Transcript Session 4 THE FAMILY IN HEALTH AND

THE FAMILY IN
HEALTH AND DISEASE:
THE ILLNESS
TRAJECTORY
DEPT. OF PUBLIC HEALTH & PREVENTIVE
MEDICINE
FACULTY OF MEDICINE
PADJADJARAN UNIVERSITY
Learning Objectives
• Describe the effect of family on the health of its member
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(C2)
Recall the definition of diseases and illness (C1)
Discuss the meaning of illness for the family (C2)
Understand the illness trajectory (C1)
Describe the impact of illness on the family (C2)
MAIN EFFECTS OF FAMILY
ON THE HEALTH
WHAT ARE THE SIX MAIN EFFECTS ON THE HEALTH OF
ITS MEMBERS OF THE FAMILY ?
THE FAMILY HAS SIX MAIN EFFECTS ON THE HEALTH
OF ITS MEMBER, THOSE ARE :
1.
GENETIC INFLUENCES
every individual is a product of interaction between
his genotype and environment
recent advances
in our genetic aspects of disease has made this an
important subject for the family physician  genetic
counseling
2. THE FAMILY IS CRUCIAL IN CHILD DEVELOPMENT :
there are many evidence supporting the relationship
between family dysfunction and childhood disorders
(physical and behavioral)
THE FAMILY HAS SIX MAIN EFFECTS ON
THE HEALTH OF ITS MEMBER (cont’d)
3. SOME FAMILIES ARE MORE VULNERABLE TO
ILLNESS THAN OTHERS
4. INFECTIOUS DISEASE SPREADS IN FAMILIES,
e.g., streptococcal infection is related to acute
and chronic family stress, respiratory and
intestinal infection decrease in frequency with
increasing age and the number infections falls
rapidly as immunity is acquiried during the early
school years
THE FAMILY HAS SIX MAIN EFFECTS ON THE
HEALTH OF ITS MEMBER (cont’d)
5. FAMILY FACTORS AFFECT MORBIDITY AND
MORTALITY IN ADULTS.
severe family problems  angina pectoris ⇑
widow or widower  mortality in the first year after
bereavement.
6. THE FAMILY IS IMPORTANT IN RECOVERY FROM
ILLNESS
family support is an important factor in the
outcome of all kinds of illness, especially in
chronic illness and disability
IMPACT OF ILLNESS ON
THE FAMILY
IMPORTANCE OF STUDYING THE
IMPACT OF ILLNESS
• Sickness causes suffering and disruption for the
family
• Sickness can be disruptive to family life and
hazardous to health
• Sickness is embedded in a whole matrix of difficult
family problems
Impact of Illness on the family:
Disease, Illness and the Family Illness Trajectory
• Major illness may have a devastating effect on
whole family
• If the physician is to successfully treat the
disease of the identified patient, the psychosocial
problems of both the patient and the family must
be recognized, diagnosed and addressed.
Health, Normal/Abnormal, Disease, Illness
Health: A state of
complete
physical, mental
and social wellbeing and is not
merely the
absence of
disease or
infirmity (WHO)
… struggle to
achieve !
Normal/Abnormal:
Physiological values or Psychological
values
e.x.: Hypertension/ no Hypertension
Consideration: Human variability
1. Individual variation: vary minute to
minute, hour to hour, day to day,
week to week : manifestations of the
adaptability to the environmental
change
2. Variation between individuals :
genetics and adaptation to different
environments
Disease: primary
biologic and
psychophysiologic
disorder.
Illness: disease + the
sufferer’s experience of
the disease and the broad
range of dislocations felt by
both the sufferer and
his/her family  meaning
of illness is deeply
embedded in the social,
cultural and family context
of the person who is ill.
Meaning of Illness for the Family
• Physicians investigate disease in their patients
by examining clinical and laboratory evidence of
biological and psychophysiologic dysfunction.
• Physicians investigate illness by exploring the
meaning of illness for both their patients and the
patient’s families.
Prosedures to investigate the meaning of
illness
• The patient’s explanatory models
(explain the nature of their illness according to
their perception) provide the cognitive
framework for patient understanding the reason
for onset of their illness, etiology,
pathophysiology, course and outcome of their
illness and how appropriate treatment may affect
the trajectory of their illness.
Prosedures to investigate the meaning of
illness
• Investigation of the patient’s semantic illness network 
the set of meanings, experiences and concerns
that patients associate with their illness (previous
experience with a disease or therapy)
• Investigation the family members' meaning of illness 
sudden sense of being vulnerable to disease
Passage through suffering:
The family Illness Trajectory
• The natural history of an illness episode or the
normal course of the psychosocial aspects of
sickness for the patient and family
• Every stage of the natural history of disease has
different meaning of illness to the family and
family members.
Natural History of the disease
Before man is involved
The course of the disease in man
Interrelation of the various:
- AGENT
- HOST
- ENVIRONMENT factors
(known & unknown)
which
Chronic state
Defect
Disability
Illness
Signs & symptoms
Tissue & physiologic
changes
Immunity &
resistance
STIMULUS & AGENT becomes
established & increases by
multiplication or increment
RECOVERY
bring AGENT & HOST
Interaction of
in the
together, or
produce a disease-provoking human HOST & STIMULUS
HOST
STIMULUS
Discernable early
Early pathogenesis
Pre-pathogenesis
DEATH
lesions
HOST reaction
Advanced
disease
Pathogenesis
Convalescence
• Understanding of such an illness trajectory allows
FP to predict, anticipate and deal w/ family’s
response to illness
• What responses are normal
• What responses are pathologic
Illness
Patient and family member
-Denial, fears
- Convince the doctor that
something is wrong
Stage 2: Reaction to
Diagnosis – The
Impact Phase
Stage 3: Major
Therapeutic Efforts
The family Illness Trajectory
Stage I: Onset of
Illness
Stage 4: Early Adjustment
to Outcomes- Recovery
Stage : 5 Adjustment to
the permanency of the
outcome
- Depends on the disease …
shock & overwhelming
anxiety.
Role of physician
-Prediagnostic phase about the patient
and the fam.
-Ease the patient and fam. anxieties &
concerns
-Responsible for making a clinical
judgment about the amount of
information the patient can absorb.
-Encourage to clear the nature of illness
-Develop plan for realistically coping w/
them
-Choice of therapeutic plan
-Emotional not well
equipped
-Responsibility of the
process treatment
-Psychological state of patient and fam.
is an important determinant of choice of
therapeutic plan .
-Depends on patient education,
reassurance, lifestyle, culture, economic
-Depression
- Anger and disappointment :
economic factor
-Uncertainty about the
outcome
-Active role
-Serve the fam. well, trying to find out
just how the member understand what
has happened
-Alert about potential problem
-Second crisis occur because
of permanency & disability
-Unwillingness to incorporate
the reality
-Anticipate the second crisis of
adaptation to permanency of the
outcome
-Help the family deal with it openly and
directly
The family Illness Trajectory
Reaction and meaning
of illness depends on
Rapid onset/acute : accidents
Clear onset and therapy
Chronic
Hypochondria
References
1. Mc Whinney. A textbook of Family Medicine. Third
Edition, Oxford New York, 2009. pp 217-45.
2. Lee Gan, Azwar.A, Wonodirekso. Family Medicine
Practice. Singapore, 2004. Section 3 chapter 2 pp 5662.
3. Good BJ, Good MD, Burr BD. Impact of Illness on the
Family: Disease, Illness and the Family Illness
Trajectory. In Robert T. Family Medicine Principles and
Practice. Springer – Verlg. New York. 1978. pp 32 – 44.