Categories
Psychology

Families and Chronic Illness: Therapy using a Systemic Approach

Abstract

Chronic illnesses are putting a strain on the healthcare budgets of many countries. With advanced medical technologies, people are leaving longer lives, which contribute to the development of chronic illnesses. Chronic illnesses are long-term in nature, which means that patients, caregivers, and family members must adjust and cope with the physical and emotional demands of the illnesses. Chronic illnesses are caused by a variety of factors such as poor diet, tobacco use, and inactivity, and other risk factors such as aging, pollution, and substance abuse. The impacts of these diseases on family members demand that their management involve all family members. Treatment must include support to families in order for them to manage the negative feelings associated with the disease.


Table of Contents

Abstract 2

Table of Contents. 3

Introduction. 4

Etiology. 4

Causes 5

Prevalence. 7

Assessment 9

Impact on family relationships 11

Impacts on the patient 12

Impacts on marital and family relationships. 14

Treatment considerations. 17

Standards of treatment 20

Conclusion. 23

References 24

 

 

 

Introduction

Rising cases of chronic illnesses are exerting pressure on patients and their families in coping and adapting to the long-term nature of these diseases. Physical inactivity, poor diets, and substances are some of the causes of chronic illnesses. However, it is important to note that other risk factors such as aging, alcoholism, poverty, and pollution exacerbate these illnesses. Chronic illnesses are poorly understood, and treatments are focused on helping patients and their families to succumb to the physical and emotional demands of these diseases. Emotional focused therapy (EFT) is the most effective intervention in the management of chronic illnesses. This intervention helps patients, caregivers and family members cope with the negative feelings associated with chronic illnesses, and studies on the intervention have shown positive outcomes for chronic health conditions.

Etiology

Chronic illnesses are diseases that develop slowly and are long-term in nature. Examples of chronic illnesses are cancer, coronary diseases, stroke, diabetes, and chronic respiratory diseases. Currently, chronic diseases are the major causes of mortality globally, which represents sixty-three percent of all deaths globally. Chronic illnesses cause changes to lifestyles and inter-personal relationship because they are demanding in terms of management and treatment. These diseases influence the self esteem of the patients and how they relate to other individual especially family members. Chronic illnesses lay attributes to a number of changes that may add additional stress to the already demanding health condition. They will be required to adjust and live with the physical impacts of the disease. The treatments of these diseases are not comfortable, and they will have to handle the adverse effects of some medications such as those used in cancer treatment (Leahey & Wright, 2005). The negative feelings that come with such illnesses will require patients to adjust emotionally in order to manage the negative feelings that go with the disease. Since most of these diseases require close monitoring and follow-ups, patients will have to maintain a clear communication channel with doctors, which may consume significant amounts of money. Most chronic illness cause loss of personal confidence, and in order to regain their previous self-image patients must invest time and money.

Dealing with the stress caused by chronic illness is not only the additional demand brought by these diseases because the patient will have to avoid social isolation, as the disease will take more time. Consequently, they will not have the time to engage in social activities that build and enhance relationships (Leahey & Wright, 2005). Other demands will involve an understanding of the disease in order to live the recommended lifestyle. Another challenging aspect of chronic illnesses is maintaining social relationship at times when the future is uncertain, and symptoms of the disease increase in intensity, and when coupled with the demand of controlling the signs of the disease, this demand may overcome the patient (Anderson, 2004). For some patients, maintaining trust in doctors becomes a challenge when the medication prescribed does not work.

Causes

The causes of chronic illnesses or predisposing risk factors are well known; the risk factors are the main causes of most common chronic illnesses. The risk factors are changeable and are similar in both genders. Lack of physical activity, poor diets, and tobacco use are documented causes of chronic diseases. These causes of chronic illnesses are expressed through disease symptoms for instance the increased blood pressure, overweight, high levels of glucose,  odd blood fats, and obesity. The adjustable risk factors when coupled with unchangeable risk factors such as age and genetic makeup explain the occurrence of novel cases of stroke, heart diseases, cancer, and diabetes. The link between the common changeable risk factors and the common chronic illnesses are the same in all parts of the globe.

