FAMILY MEDICINE CONCEPTS Franciosa L.G. Gavino, MD, DPAFP Department of Preventive and Community Medicine UERMMMCI

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 structure SECOND 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: family tree (including its description) functional chart family illness / history

1969 heart disease 2002 2004 diabetes colorblind ovarian growth 66 66 33 36 33 32 32 31 23 22 heart disease 2002 2004 diabetes 2 6 colorblind ovarian growth

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.

coalition between members 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