Impact of Illness on the Family

Javier, Mark Leo G.

 Illness
• Affects patient’s emotional, mental, social
well-being and influence the functioning of
his/her family.
• Presence of a ‘disease’ itself does not always
drive the patient to seek consult. This is what
we refer to as ‘illness’.
 Illness
• Disrupts normal family relations
• Affects family member’s social functioning due
to little time to pursue recreational activities
 Social Isolation
• Burden of Financial Stress
• Depression, Anxiety, Sleep problems 
Psychoemotional stress
Factors Influencing How Families
Cope with Illness
 Factors Influencing How Families Cope with
Illness

• The ability to cope with the onslaught of illness

depends both on the internal integrity and
resources of the family and the external
burden of the disease.
• Intrafamilial factors
– Family Resources
– Family Life Cycle Stage
– Degree of Family Functioning
• External factors
– Typology of illness
– Stigma associated with the disease
How to Assess the Family’s
Ability to Cope with Illness
 Active Listening & Learning
• 1. What is the nature and characteristic of the
illness that the family is dealing with?
• 2. What does the illness mean to the patient
and to his family? What are their fears and
uncertainties?
• 3. How have they been coping with the illness
so far? What has helped or hindered them?
• 4. How did the experience of illness change the
patient and his family?
 Active Listening & Learning

• The Physician should be guided based on this

assessment:
• Supportive role
– if Family’s coping strategies are intact
• Family Counseling / Family Therapist referral
– if Family’s coping mechanism is poor
 Family Tools that can be used:
• Family Genogram – members role
• Family Map – members relationship
• Family APGAR – degree of functionality
• Family SCREEM – available resources
Family Illness Trajectory
 Case 1:
• Joed, 32 y.o. Male, Hog raiser in Organico is
having episodes of Right Flank Pain for almost
2 weeks. He browsed through the internet and
read about an article about: “Sambong and its
Anti-Kidney Stone Abilities”. Immediately he
bought CHRO-PLUS w/ SAMBONG and started
drinking 1 capsule 3x/ day. What level in the
illness trajectory is Joed in?
 Case 2:
• Jodelle, 32 y.o. Female, a Commercial Sex Worker in
Infinty KTV owned by Mr. Maningo, was recently
diagnosed with STD 2 weeks prior. However, her co-
worker, Phoebe, 31 y.o., was diagnosed with
Cervical Cancer St. I, 2 days ago. As her bestfriend,
Jodelle screamed out of her emotions and said
“Pataka lang man na ug diagnose si Dr. Banaay
nato oe! Basig siya naay STD & Cervical Cancer!
Grrrr!!!” what level is Jodelle in the Illness
Trajectory?
 Case 3:
• Hans’ Father, Manuel Momongskie, recently
had an accident while driving his BMW. He
underwent BKA of the Right Leg. While lying in
the hospital bed, Manuel said to Hans, “Hans,
I Am Your Father. But from now on, you will be
the one to bring home the bacon daily to your
mother Geselita.” What level in the Illness
Trajectory is Hans in?
 Case 4:
Christine 4.y.o, Female, child daughter of Marco &
Grace was noted with a 2x2 cm mass in her Right
neck region for almost 1 month. Marco sought
consult to Dr. Alinsug and asked “Gamot sa Bukol
meron ka?” However the AP opted for Surgical
treatment & Anti TB Meds. Confused with the AP’s
explanation, Marco talked with Grace and they
decided to undergo with the contemplated
procedure. What level in the illness trajectory are
the parents in?
 Stage 1: Onset of Illness/Symptoms

- Period from the time the patient demonstrates

physical symptoms or feels that there is
something wrong up to the period
consultation is sought.
 Onset of Illness/Symptoms
• Acute, self-limiting & non-incapacitating
illness is oftentimes treated using self-
medication and rarely brought to physicians.
• Health beliefs and previous experience help
shape what patients and their families do and
how soon they seek consult.
 Stage 2: Impact phase – reaction to
diagnosis
• Initial contact with physician is established
• Reaction to terminal illness  DABDA
• Physician explores the patient and his family
of what they already know and what they still
want to know.
 Impact phase – reaction to diagnosis
• Typical Filipino setup: Family withholds the
truth from the patient.

“Diagnostic information regarding one’s body

and life belongs to the person to whom it refers,
not to family or physicians. Therefore, a
patient’s wish to know or not to know the truth
is the most important determining factor.” -
Fetherstonhaugh (1997)
Stage 3: Major Therapeutic Efforts
• Period of mobilization when the family
pursues treatment or palliation.
– Good support system & wealth of resources help the
family go through this stage
• Physician offers options to the family that are
cost-effective and acceptable to the patient’s
belief
– Explore patient & family’s reaction to the therapy
– Family as ‘Therapeutic ally’
 Stage 4: Recovery Phase – adjustment to
outcome
• Disappearance of symptoms for acute, self-
limiting illness or returning to the home
environment and some degree of functionality
for chronic illnesses.
• Adjustment depends on the Intrafamilial and
External factors
– Full recovery  no problem
– Partial recovery, permanent disablity, death
 crises develops
Recovery Phase – adjustment to outcome

• “Readjustment of roles” – accomodate to the

new status of the ill member
• Physician prepares a realistic plan for the
family for potential outcomes of a disease
– Provides support, guidance, educates caregiver
and arrange for home care to chronically ill
patients
 Future Developments
• Assessment of the impact of illness on families
has been increasingly recognized in medicine
where the biopsychosocial approach is now
being adopted.
• Culturally relevant tools to assess this impact
are needed and remain to be a rich area for
research.
Thank You