There are other risk factors that have been discovered more recently that contribute to chronic illnesses, but their contribution is minimal. Excessive consumption of alcohol is known to play a role in causing a variety of diseases, but its contribution to chronic illnesses in more intricate. Other well-known risk factors that predispose individuals to chronic diseases include air pollution that cause a variety of respiratory infections such as asthma, infectious contaminants that cause liver and cervical cancers, genetic makeup, and psychosocial factors (Anderson, 2004). Childhood risk is also another risk factor of chronic illnesses due to in-depth research from many countries that link conditions prior to birth and early childhood to health conditions later in life. The  low birth weight, which is associated with heart diseases, elevated blood pressure, diabetes, and stroke during adulthood is an example. Poverty is also a well-known risk factor of chronic illnesses and is linked in a vicious circle. The deteriorating poverty conditions cause chronic disease because poor people are exposed to dangerous contaminants that can cause these diseases (Wu & Green, 2000). Lack of access to medical services cause the worst outcomes for patients from poor backgrounds and impede monitoring and continuity of treatment. Poverty also prevents access to preventive treatment that can aid the identification of the disease at preliminary stages. Furthermore, the lower class people in the society do not afford the medical care, thus, when coupled with psychosocial stress it becomes a key contributor of chronic illnesses. Ageing also plays a role because with age, modifiable risk factors build up; therefore, the effect of risk factors augments with ageing (Wu & Green, 2000). There are also underlying determinants of these diseases that mirror the main forces driving economic, cultural change, urbanization, social, globalization, ageing of the population and implementation of key policies that affect healthcare.

Prevalence

The prevalence of chronic illnesses is high in the United States among other parts worldwide. This is because it causes more than sixty-five percent of all deaths in the nation and consumes about seventy five percent of direct medical expenditures according to the U.S Department of Health and Humans Services (USDHHS) and Center for Disease Control (CDC). Chronic illnesses consume approximately $ 1.5 trillion in direct costs alone, while indirect cost associated with non-reimbursed personal expense and lost productivity run into hundreds of billions of dollars. Considering that the prevalence of chronic illnesses increases with ageing, the number of people suffering from these illnesses will increase gradually, which translates to higher medical costs. This is illustrated by data that showed that by the turn of the nineteenth century, the life expectancy of Americans stood at forty-seven years, but a century later the life expectancy averaged at seventy years (CDC, 2005). This has resulted into an increasing ageing population with the number of those over sixty-five years rising from three million to thirty five million.

High life expectancies are the result of modern medical advances, which has also lowered the infant mortality rate and management of infectious disease that were the main cause of death in the nineteenth century. Other advances are in the sectors of public sanitation and purification of drinking water. With a higher life expectancy, chronic illnesses such as arthritis, neurodegenerative illnesses, and heart disease have the time to establish themselves. The management of illnesses that was deadly some years ago such as Acquired Immunodeficiency Syndrome (AIDS) and diabetes has also caused prevalence of chronic illnesses. These diseases are not curable, but have been converted to chronic illnesses and contribute to an increased life expectancy. The cost of managing these diseases in long-term is high, which contribute to the soaring health budget.

According to the American Heart Association (AHA), approximately 64.4 million Americans suffered from one or more forms of heart diseases by 2004. Out of this value, 50 million Americans suffer from high blood pressure (hypertension). A further 13.2 million Americans suffered from coronary heart diseases, which manifest itself as myocardial infarction in 7.8 million and as chest pain disorders in another 6.8 million. Some people may suffer from both conditions (CDC, 2005). Another five million are afflicted with congestive heart failure, while another 4.8 million experiences strokes annually. A combination of strokes and coronary diseases caused forty percent of all deaths in America in 2001, and played significant roles in a further 20% of deaths.

