Family Principles

Family principles
outline
o Definition Of Family
o The Filipino Family
o Family As A Special Unit/ Family A Unit Of Care
o Family Structures
o Family Life Cycle
o Stages Of Family Life Cycle
o Impact Of Illness
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WHAT IS A FAMILY?
“A group of two or more persons related by

birth, marriage, adoption, or emotional ties
residing together in a single household.”
Leopando, Z. (2014). Textbook of Family Medicine 3

WHAT IS A FAMILY?
• McDaniel et.al. 2005: Any group of people related either
biologically, emotionally or legally
• Carter and McGoldrick, 1999: comprise of people who have

a shared history and shared future
• Murdock, 1965: A social group characterized by common

residence, economic cooperation and reproduction
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THE FILIPINO FAMILY AS FOCUS
• Filipino perceives the family unit as the most basic

element of his/her kinship
• It is where he/she learns his values and where the

norms of society and his/her outlook in life came
together
• Other evident traits:
• Closely knit – rooted from strong catholic faith, rarely that
we see a patient not accompanied by another family member
• Bilaterally Extended - RESIDE CLOSELY TO ONE ANOTHER, WILLINGLY LENDING ANY
FORM OF ASSISTANCE IF A RELATIVE IS IN NEED
• Property-owning unit – seen in large and small scale

businesses
• Other evident traits:

• Authority based seniority – bunso usually makes certain
household chores
• Respect to elderly – the use of po an opo

FAMILY AS A SPECIAL UNIT/ FAMILY AS UNIT OF CARE
“FAMILY IS THE SOCIAL CONTEXT IN WHICH ILLNESS

OCCURS AND WHERE RECOVERY TAKE PLACE.”

o WHATEVER ILLNESS MAY BESET THE PATIENT, PARTICULARLY IF IT
IS LIFE THREATENING, POTENTIALLY SERIOUS, COMPLICATED
WILL AFFECT THE ENTIRE FAMILY IN VARYING DEGREES
o FAMILY IS SEEN AS A SYSTEM
o DECISIONS ARE MADE WITHIN THE CONTEXT OF THE FAMILY

o THE TRANSACTION IS NOT JUST BETWEEN THE DOCTOR AND THE

PATIENT. IT SHOULD BE SEEN AS THERAPEUTIC TRIAD.
o THIS KIND OF APPROACH THAT RESPECTS FAMILIES AS INTEGRAL

AND CO-EQUAL PARTS OF HEALTH CARE TEAM EXPECTEDLY
IMPROVES THE QUALITY AND SAFETY OF PATIENT’S CARE
o Case of mrs. aragon, a 43-year old housewife who is presently

confined to a wheelchair because of left-sided hemiparesis. She was
diagnosed to have hypertension but was not compliant to
medications and other supportive treatment. Although very
conscientious of her chores at home, she completely disregarded
her medical condition until she had a stroke, she feels depressed
because she has become unproductive.
FAMILY STRUCTURE
 Nuclear Family
o SMALL FAMILES CONSISTING OF MARRIED COUPLE (OR DIVORCED OR WIDOWED PATIENT) WITH
UNMARRIED CHILDREN – ex: parents and 3 children who are not yet independent and living
on the same house
 EXTENDED Family
o NUCLEAR FAMILIES LINKED TOGETHER BY VIRTUE OF KINSHIP BOND BETWEEN PARENTS AND
CHILDREN OR BETWEEN SIBLINGS – ex: 1st generation: father mother
2nd generation: children
3rd generation: grandchildren
FAMILY STRUCTURE
 LINEAL Family
o CONSISTING OF TWO OR MORE GENERATIONS WITH EACH GENERATION COMPOSED OF ONE MARRIED
COUPLE
 JOINT Family
o CONSISTING OF TWO OR MORE MARRIED COUPLES (OR DIVORCED PERSONS, WIDOWS, OR WIDOWERS) OF
THE SAME GENERATION

FAMILY STRUCTURE
 BLENDED Family
o ONE OR BOTH OF THE PARENTS HAVE HAD A PREVIOUS MARRIAGE, AND POSSIBLY CHILDREN
FROM THAT MARRIAGE ex:Two nuclear family merged together because of remarriage
can become blended
 ADOPTIVE Family
o CHILD IS NOT RELATED BY BLOOD TO THE PARENT, BUT HAS BEEN ADOPTED LEGALLY

FAMILY LIFE CYCLE
o thoroughly understanding the health and illness responses of
patients and their families
o It delineates various developmental stages in the status of

families and describes the manner in which a family is
functioning.

