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Handout for Impact of Illness Lecture (Oct. 19, 2015)- Lecturer Dr. Perla Angelina B.

IladaAgapay
Difference between Disease and Illness
Disease- Primary biologic and psycho-physiologic disorder
Illness- includes the sufferers experience of the disease and the broad range of dislocations felt
by both the sufferer and his family.
- Deeply embedded in the social, cultural and family context of the person who is ill.
Objectives:
To discuss impact of Illness on the family.
To discuss the stages of Illness trajectory.
To determine the role of physician on each stage.
The Family Illness Trajectory-Passage Thru Sufferings
Natural course of the psychosocial aspects of disease
Knowledge of the trajectory allows the physician to predict, anticipate, and deal with a
familys response to illness
Indicates normal and pathologic responses thus enabling physicians to formulate special
therapeutic plans
Why study impact of illness?
Sickness of a patient causes suffering and severe disruption for the patients family, thus
when a patient is sick the whole family suffers.
Illness sets in motion processes that are disruptive and hazardous to health of family
members, there is a role reversal, income loss and disruption of activities and
susceptibility of disease transmission.
Prolonged and complicated illnesses result in structural change within the family system
to a point that leads to different roles and functions.
Stages in Family Illness Trajectory
Stage I
Stage II
Stage III

Onset of Illness to Diagnosis


Impact Phase-Reaction to Diagnosis
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 to Diagnosis

Warning sign of malaise which initiates preliminary stage of the illness trajectory

Stage experienced prior to contact with medical care providers


Nature of illness may play an important role on impact of illness
Types of Illness:
Nature of illness
Acute, rapid
Chronic, debilitating
Nature of onset
Rapid, clear onset
Gradual onset
Characteristics of
Provide little time for
Suffer from state of
experience
physical/psychological
uncertainty over meaning
adjustments- short period
and symptom
between onset, diagnosis, and
management thereby leaving
a little time to remain in a
state of certainity.
Impact on family
- Caught up in suddenness
- Vague apprehension and
- Immediate decision
anxiety
- Little support w/in and
- Fear, denial of seriousness
outside family
of symptoms and possible
implications
Physician Responsibilities in Stage I

Explore fear that the patients/ family bring up in the clinic

With inappropriate label of illness, acknowledge and explore conflicts the patient and
family may be experiencing
Explore aspects of pre-diagnostic phase of patients and families

Stage II- Reaction to Diagnosis: Impact Phase


2 PLANES OR AREAS BY WHICH A PATIENT/FAMILY REACT AND ADJUST
EMOTIONAL PLANE
COGNITIVE PLANE
-Denial, disbelief, anxiety (min to hrs)
Phase 1: Tension and confusion, lack of
-Emotional upheaval such as anger, anxiety and capacity for problem solving
depression (wks)
Phase 2: Repeated failure in deriving the
-Accommodation and acceptance- this is very
diagnosis leading to increased distress- some
important for the implementation of therapeutic patient may resort to prayers and still they have
plans.
the capacity to problem solve
Phase 3: Receptivity of family to new
approach for relief of distress- patient go doctor
shopping, some patienst are capable and willing
to actively participate and accept responsibility.
- The physician have the opportunity
to assist the family in realigning
roles and expectations
Phase 4: Eventual acceptance of diagnosis
Responsibilities of the Physician in Stage II
1. Anticipate problems and help family cope and adapt through family meetings/ discussion.

2. Make clear about the nature of illness by helping the family maintain openness that allows
sharing and support.
3. Know that the feeling of guilt is a natural response to stress of grief and loss, anticipate
such feelings, and make realistic goals to correct the feeling.
4. Help the family assess the likely effect of the illness on the family
5. Assess the capability of the family to cope with stress
6. Offer alternative interpretation of proposed therapeutics
7. Describe disease and treatment according to patients level of comprehension and
understanding
8. Make a clinical judgment about the amount of information to give and be absorbed by the
patient
9. Give small doses of information over time
10. If diagnosis is confusing or stressful
a. Provide support and continuity of care
b. Interpret findings
c. Offer advice and encouragement
Stage III- Major Therapeutic Efforts
-Represents one of the most challenging and rewarding part of medical practice
-Physician should deal with multiple variables
*work in harmony with the wishes of the patient and family
*Coordinate all aspect of the therapy
WORKING WITH FAMILIES
METHODS:

Family-oriented approach with individual patient


Involving family members in routine office visits
Family conference/ meeting
Involving Family Members in Routine Office Visits
- One or more family members are present
- Common medical Situation: Well-child and prenatal care, diagnosis of a chronic
illness
- Length of visit: 15-20 min
- How scheduled: Request family member attendance
- Family Interviewing
Family Conferences
- A specially arranged meeting requested by the physician, patient or family to discuss
the patients health problem in more depth than can be addressed during a routine
office visit
- Medical Situation: Terminal Illness
Institutionalization
- Length of visit: 30-40min
CRITICAL ISSUES IN CHOOSING THE THERAPEUTIC PLAN

1. Psychological state and preparedness of the patient and family- if patients belief system in
certain treatment plan is different with that of the physician, he might resist the treatment.
Thus the physician should investigate for signs and symptoms of non-compliance.
2. Assume responsibility of care very early in the treatment plan. Define roles
3. Economic status- of what good is the treatment if the family cant afford it.
Economic impact of illness
a. Emotional trauma
b. Social dislocation
c. Economic catastrophe- wipes out family savings
4. Lifestyle and cultural characteristics of the family
5. Effects of hospitalization, surgery, and other therapeutic methods are emotionally stressful
to the family.
- Hospitalization give rise to stressful logistic problem
o Father- special economic burden
o Mother- greatest impact on other family member and poses high risk of family
dysfunction.
RESPONSIBILITIES OF THE PHYSICIAN in Stage III
1. Remain open and work in harmony with the patient and his family
2. Deal with multiple variables; consider all factors when planning
3. Coordinate all aspects of therapy
4. Anticipate pathologic responses and be able to deal with them
Stage IV- Early Adjustments to Outcomes- Recovery
Return from the hospital or major therapy
Gradual movement from the role of being sick to some form of recovery or adaptation
Adjustment of relation within the family
Types of Outcomes
1. Return to full health- simplest outcome
Gains from illness experience
Patient allowed to take over abandoned obligation
2. Partial recovery
Followed by a period of waiting to see if illness will return
Fear of death
Constant sense of vulnerability
3. Permanent disability
RESPONSIBILITIES OF THE PHYSICIAN in Stage IV
1. Deal with immediate effects of trauma
2. Alleviate anxiety and assure adequate rest
3. Psychological support
4. Explore level of understanding of patient and family

Stage V- Adjustment to the Permanency of the Outcome


- Familys adjustment to crisis
- Second crisis occurs as family realizes that they must accept and adjust to a permanent
disability
- FOR ACUTE ILLNESS: Potential for crisis when routines are suspended
Physician can facilitate acceptance of diagnosis
- FOR CHRONIC ILLNESS: Prolonged fear and anxiety leads to higher incidence of
illness in other members of the family
Feeling of guilt brings about anger and resentment
Physician should encourage ventilation of feelings, give reassurance and
reinforcement of care
- FOR TERMINAL ILLNESS: Highly emotional and potentially devastating
Single most difficult time of the entire illness experience
If family is functional: members are drawn close together
If family is dysfunctional: seed for future family discord and breakdown
Physician should provide quality home care