Arthritis is also another chronic illness with a high prevalence rate, which afflicted approximately fifty to seventy million Americans as by 2005. Cases of disability cause by arthritis and back pain are common, and contribute to a third of all illnesses that are not linked to mental diseases among individuals over fifteen years of age in America. The National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMSD) project that by the year 2020 instance of arthritis in America will increase by fifty percent due to an ageing population (CDC, 2007). These rising numbers will exert a burden on both individual finance and the economy due to medical costs and lost productivity. Asthma and diabetes are also other chronic illnesses that afflict 15 million and 17 million Americans respectively. Both diseases contribute to substantial disability.

Chronic neurodegenerative illnesses such a Parkinson’s disease and Alzheimer’s are the most complex to detect correctly and challenging to manage because they affect both the patient and family members. 4 million American suffered from Alzheimer’s disease and 1.5 million from Parkinson’s disease as of 2004 (CDC, 2005). Aging of the population will also contribute to increase in blindness and hearing diseases. A study conducted in 2003 on recipients of Medicare benefits showed that diabetic retinopathy, macular degeneration, and glaucoma increased in prevalence over nine years of the study duration. Mental disorders are hard to classify as chronic illnesses, but they have similar demands as chronic diseases. The Surgeon General of the United States estimates that thirty percent of the total population is afflicted with either mental disorders or addictive disorders, and in some instances both of them (CDC, 2007). A prospective study that appeared in the Journal of American Medical Association in 2010 showed that incidences of chronic illnesses in children between 2 years and 8 years increased from 12.8 percent in 1994 to 26.6 percent in 2006. Asthma, behavior and learning challenges, and obesity were cited as the main diseases in the study.

Assessment

Three models are used in the assessment of quality of improvements in the management of chronic diseases. The Assessment of Chronic Illness Care (ACIC) is a tool used by medical staff to identify sections of improvement prior to initiating quality improvement effort in the provision of care for patients suffering from chronic illnesses. This tool also aids in the development of improvement strategies and in the evaluation of the degree and impacts of quality improvement efforts (Lubkin, 2013).

The patients can also assess the effectiveness of chronic illnesses care using Patient Assessment of Chronic Illness Care (PACIC). This self-reporting tool helps patients determine the degree of care they receive and check if it is aligned to the Chronic Care Model (CCM). CCM is widely acclaimed has the most appropriate tool for creating and executing evidenced-based services to improve the quality of care to patients suffering from chronic illnesses. The main advantage of CCM as an assessment tool is is its role in a variety of chronic illnesses including diabetes (Lubkin, 2013). PACIC and ACIC are useful in assessing the quality of care patients receives and if it meets CCM standards. They are also practical assessment tools that can be used to compare diverse healthcare settings, appraise intervention strategies, and aid in implementing quality improvement programs. Through studies that have been carried out in integrated health maintenance institutions and with patients suffering from different chronic illnesses, researchers have found that PACIC possesses practical psychometric traits that make it appropriate for different chronic illnesses.

The 5A’s is a useful tool used in the diabetes personal management. It stands for Ask, Advise, Agree, Assist, and Arrange. This model, which has the advantage of being evidence-based, is increasingly being applied. It is useful in aiding quality improvement. This framework is compatible with CCM and is a patient-centered form of behavioral counseling that can boost personal-management support and connection to community resources, which are two elements of CCM (Lubkin, 2013).

Functional Assessment of Chronic Illness Therapy (FACIT) is a measurement system that is made up of Health-Related Quality of Life (HRQOL) questionnaires that are aimed at managing chronic diseases. It started with the development of the basic questionnaire known as Functional Assessment of Cancer Therapy General (FACT-G). The most recent version contains twenty-seven questions, which are categorized into the following Quality of Life Domains (QOL): physical well-being, emotional well-being, social or family well-being and functional well-being (Webster, et al, 1999). This system is applicable in patients suffering from different types of cancer; its extensions have being applied in other illnesses such as multiple sclerosis, rheumatoid arthritis, HIV/AIDS and Parkinson’s disease. In this system, assessment of an individual patient is structured to ensure that the most applicable questions are asked and administration duration is less than fifteen minutes. These requirements are achieved by using precise subscales for applicable spheres of HRQOL, or Computerized Adaptive Testing (CAT) of chosen disease signs and useful areas (Webster et al, 1999). The questionnaires can be administered by personal-report using a computer or paper, or a face-face interview over the telephone. Interpretation of outcomes is possible using normative data, information on meaningful alteration and existing scoring within the framework of an emergent literature foundation. Applications of FACIT questionnaires vary from phase I to III clinical trials and other treatments assessments, an intervention instrument in the clinical supervision of clinical signs comprising psychological and physical signs, and as results determinant in healthcare practice studies.