FAMILY LIFE CYCLE
o In each stage, a family projects various identities and roles, the

fulfillment of which would ensure advancement to the next or
higher level

FAMILY LIFE CYCLE

FAMILY LIFE CYCLE
o The family has to cope with the crisis brought about by an

illness situation, particularly a serious or complex one, or
the stresses of everyday living, such as those that have to
deal with finances, dislocation, or even environmental
stress

FAMILY LIFE CYCLE
o We can usually see these in certain ages which can predispose
family members to conditions such as hypertension,
heart disease arthritis and osteoporosis.
o Child’s healthy development to be better equipped adult

depends on the ability of the parent to provide safe, caring
and receptive environment.
IMPORTANCE OF FAMILY LIFE CYCLE
“allows us to analyze and predict how

illness will affect family psychodynamics
so that we may give appropriate
psychosocial support.”
STAGES OF FAMILY LIFE CYCLE
NINE-STAGE CYCLE NINE-STAGE CYCLE EIGHT-STAGE CYCLE SIX-STAGE CYCLE FIVE-STAGE CYCLE
STAGE 1: Experiences with STAGE 1: The Young STAGE 1: interdependence

Family of origin Unattached Adult
STAGE 2: Leaving home
STAGE 3: Pre-marriage
STAGE 1: Establishment STAGE 1: Establishment STAGE 4: Childless couple STAGE 2: Newly-married STAGE 2: Coupling or
(newly-married couple) (newly-married couple) couple marriage
STAGE 2: New parents (infant STAGE 2: New parents (infant STAGE 5: Family with Young STAGE 3: The Family with STAGE 3: Parenting-babies
to 3 years old) to 3 years old) children young children through adolescence
STAGE 3: With pre-school STAGE 3: With pre-school

children children
STAGE 4: With School-age Stage 4: With School-age

children children
STAGE 5: Teenage STAGE 5: Family with early STAGE VI: Family with STAGE 4: The family at Midlife
children/adolescents adolescents adolescents with Adolescents
STAGE 6: Late adolescents STAGE 6: Family with young

adults
STAGE 7: Launching family STAGE 7: Launching family STAGE VII: Launching Family STAGE 5: The stage of STAGE 4: Launching Adult
Launching
STAGE 8: Middle-aged parents STAGE 8: Middle-aged parents STAGE VIII: Family in Later STAGE 6: Family in Later Life STAGE 5: Retirement
Years
STAGE 9: Aging family STAGE 9: Aging family Lauer & Lauer, 2004, Goldberg
Leopando, Z. (2014). Textbook of Family Medicine

& Goldberg
21
Duval, 1957 Barnhill, Ang & Longo, 1978 Carter & McGoldrick, 1999
FAMILY LIFE CYCLE
o THE MOST WIDELY USED AMONG THE PRESENTED FAMILY LIFE CYCLE STAGES IS THE SIX-
STAGE CYCLE
o TWO LEVELS OF ORDERS OF MAGNITUDE OF CHANGE
o First Order Changes
•involve increments of mastery and adaptation
• do not involve change in the main structure of the family
• do not involve a change in an individual’s identity and self-image
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FAMILY LIFE CYCLE
First Order Changes

o tasks that must be accomplished by the family and family
members working within a stage of the Family Life Cycle
o E.g.: A change that is present when a family moves to a new
residence
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FAMILY LIFE CYCLE
Second Order Changes

o involve transformation of an individual’s status and
meaning
o a “NEED TO BE” something new
o Change in the very basic attributes of the family system
o Change in the role and identity of family member
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FAMILY LIFE CYCLE

