illness experience If family is functional -- members are drawn closer together If family is dysfunctional-- seed for future family @ discord and breakdownOUTCOMES- RECOVERY © RESPONSIBILITIES OF THE PHYSICIAN - Deal with immediate effects of trauma - Alleviate anxiety and assure adequate rest - Psychological support can be given through understanding and repeated reassurance Perce IV- EARLY ADJUSTMENT TO - )Pisrace Iv- EARLY ADJUSTMENT TO OUTCOMES- RECOVERY @ RESPONSIBILITIES OF THE PHYSICIAN + Assist patient & family in relating to health care system + Aid patient & family in efficient & functional readjustment + Provide quality care Home care is the best & most accepted & least demanding + Preparation for death (early grief)“Family is the support you will never have to pay for because come rain or shine, they will be there to cheer you on with every of your life goals.” —anonymous