Impact on family relationships

Chronic illnesses touch on every aspects of the family starting from the individual suffering from the disease to immediate family members with financial and emotional stress being the main stressing factors. Chronic diseases have a deep negative impact on spousal relationships because one of the partners may not feel the way the felt before the onset of the disease and the other partner may not know how to provide care for the sick partner (Roland, 1994). This also applies to families who have children suffering from chronic diseases, as it will be difficult managing work place duties, family commitments and the time for providing care.

Impacts on the patient

Chronic illnesses take a toll on the individual because of the changed status. Individuals experience a painful chasm between the past and the present, which causes chronic sorrow. Chronic sorrow is an unending sadness that is caused by the loss of one’s individuality due to the chronic disease or the disabilities associated with it. According to Kaethe (2012), Chronic illnesses cause chronic sorrow and self-loss because some chronic diseases can make the patient or family members wonder if the person is sick or not. Chronic sorrow is a normal reaction  when one realizes that they have to live with continuous losses. Some of the diseases that cause chronic sorrow are AIDS, chronic mental diseases, multiple sclerosis, and Parkinson’s disease among others. According to an interview of patients suffering from chronic illnesses carried out in 2007 and published in the Journal of Clinical Nursing, majority of them cited different reasons. They cited in order of incidence not ruthlessness that the loss of body functions, failure of relationships, loss of personality, loss of inspiring emotions, loss of action, loss of an independent life, loss of a future imagined and loss of responsibility as among the factors that trigger chronic sorrow (Kaethe, 2012). These distinguished losses make it difficult for individuals to develop personal trait of emotions and objectives, and directions for performance in a social environment. The loss of self-narrative, which is the cognitive behavioral makeup that determines our daily lives, can be interrupted by chronic sorrow in three ways.

The disorganization of this narrative is the first way that occurs when the self-narrative is broken down by the demands of the disease and loss of meaning in a person’s life sets in. secondly, narrative disruption is the tapering of the self-narrative. In some instances, losses due to a chronic illness are hard to comprehend and communicate to other people or even to the patients themselves. Lastly, narrative dominance is the overshadowing of one self-narrative, which crowds out of other forms of the self-narrative.

Many patients struggle with the new reality that they have to rely on others for functions that they managed themselves in the past.  In this regard, they tend to think that others view them as less functional and in the process thin their self-narrative. The limitations that are brought out by these illnesses lead some patients to want to hide from themselves and others. Adapting to the realities of the present condition may be challenging to patients because the thought of an illness that is uncommon, is of indefinite period and partially comprehended causes uncertainty. As most chronic illnesses are regressive in nature, they contribute to isolation and stigmatization of the patient.

Some disabilities cause patients to build an armor around themselves to safeguard against the rejection that comes from the outside world, but this is just to hide the fear, despair, helplessness and shame that is associated with physical and mental limitations caused by chronic illnesses (Kaethe, 2012). Some patient may alternate from inflated irritated self to a deflated, self-hating self. The ‚Äúspoiled identity‚ÄĚ tag that the society heaps on people suffering from a visible disability shows the disruption of the self-narrative. The stigmatizations resulting from this societal treatment drive some patients into committing suicide. In a society that is preoccupied with output, people suffering from disability caused by chronic illnesses are condemned to misery because they must include personal caring as part of their output.

In a struggle to fill the gap between the past self and the present self, the thought of what they would become and what they are at present can result into suicides. For some, challenges that are involved in daily living when suffering from chronic illnesses become intolerable, and death becomes the only option. Loss of a friend who cannot tolerate the hopelessness resulting from physical and emotional pain can lead to patients feeling unwanted and unloved (Kaethe, 2012). Hopelessness caused by chronic illnesses is compounded by the fact these disease are partially understood and most of the treatments are still at the experimental stages. This drives patients to feel that they cannot live long enough until cures are found.