o Occur between stages of the Family Life Cycle
o One characteristic intergenerational connectedness
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FAMILY LIFE CYCLE
Example:
o A change that is present when a family moves into the stage of the birth of the
first child.
o Husband becomes the father and wife becomes the mother of a dependent sibling
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Family Life Cycle Stage Emotional process of transition Changes in Family Status Required to Proceed Developmentally
I.LEAVING HOME: Accepting Financial and Emotional • Differentiation of the self in relation to the family of origin
Unattached Young Adult responsibility for oneself • Development of intimate peer relationships
• Establishment of the self in relation to work and financial independence
o CONTECT
II.THE JOINING FAMILIES Commitment to the new system • Formation of the marital system
THROUGH MARRIAGE: • Realignment of the relationship with extended families and friends to include the spouse
The new couple
III.BECOMING PARENTS Accepting new members into the • Adjusting the marital system to make space for children
AND FAMILIES WITH system • Joining in child-rearing and financial and household tasks
CHILDREN • Realignment of relationships with the extended family to include parenting and grandparenting
roles
IV. THE FAMILY Increasing flexibility of family • Shifting of parent-child relationships to permit adolescents to move in and out of the system
ADOLESCENTS boundaries to include children’s • Focus on midlife marital and career issues
independence and grandparent’s
frailties
V. LAUNCHING FAMILY Accepting a multitude of exits from • Beginning shift toward joint caring for the older generation
and entries into the system • Renegotiation of marital system as a dyad
• Development of adult-to-adult relationships between grown-up offspring and their parents
• Realignment of relationships to include in-laws and grandchildren, dealing with disabilities and
death of grandparents
VI.THE FAMILY IN LATER •
Maintaining own and/or couple functioning and interests in the face of physiologic decline;
LIFE exploration of new familial and social role options
• Support for a more central role of middle generation
• Making room in the system fir the wisdom and experience of the elderly and supporting older
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generation
• Dealing with loss of spouse, siblings and peers and preparation of one’s own death
Stage 1:Unattached Young Adult
❑ also called “Between Families”
❑ young adult separates from family of origin
❑ He /she formulates personal goals in developing as an
individual

o Stage 1:Unattached Young Adult
❑ Emotional Process of Transition: Accepting parent offspring separation
❑ If not done may result:
❑ Parents encouraging the dependence of their young adult children
❑ Young adults either remaining dependent or breaking away in a
pseudo-independent cut off from their parents or families

❑ Stage 1:Unattached Young Adult
❑ Second Order Changes:
❑ Differentiation of the self in relation to the family of origin
❑ Development of intimate peer relationship
❑ Establishment of self in work

❑ First Order Changes:
❑ Extend social contact outside of home
❑ Job employment
❑ Living accommodation

❑ Psychosocial Problems:
❑ Psychosomatic problems secondary to new job, role and peer group
❑ Depression secondary to:
❑ adjustment to life away from home
❑ difficulty in finding employment, suitable life partner
❑ parental expectation
❑ Psychosocial Problems:
❑ Peer group pressure on acquiring vices, such as alcoholism,
smoking
❑ Fiancee/intimate partner pressure for marriage and premarital
sex
❑ Stage 2: THE JOINING FAMILIES THROUGH MARRIAGE: The new couple
❑ transition stage of the couple from their lives as an individual to life as couple
❑ Many factors make adjustment difficult:
❑ Couple meets and marries shortly after a significant loss
❑ Family backgrounds are significantly different
❑ Couple resides either extremely close to or at a great distance from either family of
origin

❑ Stage 2: THE JOINING FAMILIES THROUGH MARRIAGE: The
new couple
❑ Emotional Process of Transition: Commitment to the new system
❑ Marriage requires that a couple renegotiate a great many
personal issues that they have previously defined for themselves
or that were defined by their parents
❑ Second Order Changes
❑ Formation of marital system
❑ Realignment of relationship with extended families and friends to include spouse
❑ It stresses a family to open itself to an outsider who is now an official member
of its inner circle

