Family Issues

  1. Routinely ask about family issues to understand their impact on the patient’s illness and the impact of the illness on the family
    • periodically,
    • at important life-cycle points (e.g., when children move out, after the birth of a baby).
    • when faced with problems not resolving in spite of appropriate therapeutic interventions (e.g. medication compliance, fibromyalgia, hypertension).


  • Supports/confidants
  • Power of attorney
  • Conflicts, abuse
  • Culture, religion
  • Family member's views on patient's medical conditions

Life cycle stages

  • Independence
    • Beginning the emotional separation from parents
  • Coupling
    • Establishing an intimate relationship with partner
    • Further development of emotional separation from parents
  • Learning to live together
    • Dividing the various couple roles in an equitable way
    • Establishing new, more independent relationship with family and friends
  • Parenting
    • Opening the family to include a new member
    • Dividing the parenting roles
  • Living with the adolescent
    • Increasing the flexibility of the boundaries to allow the adolescent to move in and out of the family system
    • Refocusing on midlife marital and career issues
  • Empty nest (launching children)
    • Accepting the multitude of exits from and entries into the family system
    • Adjust to the ending of parenting roles
  • Retirement
    • Adjusting to the end of the wage-earning roles
    • Developing new relationships with children, grandchildren and each other
  • Old age
    • Dealing with lessening abilities and greater dependence on others
    • Dealing with losses of friends, family members and eventually each other
    • In the normal aging process, there is often a decline in physiologic function
    • Weigh potential harms of screening
      • Consider risks/benefits of treatment if a disease is detected, functional status, comorbid conditions and predicted life expectancy