Impacts on marital and family relationships

Chronic illnesses have a big impact on the relationships between couples and if not managed effectively it can have devastating results on the relationship (Roland, 1994). In many instances, one of the partners must assume the role of the caretaker because the diseases can lead to physical incapacitation. The imminent loss that may result from chronic illnesses forces families to restructure their plans and life goals because these illnesses intrude into a relationship unannounced. The limitation that results from severe illnesses and disability affects the relationship’s guidelines and revered boundary. With advanced medical technology, couples are living with chronic conditions that were fatal some years back; therefore, they must restructure their relationship to cope with long-term medical conditions. Intimacy and communication are the two aspects of a relationship that are strained if one partner suffers from a chronic illness. The psychosocial demands of the illness and the form of functioning and resources devoted to it determine whether the condition will be managed or not through coping and adaptation. Different chronic illnesses have different impacts on the relationship based on the outline of the commencement, path, result, disability, and the degree of uncertainty (Roland, 1994). Other factors that may affect the management of an illness are vital family variables and key stages in their natural history. All intimate relationships operate within a comfort zone that develops over the course of the relationship. The forces within the relationship determine whether the comfort zone will facilitate the growth or decrease of this intimacy. Disability resulting from chronic illness and the illness itself are some of the challenges may negatively affect the growth of intimacy.

When a chronic illness sets in, it pushes the emotional and physical borderlines of an intimate relationship. The illness is a new issue that must be incorporated into the relationship. Roland (1994), argue that the psychosocial nature of the illness will be a key determinant of makeup and demand of the disease and its progress and effect in the course of time. Some disabilities such as injuries to the spinal cord severely intrude on a relationship, while other disability such as disc disease, which is a relapsing illness sporadically, intrudes into a relationship. Cancer may not be demanding on a daily basis, but the prospect of a possible loss can intrude on all aspects of an intimate relationship.

Depending on culture, life cycle phase, gender, and social class, intimacy has different meanings. In a society such as the American one, intimacy is the sharing of friendship, emotions, and interests. For a working class family, intimacy is closely tied to shared protection, economic security and sharing of roles. In various facets of the relationship such as sexual, entertainment, intellectual and religious, intimacy is quantitatively unique (Roland, 1994). An intimate relationship allows both partners to express themselves both verbally and non-verbally, with the consideration that the other partner will maintain trust. Others consider intimacy as the requirement that each partner is able to maintain independence, with apparent borders and having the ability to bring their self into the relationship. Regardless of the definition or consideration of aspects of intimacy, there is a possibility of an imminent loss at one point in the life cycle. In addition, there is no strong reminder of this loss than a serious illness. It is true that during youthful years, people tend to relegate these issues to ‚Äúlater life‚ÄĚ and this cultural mindset promotes a pattern of intimacy founded on rejection of sickness and loss.

When one of the partners is diagnosed with a threatening condition, the emotions associated with a possible loss can be frightening and the reaction by couples can be either to stick together or separate. If the condition makes the relationship a regular reminder of loss, couples may pull apart. Dealing with and adapting to a life threatening condition requires that couples handle the realities of the condition in an empowering way that enhances their relationship.

Communication between couples is vital in enhancing a healthy functioning relationship. Some forms of communication in a relationship such as disdain, withdrawal, defensiveness, and censure lead to dissatisfaction and ultimately separation (Roland, 1994). Chronic illnesses, which are long-term in nature strongly tests a couple’s interaction skills. If a couple adopts a transparent and sensitive communication about issues pertaining chronic health conditions, they will adjust well to the new condition. Effective communication is a factor in determining and stabilizing challenging emotions, and developing clear sickness boundaries. Communication will play a part in discussions concerning an understanding of the condition, its psychosocial requirements, its cause, it course over time, how to live with an imminent loss, individual and relationship priorities, and responsibilities of the patient and the caregiver. Effective communication is also useful in maintaining stable mutual relationships and procedure pertaining the terminal phase of the condition.