❑ First Order Changes
❑ Establishing a home base/ a place to call their own
❑ Establishing a mutually satisfying system for getting and spending money
❑ Establishing mutually acceptable patterns of who does what and who is accountable to
whom

❑ Stage 2: THE JOINING FAMILIES THROUGH MARRIAGE: The new
couple
❑ Establishing a continuity of mutually satisfying sexual relationship
❑ Establishing system of intellectual and emotional communication
❑ Establishing a workable relationship with relatives
❑ Stage 2: THE JOINING FAMILIES THROUGH MARRIAGE: The new
couple
❑ Establishing ways of interacting with friends and associates in the
community
❑ Facing the possibility of children and planning for their coming

❑ Biomedical Problems
❑ Early pregnancy
❑ Sexually Transmitted Infection
❑ Occupational Diseases
❑ Gynecologic problems
❑ Infertility

❑ Psychosocial Problems
❑ Depression due to forced early marriage and unwanted pregnancy
❑ Jealousy to job, friends, and previous fiancee/partner
❑ Emotional problems relating to new role as a spouse (communication, personalities and
character differences in habits and background)

❑ Stage 2: THE JOINING FAMILIES THROUGH MARRIAGE: The
new couple
❑ Problems relating to in-laws, friends, peers and money
❑ Problems of adjustment to office and work

❑ Stage 3: BECOMING PARENTS AND FAMILIES WITH
CHILDREN
❑ starts with pregnancy for the first child to emergence of
adolescents
❑ coming of children defines a new family status, as the wife becomes
the mother, the husband the father
❑ Stage 3: BECOMING PARENTS AND FAMILIES WITH
CHILDREN
❑ Conflict with practices in the home and school regulations
may occur during this stage
❑ Emotional Process of Transition: Accepting new members
into the System
❑ Stage 3: BECOMING PARENTS AND FAMILIES WITH CHILDREN
❑ Accepting marital system to make space for children
❑ Taking on parenting role
❑ Realignment of relationship with extended family to include parenting
and grand-parenting roles

❑ Supplying adequate space, facilities and equipment for the expanding family
❑ Meeting predictable and unexpected costs of family life with small children.
❑ Sharing responsibilities within the extended family and between members of the
growing family

❑ Maintaining mutually satisfactory sexual relationship and planning
for the future children
❑ Creating and maintaining effective communication system in the
family

❑ Cultivating the full potentials of relationship with relatives within the
extended family
❑ Tapping resources, serving needs and enjoying contacts outside the
family

❑ Parents
❑ OB-Gyne problems
❑ Family planning issues
❑ Occupational Diseases
❑ Sexually Transmitted Infection

❑ Grandparents
❑ degenerative diseases
❑ chronic debilitating diseases
❑ Children
❑ Accidents
❑ Mental disabilities
❑ Parents
❑ problems on child rearing
❑ communication problems
❑ in-laws problems
❑ taking care of the sick and old parents or in-laws
❑ financial difficulties
❑ Grandparents
❑ psychosomatic problems related to illness loneliness an financial difficulties
❑ Children
❑ learning deficiencies
❑ child abuse and neglect
❑ Stage 4: Family with Adolescents
❑ starts when the first child reaches adolescent age
❑ generally reached a stage when the parents are approaching a
middle life stage and the grandparents are in the later stage
❑ it is not only teenagers but also their parents who are
undergoing crisis
❑ Hallmarks:
❑ Changes in balance of responsibility along with overfunctioning and
underfunctioning
❑ Marked shifts in intensity of relationships
❑ Surge of exchange with the community at large

❑ Emotional Process of Transition: Increasing
flexibility of boundaries to include children

independence

❑ Second Order Changes:
❑ Shifting of parent-child relationships to permit the adolescent to move in and out
of the system
❑ Refocus on mid-life, marital and career issues (Midlife Crisis and Crisis of Limits)
❑ Beginning shift towards concern for the older generation (Sandwich Generation)

