FAMILY MEDICINE CONCEPTS

Franciosa L.G. Gavino, MD, DPAFPDepartment of Preventive and

Community MedicineUERMMMCI

A. Family Characteristics: > family structure> family life cycle> family assessment tools

B. Impact of Illness / Family Illness Trajectory

The family > is the primary social agent in the promotion of health and well-being and disease prevention.> influences a person’s health beliefs and health-related behaviors> is a source of stress and emotional support

FAMILY STRUCTURE

• nuclear family

• extended family

• single-parent family

• blended family

• corporate / communal family

FAMILY LIFE CYCLE

• Unattached Young Adults

• Newly Married Couple

• Family with Young Children

• Family with Adolescents

• Launching of Adult Children

• Family in Later Years

ORDERS OF MAGNITUDE OF CHANGE

FIRST ORDER CHANGE There is a “need to do” something new;

involves mastery and adaptation No change in the family’s identity and

structureSECOND ORDER CHANGE There is a “need to be” something new;

involves a transformation of an individual’s status and meaning

There is a change in the role and identity of family members

FAMILY ASSESSMENT TOOLS

Family Genogram> This is a graphic representation of both

the genetic pedigree of the family and key psychosocial and interactional data using standardized symbols.

> It represents three components of the family:1. family tree (including its

description)2. functional chart3. family illness / history

66 66

3633 33 32 32

2 6

31 23 22

heart disease

diabetes

colorblind

ovarian growth

1969

20042002

FAMILY ASSESSMENT TOOLS

Family Map

The family map (developed by Dr. Salvador Minuchin) is very similar to a genogram in the sense that it utilizes common symbols. However, the family map gives a better picture of the various relationships existing among the members of the family.

clear boundary

diffuse boundary

rigid boundary

affiliation

over involvement

conflict

detouring

coalition between members

marital discord

FAMILY ASSESSMENT TOOLS

Family Lifeline> A chronological listing of important

family events that may play a significant role in the holistic management of patients (i.e. emergence of certain symptoms, compliance with medications, decision-making in certain health issues, etc.).

1969: Marriage of Juan and Maria 1982: Juan, the main breadwinner, was diagnosed

with Diabetes Mellitus, Type 2, insulin-requiring. 1990: Juan developed CKD secondary to DM

nephropathy and needed frequent hemodialysis. Financial crisis followed.

1991: Juan died of complications of DM. Maria was left with financial difficulties.

1992: Maria developed major depressive disorder. Maria started to use illicit drugs, specifically MAP.

2005: Maria was admitted at the ICU because of dilated cardiomyopathy secondary to MAP abuse.

FAMILY ASSESSMENT TOOLS

Family A.P.G.A.R.> This is a rapid screening instrument

used to measure family dysfunction. It determines the family members’ level of satisfaction about their relationships.

> ADAPTATION, PARTNERSHIP, GROWTH, AFFECTION and RESOLVE

FAMILY ASSESSMENT TOOLS

The Family A.P.G.A.R. has two parts:Part I: helps define the degree of

patient’s satisfaction or dissatisfaction with family function

Part II: delineates relationship with other members; it identifies persons who can give assistance to the patient; it indicates conflicts not revealed in Part I

FAMILY ASSESSMENT TOOLS

Interpretation of Family A.P.G.A.R. (average score of family members):

• 8-10 points: highly functional family

• 4-7 points: moderately dysfunctional

• 0-3 points: severely dysfunctional

FAMILY ASSESSMENT TOOLS

Family S.C.R.E.E.M.

> This is used to assess the family’s capacity to participate in provision of health care or to cope with various crises

> This is an acronym that stands for social, cultural, religious, economic, educational, and medical factors affecting health. These factors may be considered as resource or as pathology.

FAMILY ILLNESS TRAJECTORY

STAGE 1: Onset of Illness to Diagnosis Stage prior to contact with medical care

providers Nature of onset may play an important role

on impact of illness on family (i.e., rapid, clear, gradual)

Medical beliefs and previous experiences influence meaning of illness

FAMILY ILLNESS TRAJECTORY

STAGE 2: Impact Phase: Reaction to Diagnosis

Presence of emotional upheaval:

denial, disbelief, anxiety

anger, depression

acceptance

FAMILY ILLNESS TRAJECTORY

STAGE 3: Major Therapeutic Efforts The patient makes use of all the

available therapeutic options appropriate to his/her illness

Affected by the family’s emotional and psychological preparedness, financial status, cultural characteristics

FAMILY ILLNESS TRAJECTORY

STAGE 4: Recovery Phase: Early Adjustment to Outcome

Return to full health Partial recovery Permanent disability

FAMILY ILLNESS TRAJECTORY

STAGE 5: Adjustment to Permanency of Outcome

ACUTE ILLNESS: family routine is suspended; highly emotional experience

CHRONIC ILLNESS: brings out feelings of guilt, anger, resentment

TERMINAL ILLNESS: initial response is shock; highly emotional and devastating experience for the family; coping is dependent on the family’s functionality