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

2. A. Family Characteristics: > family structure > family life cycle > family assessment tools B. Impact of Illness / Family Illness Trajectory

3. 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

4. FAMILY STRUCTURE nuclear family extended family single-parent family
blended family
corporate / communal family

5. FAMILY LIFE CYCLE Unattached Young Adults Newly Married Couple
Family with Young Children
Family with Adolescents
Launching of Adult Children
Family in Later Years

6. 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

7. 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

8. 1969 heart disease 2002 2004 diabetes colorblind ovarian growth 66 6633 36 33 32 32 31 23 22
heart disease
2002
2004
diabetes 2 6
colorblind
ovarian growth

9. 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.

10. coalition between members
clear boundary
diffuse boundary
rigid boundary
affiliation
over involvement
conflict
detouring
coalition between members
marital discord

11. 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.).

12. 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.

13. 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

14. 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

15. 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

16. 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.

17. 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

18. FAMILY ILLNESS TRAJECTORY
STAGE 2: Impact Phase: Reaction to Diagnosis
Presence of emotional upheaval:
denial, disbelief, anxiety
anger, depression
acceptance

19. 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

20. FAMILY ILLNESS TRAJECTORY
STAGE 4: Recovery Phase: Early Adjustment to Outcome
Return to full health
Partial recovery
Permanent disability

21. 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