❑ Midlife crisis
❑ Between 40 – 60 yrs old
❑ Major task of an individual at this stage is that of “generativity”
❑ The concern for establishing and guiding the next generation
❑ Failure to achieve this can result in profound personal stagnation
❑ can be characterized by attempts to escape the emotional pain through alcohol and drugs and
through sexual infidelities

❑ Crisis of limit
❑ Period when physical stamina and strength decrease and chronic
lifestyle diseases appear
❑ There comes a realization that time is short, that one cannot live
forever, and that there is still so much to do and to accomplish

Stage 4: Family with Adolescents
❑ Professionally reach as about as high as they possibly can in their
careers
❑ Dreams of youth have often times not been achieved
❑ Think where one is going with the remainder of one’s life, given
the physical limitations that are becoming apparent

❑ struggle during this phase is to “surrender the fantasy of
unlimited possibilities”
❑ not unusual for sudden shifts in career to take place in an effort
to realign one’s life in pursuit of old dreams or in the fleshing out
of new ones

❑ Sandwich generation
❑ Generation that is simultaneously caring for parents and children
❑ May also be called “sandwich generation care givers”
❑ Typically 45- 60 yrs old, female, raising a family, having either a part- or
full- time job, and may or may not have a partner

❑ Sandwich generation
❑ Responsibilities of sandwich generation members may put pressure on
marriage of this generation
❑ Having a healthy marriage going into the sandwich generation phase of life
is a great benefit to spouses in dealing with the stresses of caring for two
other generations
❑ Providing facilities for widely different needs
❑ Working out money matters in the family with teenagers
❑ Sharing the tasks of responsibilities of family living
❑ Putting the marriage relationship into focus

❑ Keeping the communications system open
❑ Maintaining contacts with the extended family
❑ Growing into the world as a family and as a person
❑ Reworking and maintaining a philosophy of life
❑ Adolescents
❑ drug and other substance abuse disorders
❑ sexually transmitted infection
❑ acne
❑ body odor
❑ gynecologic problems such as Menstrual Problems
❑ allergies and other skin diseases
❑ circumcision
❑ Adolescents
❑ sexual experimentation leading to teenage pregnancy
❑ conflict with parents
❑ juvenile delinquency
❑ depression secondary to peer pressure, identity crisis and secondary sex characteristics
❑ child prostitution
❑ suicidal tendencies
❑ Stage 5: launching family
❑ begins when the first child leaves home and ends when the last child
leaves home
❑ In the Philippines, this is prolonged because unmarried children
usually stay with parents
❑ Launched children start their own family life cycle

❑ Emotional Process of Transition: Accepting a
multitude of entries and exits into the family

system

❑ Renegotiating of marital system as a dyad
❑ Development of adult to adult relationship between grown-up
children and their parents

❑ Realignment of relationship to include in-laws and
grandchildren
❑ Dealing with disabilities and death of parents, grandparents

❑ Adjusting to the physiologic changes of middle age
❑ Discovering new satisfaction in relation with spouse
❑ Setting up a comfortable home for themselves that accommodate periodically other members
of the family

❑ Helping their adolescent children to free themselves and become
responsible and happy adults with families of their own
❑ Re-examining their living arrangement with their own parents
❑ Adjusting to the reality of their own work situation

❑ Parents
❑ Obstetric and gynecologic problems
❑ Chronic and Degenerative diseases
❑ Children
❑ Obstetric and gynecologic problems
❑ Medical problems of adolescence mentioned above
❑ Parents
❑ Depression due to:
❑ career stagnation
❑ empty nest syndrome
❑ over-dependent married children
❑ early retirement, financial problems
❑ extra-marital affairs
❑ taking care of the sick parent or in-law
❑ adjustment of new member of the family through marriage
❑ Children
❑ independence and dependency problem
❑ juvenile delinquency
❑ peer group pressure on vices
❑ problems of old relatives, conflict with parents
❑ problems on adjustment to married life
❑ Stage 6: family in later life
❑ Begins with departure of last child and continues through
retirement of one or both of the couple and ends when both are
dead.
❑ Emotional Process of Transition: Accepting the
shifting of generational roles
❑ Maintaining own and or couple functioning and interest in the face of physiologic
decline
❑ Exploration of new familial and social options
❑ Support for more central role for middle generation

