Family Issues
- 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).
History
History
- Supports/confidants
- Power of attorney
- Conflicts, abuse
- Culture, religion
- Family member's views on patient's medical conditions
Life cycle stages
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
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