6.1 (17.6) Family dynamics in the context of serious illness Flashcards
To fully understand impact of illness on a person what two aspects of the family do we need to understand?
- the patient within their family context
- impact of serious illness on the wider family
The impact of a serious illness on the family is seen in what two major areas
1) the sharing of suffering
2) the homeostatic force within the family to maintain its usual patterns of relating and living
List two mental health impacts on the relatives of someone who is seriously ill. What major factor makes it worse?
Relatives of someone seriously ill have higher levels of anxiety and depression
-higher rates of psychological distress in spouses of cancer patients
Uncontrolled symptoms makes above worse
List four factors that influence family structure
culture values attitudes norms roles beliefs
** be curious/ask about family structure to best work with pt/family
The son of a patient says he does not want to tell the patient his prognosis in order to protect him. How do you respond?
consider four factors:
1. Ethical and legal standards that necessitate the patient is informed about their medical condition and that they understand the information sufficiently to give consent about treatment related issues.
- Refusing to take into account the genuine wishes of the family about how to manage a serious illness can result in treatment breakdown between patient/family and treatment team. Such tension only adds to trauma
- Though it should never be assumed the patient that says they do not want to know usually has some idea about their illness but may be coping through avoidance and denial
- The wishes of families and patients about how information is communicated require compassion on the part of the treating team to understand the issues of each member. Being able to discuss the fear surrounding the breaking of bad news or poor prognosis can often dispel myths and enable collaboration about how the family and team can work together.
Talk with all patients about how they would like to informed about test results and the level of information they want to receive before the test is ordered and who they want to be present
When present with patient always prudent to assess their level of understanding about current situation and what they want to know before sharing information
List three common needs that family based caregivers require from health providers and systems
- Information about diagnosis and expected prognosis
- Assistance in dealing with patient’s physical symptoms
- assistance in dealing with feelings such as inadequacy, guilt, anxiety, fear, grief
- managing personal impact of caring such as sleep disturbance, weight loss, maintaining family stability, and recognition of altered roles and choices
- Guidance around coping strategies
List five themes that warrant evaluation during family assessment
Box 6.1.1
- family understanding of illness, key symptoms, treatment
- major concerns at this moment: prognosis, death and dying, caregiving needs
- liaison with medical team and when to seek help
- family functioning - cohesion, communication and conflict
- developmental and past history: prior experience of loss and relational strains
- useful coping strategies - problem solving, team work, emotional support
- social issues - employment, finances, living arrangements
- community resources - meals, cleaning, volunteers, respite
- presence of children at home and their needs
- spiritual needs
- expectations and future concerns, what to expect as death approaches, how to talk to the patient about dying, how to say goodbye and how to manage death in the home
- how to help each other in bereavement
What tool is used to assess family function? What therapy can be offered to families at risk?
Family relationships index (FRI)
Family focussed grief therapy
What are the two broad types of intervention offered to families
- Those that are preventative, supportive, and focussed on enhancing coping
- Those that focus on the actual dysfunction in the family
You are planning a family meeting. List six steps you will take before and during the meeting
5th edition:
- Planning/set up - who to invite
- Welcome and orientation of the family to the goals of the family meeting
- Check each family member’s understanding of the illness and its prognosis
- Check for consensus on current goals of care
- identify family concerns about the management of key symptoms and care needs
- Clarify the family view about what the future holds
- clarify how members are coping and feeling emotionally
- identify family strengths and affirm their level of commitment and mutual support for each other
- close the family meeting by final review of agreed goals of care and consensus about what the future holds
List four principles/goals when conducting a family meeting
Table 6.1.2:
- Open communication and willing provision of medical information
- identification of issues or concerns held by family members
- Recognition of current or past patterns of relating
- problem solving around provision of instrumental care
- encouragement of acceptance of community support
- affirmation of the strengths and courage of the family as a whole
- comfort for the inherent suffering yet optimism about their capacity to cope
List four facilitation techniques to be used in family meeting
circular questions - ask each member to comment on their thoughts of how family/family member is coping
Reflexive questions - invite family to reflect on possibilities, hypotheses, and range of outcomes to stimulate their internal efforts to improve family life
strategic questions - here a solution is incorporated into the question to help guide the family to an outcome that is considered preferable
integrative summary of family’s concerns - family’s views are reflected back to highlight levels of tensions or discordance in different member’s opinions while maintaining neutrality
List 3 features that make families challenging to deal with
rigid in structure and processes
find it difficult to accept change
relationships are chaotic and unstable
distress generates psychiatric disorder such as MDD