❑ Adjusting to physiologic changes of later life
❑ Re-examining their living arrangements
❑ Participating in-group activities
❑ Maintaining contact with younger generations

❑ Parents and Grandparents
❑ degenerative diseases
❑ gynecologic problems
❑ urologic problems
❑ Children
❑ Obstetric and gynecologic problems including menopause
IMPACT OF ILLNESS
✗ DISEASE VS ILLNESS
✗ Disease – physiological abnormalities taking place in a
patient’s body
✗ Illness – encompasses the person’s perceptions, emotions,
and experiences of the disease, including suffering and
changes the patient and family have to undergo
WHY DO WE NEED TO STUDY THE
IMPACT OF ILLNESS ON THE FAMILY?

Effects of Illness in Family
Physical Impact
o There is decreased physical well- being and increased
utilization of medical services for perceived physical
symptoms among family members living with and
caring for chronically ill patients

Social Functioning
o With the need to care for the ailing member and perform other
tasks, the other members of the family may find that they have
little tine to pursue recreational activities.
o This may contribute to the feeling of social isolation

Financial Impact
o The burden of financial stress is greater among
families in the lower socio-eConomic bracket
o In a study among Filipino caregivers of children with
cancer, the majority disclosed that inadequate
economic resources is a marked hindrance and
contributes to strain of dealing with illness
Psychoemotional Impact
o Readily apparent among family members who see the
suffering of their loved ones
o Depression, anxiety and sleep problems are common
among family members dealing with chronic and life
threatening illness

Factors Influencing How Families Cope
Intrafamilial factors
✗ Family Resources
✗ Family life cycle
✗ Degree of Family Functionality
External Factors
✗ Typology of Illness
✗ Stigma associated with disease
oComponent
CONTECT Enablers Barriers
Resources • adequate financial • limited financial
resources resources
• good social support • lack of social support
system group
• strong spirituality • lack of access to
• ability to tap community resources
community resources
CONTECT
o Component Enablers Barriers
Life cycle stage Stage wherein family members Stages that are supposed to launch
are concentrating within the members outside the system
family

CONTECT
oComponent Enablers Barriers
Functionality Functional families that are: Dysfunctional families with:
• flexible in adapting to • poor lines of communication
changing roles • poor emotional connectivity
• have healthy communication
lines
• provide good emotional
support

Component Enablers Barriers

Typology of Illness • Acute and self limiting • Acute life- threatening
• Non-fatal diseases with no • Chronic and debilitating
incapacitation • Rapidly progressive
• Terminal Illnesses

Component Enablers Barriers

Stigma No social stigma Highly communicable diseases that
carry with it social stigma isolating
patients and families

Assessing Family’s Ability to cope
❑ Family Assessment tools
❑ Genogram
❑ Family Map
❑ Family APGAR
❑ SCREEM

IMPACT OF ILLNESS
❑ If the family’s coping strategies are in place, a
supportive role will be adequate
❑ If coping mechanisms are poor, the physician should be
ready to offer family counselling or refer to a family
therapist

Family Illness Trajectory
❑ normal course of the psychosocial aspects of disease for the patient
and the family
❑ knowledge of trajectory allows the physician to predict, anticipate

& deal with a family's response to illness
❑ indicates normal & pathologic responses thus enabling physicians

to formulate special therapeutic plan
Family Illness Trajectory
❑ normal course of the psychosocial aspects of disease for the patient
and the family
❑ knowledge of trajectory allows the physician to predict, anticipate

& deal with a family's response to illness
❑ indicates normal & pathologic responses thus enabling physicians

to formulate special therapeutic plan
IMPACT OF ILLNESS
▪ STAGE I: Onset of Illness to Diagnosis

