Impact of Illness

on the
Family Life Cycle

FCM I College of Medicine

Emilio Aguinaldo Educational
Foundation

Objectives
To discuss the impact of illness in
the family
To identify and discuss the different
stages in family illness trajectory in
relation to the different stages in the
family life cycle
To discuss the psychosocial aspects
of disease for the individual and the

Why Study Impact of

Illness?
Sickness of patient
causes suffering
and severe dysfunction for the
patients family
Particular illness sets in motion
processes that are disruptive of
family life and hazardous to the
health of family members
role reversal
income loss
disruption of activities
danger of transmission

Why Study Impact of

Illness?

Patients 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,poor nutritional
habit, inadequate housing

Why Study Impact of

Illness?

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 cares system

Why Study Impact of

Illness?
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

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 patents place
children of family at greater risk

DISEASE vs. ILLNESS

The two represent one
phenomenon but 2 aspects of
sickness
DISEASE
ILLNESS
Primary biologic &
psycho-physiologic
disorder

Includes the sufferers

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

Discovering the Meaning

of
Illness for the Family
Investigate
Investigate
Disease:
Illness:
Examining clinical Exploring the
and laboratory
evidences of biologic
and psychophysiologic
dysfunction

meaning of illness to
the patient and the
patients 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

 Clear family organization

good

diabetic control

Dysfunctional psychosocial factors

(such as absent fathers, poor living
conditions, chronic family conflict,
inadequate parental functioniong, and the
lack family involvement)

Increase the likelihood of poorly

controlled diabetes

Low family cohesion and high conflict

Poor diabetic control
Parental indifference

Illness as Essential to
Family Functioning
Somatic symptoms may actually
serve an adaptive function within
the family and may be maintained
by family patterns
Ex.
Children from enmeshed family
were having recurrent episodes of
diabetic ketoacidosis despite their
adherence to diet and insulin

The Family Illness

Trajectory
Passage

Normal
coursethru
of the Sufferings
psychosocial
aspects of disease for the patient
and the family
Knowledge of trajectory allows the
physician to predict, anticipate and
deal with a familys response to
illness
Indicates normal and pathologic
response thus enabling family

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 ones self
and in love ones that keeps
existential fears of impending death
and separation at bay

Stage in Family Illness

Trajectory

Stage I:
diagnosis
Stage II:

Onset of illness to
Impact Phase
- Reaction to

diagnosis
Stage III: Major therapeutic efforts
Stage IV: Recovery Phase
- Early Adjustment
to outcome
Stage V:
Adjustment to the

STAGE I 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.

Cont. Onset of illness

Onset - acute/gradual
Family adaptation in acute
illness requires:
ability to tolerate highly
charged situations, rapid
mobilization of family resources,
flexible role, problem solve
efficiently, abut to together made
of use of outside resources

Nature of
Illness

Nature of
Onset

Acute, rapid
illness/accide
nt

Rapid, clear

Provide little
time for
physical and
psychological
adjustment
Short period
bet. onset,
diagnosis &
management

Caught up in
suddenness
Deal w/
immediate
decision
Often with
little support
from w/in and
outside the
family

Chronic,
especially
debilitating

Gradual

Suffer from
state of
uncertainty
over meaning
and symptom

Vague
apprehension &
anxiety
Fearful
fantasies over
denial of
seriousness of
symptoms and

onset

onset

Characteri Impact on
stic of
Family
Experience

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

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
patients level of understanding
and comprehension

 Give small doses of information over time if

the diagnosis is particularly traumatic and the
patient and his family may be unable to
receive so much
If the diagnosis is confusing and stressful and
shuttering, the physician must:
Provide support and continuity of care
Interpret findings which are misunderstood
Offer advise and encouragement
Clarify meaning of specialists message &
outcome of illness and operation

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

(anger, anxiety and depression)
Depends on disrupted roles and
channels (period of weeks)

