1. THE FAMILY in HEALTH and DISEASE: The Illness Trajectory
DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE
FACULTY OF MEDICINE
PADJADJARAN UNIVERSITY

2. Learning Objectives
Describe the effect of family on the health of its member (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)

3. MAIN EFFECTS OF FAMILY ON THE HEALTH

4. 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)

5. 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

6. 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

7. Impact of Illness on the family

8. 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

9. 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.

10. Health, Normal/Abnormal, Disease, Illness
Health: A state of complete physical, mental and social well-being 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
Individual variation: vary minute to minute, hour to hour, day to day, week to week : manifestations of the adaptability to the environmental change
Variation between individuals : genetics and adaptation to different environments

11. 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.

12. 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.

13. 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.

14. 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

15. 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.

16. Natural History of the disease
Pre-pathogenesis
Pathogenesis
Before man is involved
The course of the disease in man
Interrelation of the various:
- AGENT
- HOST
- ENVIRONMENT factors
(known & unknown)
which
bring AGENT & HOST
together, or
produce a disease-provoking
STIMULUS
in the human HOST
Early pathogenesis
Discernable early
lesions
Advanced
disease
Convalescence
Interaction of
HOST & STIMULUS
HOST reaction
STIMULUS & AGENT becomes
established & increases by
multiplication or increment
Tissue & physiologic
changes
Signs & symptoms
Illness
Disability
Defect
Chronic state
DEATH
RECOVERY
Immunity &
resistance

17. 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

18. Patient and family member
Stage I: Onset of Illness
Stage 2: Reaction to Diagnosis – The Impact Phase
Stage 3: Major Therapeutic Efforts
Stage 4: Early Adjustment to Outcomes- Recovery
Stage : 5 Adjustment to the permanency of the outcome
Role of physician
Patient and family member
Psychological state of patient and fam. is an important determinant of choice of therapeutic plan .
Depends on patient education, reassurance, lifestyle, culture, economic
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
Prediagnostic phase about the patient and the fam.
Ease the patient and fam. anxieties & concerns
Illness
Denial, fears
Convince the doctor that something is wrong
- Depends on the disease … shock & overwhelming anxiety.
Choice of therapeutic plan
Emotional not well equipped
Responsibility of the process treatment
Depression
Anger and disappointment : economic factor
Uncertainty about the outcome
Second crisis occur because of permanency & disability
Unwillingness to incorporate the reality
Active role
Serve the fam. well, trying to find out just how the member understand what has happened
Alert about potential problem
Anticipate the second crisis of adaptation to permanency of the outcome
Help the family deal with it openly and directly
The family Illness Trajectory

19. The family Illness Trajectory
Reaction and meaning of illness depends on
Rapid onset/acute : accidents
Clear onset and therapy
Chronic
Hypochondria

20. References
Mc Whinney. A textbook of Family Medicine. Third Edition, Oxford New York, pp
Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice. Singapore, Section 3 chapter 2 pp
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 pp 32 – 44.