▪ STAGE II: Impact Phase - Reaction to Diagnosis
▪ STAGE III: Major Therapeutic Efforts
▪ STAGE IV: Recovery Phase - Adjustment to Outcome

STAGE I: Onset of Illness to Diagnosis
❑ warning sign of malaise which initiates
preliminary stage of the illness trajectory
❑ stage experienced prior to contact with medical
care providers
❑ Medical beliefs & previous experiences provide
influence to meaning of illness

❑ Nature of onset may play an important role on impact of
illness on a family
❑ Acute, rapid, clear onset
❑ provide little time for physical and psychological adjustment
❑ short period between onset, diagnosis and management
thereby leaving little time to remain in state of uncertainty

❑ Chronic, debilitating, gradual onset
❑ suffer from state of uncertainty over meaning and symptom
❑ Impact
❑ vague apprehension and anxiety
❑ fearful fantasies over denial of seriousness of symptoms
and possible implications

❑ Responsibilities of the Physician
❑ explore routinely the explanatory model & fear that patients
bring to the clinic set-up
❑ with inappropriate label of illness, acknowledge & explore
conflict the patient maybe experiencing
❑ explore several aspects of pre-diagnostic phase of patients &
families

STAGE II: Impact Phase - Reaction to Diagnosis
❑ Where initial contact with physician is usually established
❑ Disease and appropriate treatment can be described according
to the patient’s level of comprehension and understanding
❑ Unnecessary frightening and anxiety may occur if
information is not understood.

✗ It is important that the physician elicits
explanatory model of diagnosis to patient if
disease is not life threatening and patient is
liable to be unduly alarmed

❑ If diagnosis is confusing and stressful and shuttering, the
physician must
❑ provide support, and continuity of care
❑ interpret findings which are misunderstood
❑ offer advise and encouragement
❑ clarify meaning of specialist's message & outcome of illness
and operation
❑ Patient and Family react on emotionally and cognitively
to diagnosis
❑ Emotional Plane
❑ The diagnosis of curable disease or chronic non-
debilitating disease will more likely lead to
acceptance and immediate movement to the third
stage of major therapeutic efforts
105
❑ Emotional Plane
❑ Reaction to debilitating or terminal
illness, however might range from
denial, anger, bargaining, depression
and acceptance and result in protracted
second stage 106
107
❑ Cognitive Plane
❑ PHASE 1: Initially there is tension & confusion with
probable lack of capacity for problem solving
❑ PHASE II: repeated failure in deriving the diagnosis
may lead to exacerbation of tension & increase
distress
108
❑ General Responsibility of Physician
❑ Anticipate number of problems and help families to
cope and adapt more through family conference, and
discussion with parents and other family members
109
❑ Specific Responsibilities of Physician
❑ The family should from the very beginning be
encouraged to make clear to each other & to
the patient the nature of the illness by helping
family maintain openness that allows sharing
& support
110
■ Source of dilemma in the Filipino setting as far as terminal illness
diagnosis is concerned is when the family wishes to withhold the
truth from the patient
● Diagnostic information regarding one’s body and life belongs
to the person to whom it refers, not to family or physicians
● Therefore, a patient’s wish to know or not to know the truth is
the most important determining factor
111
■ Pattern of non-sharing / silence limit the openness & spontaneity
of families and hampers their ability to share & openly support each
other
■ Process of isolation is more terrifying and may be perceived as
abandonment by the patient
112
❑ The physician should help family members and patient
themselves who have feeling of guilt or self blame through
careful explanation of etiology
❑ The physician should know that feeling of guilt is a natural response
to stress of grief and loss
❑ Family members may have the irrational feeling that they personally
caused the patient's disease
113
❑ Help the family assess the likely effect of the illness on
the family
❑ Predict problems likely to arise
❑ Develop plans for realistically coping with them
❑ Assess the family capabilities to deal with such stress
114
STAGE III: Major Therapeutic Efforts
❑ represents one of the most challenging & rewarding
part of medical practice
❑ Physician should deal with multiple variables, works
in harmony of the wishes of the patient and family,
and coordinates all aspects of the therapy
115
❑ Period of great mobilization when the family pursues
avenues for treatment or palliation
116
❑ Critical issues in choosing therapeutic plan
❑ Psychological state and preparedness of the patient and family
determine the choice of therapeutic plans as well as the
alternative choices
■ If the patient's belief system & trust in therapeutic modality is at
variance with that of physician, he may resist attempt at education
and reassurance
■ Thus, the physician should investigate for signs of non-compliance
117
❑ Assumption of responsibility of each member of the family for
different aspects of care for the patient very early in the
treatment plan
❑ View family as therapeutic ally and not merely as recipient of care
❑ Establishment & definition responsibilities of each party
❑ Give realistic role to everyone
118
❑ Economy of Therapeutic plan
❑ Of what good is therapy if family cannot afford it
❑ Diligence on the part of physician in keeping costs
down by involving family in all major decisions
which affect the patient
119
❑ Life style & cultural characteristics of a family are
important in choosing a therapeutic plan
❑ Effects of hospitalization, surgery and other major
therapeutic method also have great impact on decision
making
120
❑ Effects of sickness in particular members of Family
■ Father - special economic burden
■ Mother - greatest impact on other family members; poses high risk of
family dysfunction
■ Children - special syndrome of emotional problems of families; may
encounter issues of hostility and abandonment
■ Geriatric - vulnerable to fears of death, rejection, abandonment,
121
❑ Responsibilities of Physician
❑ Remain open to the family
❑ indicate they will not be abandoned
❑ provide them information
❑ Deal with multiple variables and consider all factors in planning
❑ Work in harmony with patient & family
122
❑ Coordinate all aspects of therapy
❑ Anticipate pathologic response
❑ Such responses of family members occur when there is severe emotional symptoms such as:
❑ deep depression
❑ psychological reactions
❑ organic symptoms
❑ behavioral problems like addiction to alcohol, work inhibition, and pathologic
acting out
123
STAGE IV: Recovery
❑ Marked by disappearance of symptoms or returning to
home environment
124
STAGE IV: Recovery
❑ Deal with immediate effects of trauma
❑ Alleviate anxiety & assure adequate rest
❑ Psychological support can be given through understanding and
repeated reassurance
125
STAGE IV: Recovery
❑ Explore level of understanding of patient & family
❑ Call on other members of family for means of support
❑ Try to find out how members understand what happened,
what kind of labelling do they have
❑ Do they label person as still ill or do they label him as
once again well or has returned to health?
126
Thanks for
listening!
127