2 Planes or Areas by which

Family and Patient React and
Adjust:
EMOTIONAL PLANE

Accommodation: accommodate and

accept diagnosis
Very important for the
implementation of therapeutic plans

2 Planes ...
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; still earn capacity
to problem solving

 COGNITIVE PLANE
Phase III: increasing assessment and
receptivity of family to new approach
for relief of distress
some go doctor shopping; some are
willing and capable for active
participation

Phase IV: eventual acceptance of the

diagnosis enabling them to mobilize
resources and recognize the family
quality of family reorganization; if
there is no movement to this phase,
family will be inefficient in achieving
healthy adaptation to the crisis and

Responsibilities of the
Anticipate number of problems and help
Physician

families to cope and adapt more through

family conference, discussion with parents,
etc.
Specifically:
Family should from the start be encouraged to
make clear to each other & to the patient the
nature of illness by helping family maintain
openness that allows sharing and support
MDs should know the feeling of guilt is a natural
response to stress of grief and loss
Family members may have the irrational feeling
that they personally caused the patients disease
MDs should help family members anticipate such
feelings & make realistic efforts to relieve patient
of self-blame through careful explanation of

STAGE III: Major

Therapeutic
Efforts
Management/therapy represents
one of the most challenging &
rewarding part of medical practice
Have multiple variables, works in
harmony with the wishes of the
patient and family; coordinates all
aspects of the therapy which
involve specialists and others

Critical Issues in Choosing

Therapeutic Plans
Psychological state and preparedness
of the patient & family determine the
choice of therapeutic plans as well as
the alternative choices
Assumption of responsibility for care
and very early in the treatment plan.

Economy of therapeutic plan

Of what good is therapy if the family
cannot afford it
Diligence on the part of the MD in
keeping costs down by involving
family in all major decisions which
affect the patient as in-request for
tests/referrals which are really
necessary
Economic impact of illness
Emotional trauma
Social dislocation
Economic catastrophe wipes out

 Life style and cultural characteristics

of a family are important in choosing a
therapeutic plan
Effect of hospitalization, surgery and
other therapeutic method are stressful
for the patients family:
Father special economic burden
Mother greatest impact on other family
members posing high risk of family
dysfunction
Children special syndrome of emotional
problems of families; hostility /
abandonment
Parents helpless, guilt, frustrated or hurt
Geriatric vulnerable to fears of death,

Responsibilities of the
Physician
Remain open to the family, provide

information
Deal with multiple variables; consider
all factors in planning
Work in harmony with patient and
family
Coordinate all aspects of therapy
Anticipate pathologic responses
Depression
Psychological reaction
Organic symptoms
Behavioral problem

STAGE IV: Early Adjustment

to
Outcomes Recovery
Initiates a period of gradual
movement from the role of being
sick to some form of recovery or
adaptation with corresponding
adjustments of relation within the
family
Illness outcome is an important
phase for patients and family

Type of outcome:
Return to full health (simplest
outcome)
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;
maintaining sense of vulnerability

Permanent disability
requires acceptance of condition

Responsibilities of the
Physician
Deal with immediate effects of trauma
Alleviate anxiety and assure adequate
rest
Psychological support
understanding and
reassurance
Explore level of understanding of
patient and family

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

Adjustment to the
Permanency of the Outcome
For Acute Illness
potential for crisis especially when family
routines are suspended

For Chronic Illness

higher incidence of illness in other
members of the family due to prolonged
fear and anxiety

For Terminal Illness

highly emotional & potentially devastating
Functional: members will be drawn
together

Adjustment to the
Permanency of the Outcome
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)

Responsibilities of the

Acute illness
Physician
Facilitate healthy response or acceptance
of diagnosis & recognize danger signals
such as delayed or prolonged reaction

Chronic illness
Encourage ventilation of feelings, give
reassurance and reinforcement of care

Terminal illness
Assist patient & family in relating to health
care system
Aid patient & family in efficient &
functional readjustment
Provide quality care

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

 Medical care should

result in
treatment of disease,
which is
technologically brilliant,
as well as
adequate treatment of
illness.