Family Principles

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Family Principles

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Family principles

“A group of two or more persons related by

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• Carter and McGoldrick, 1999: comprise of people who have

• Murdock, 1965: A social group characterized by common

• Filipino perceives the family unit as the most basic

• It is where he/she learns his values and where the

• Property-owning unit – seen in large and small scale

• Other evident traits:

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“FAMILY IS THE SOCIAL CONTEXT IN WHICH ILLNESS

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o FAMILY IS SEEN AS A SYSTEM

o DECISIONS ARE MADE WITHIN THE CONTEXT OF THE FAMILY

o THE TRANSACTION IS NOT JUST BETWEEN THE DOCTOR AND THE

o THIS KIND OF APPROACH THAT RESPECTS FAMILIES AS INTEGRAL

o Case of mrs. aragon, a 43-year old housewife who is presently

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o It delineates various developmental stages in the status of

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o In each stage, a family projects various identities and roles, the

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o The family has to cope with the crisis brought about by an

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o Child’s healthy development to be better equipped adult

“allows us to analyze and predict how

STAGE 1: Experiences with STAGE 1: The Young STAGE 1: interdependence

STAGE 2: Leaving home

STAGE 3: With pre-school STAGE 3: With pre-school

STAGE 4: With School-age Stage 4: With School-age

STAGE 6: Late adolescents STAGE 6: Family with young

Leopando, Z. (2014). Textbook of Family Medicine

First Order Changes

Second Order Changes

Second Order Changes

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flexibility of boundaries to include children

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multitude of entries and exits into the family

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