According to Roland (1994), couples fail to communicate effectively due to cautiousness to try new boundaries, fear of upsetting the other partner or worsening the illness, or fears that openness regarding certain aspects will break the relationship. Since partners in a relationship may desire to discuss certain issue related to illness in the relationship when the other person is not in the mood for such discussion, it may put a strain on communication in the relationship. Chronic illnesses are also associated with strong thoughts and emotions that are shameful, and secret. Effective communication will not be possible without the normalization of feelings such as strong anger, suicidal thoughts, ambivalence, and getaway fantasies.

For families with children suffering from chronic illnesses, there is a likelihood of marital distress. In a study conducted by Speechy & Noh in 1992, parents with children suffering from chronic illnesses are exposed to marital distress than those with non-disabled children, which can affect the functioning of their relationship (Cleveland et al, 2011). Parents have vital roles in providing care to their chronically ill children and in this process, the emotional and physical demands, and the likelihood of an imminent loss exert pressure on the marital relationship (Cleveland et al, 2011). Chronically ill children can cause the rising of negative emotions among couples’ in the some instances one partner may leave.

Treatment considerations

There are various considerations to factor in when choosing treatment of a chronic illness. Herbal medicines are forms of alternative treatments that are used to manage chronic illnesses. Herbal medicines have been effective in showing therapeutic efficacy and are safe. Care must be taken in managing the side effects because they too have side effects. They can alter blood pressure, tamper with the nervous system, liver, and kidneys and liver. It is imperative that they can also interact negatively with other medication that the patient may be taking because they contain medicinal compounds (Lubkin, 2013). It is advisable to consult a physician before taking herbal medicine in order to under potential interactions.

Oxygen therapy is a form of an integrative approach of managing chronic illnesses that use oxygen as an intervention. Oxygen is used in the management of Chronic Obstructive Pulmonary Disease (COPD), emphysema and chronic bronchitis. These illnesses require patients to take additional oxygen when the condition deteriorates or on a daily basis. During conditions of breathlessness, oxygen is given to patients suffering from respiratory or cardiac failure, and advanced levels of neurodegenerative illnesses and cancer.  Heat therapy is another form of alternative treatment that involves the application of heat to the whole body or certain parts to increase the temperatures. In cancer treatment, it is used to enhance other types of therapies such as chemotherapy and radiation. The role of heat in these treatments is to lower some times of infections and pain associated with these treatments. In combination with other medication such as dinitrophenol, heat therapy is used in inducing fever. Heat therapy is also applicable in relieving pain that is caused by inflammation, arthritis and other forms of injuries. Heat therapy functions by lowering muscle spasms, softening stiff tissues and reducing stiffness of joints (Lubkin, 2013).

Cultural, gender and contraindications of medical approaches in managements of chronic illnesses are considerations that must be considered. Since most chronic illnesses require end-of-life care, the cultural backgrounds influence any discussions between the healthcare provider and the patient. Any effective discussion is influenced by factors such as sufficient time in discussing the topic, training of the provider, comfort of the provider in handling the topic and provider’s experience in the discipline.

A medical practitioner must have a clear understanding of the distinct cultural backgrounds that influence a patient’s decision. This is because different cultural groups have different attitudes, norms, preferences, and decisions regarding end of life care. Failure to understand the cultural preference of a patient will undermine the provision of healthcare, as it will lead to conflicts that result into poor management of disease signs, health disparities among cultural groups, ineffective communication, fragmented care, and a poorly managed and difficult death (Lubkin, 2013).

Gender is another consideration that has become important when researching chronic illnesses. Sex and Gender-Based Analysis (SGBA) is a vital tool that is used getting important information regarding management and prevention of chronic illnesses. Despite the fact that women have a higher life expectancy in most societies than men, chronic illnesses affect both genders differently, and women are exposed to chronic illnesses more than men, and this greatly affect their quality of life (Lubkin, 2013). According to varies studies undertaken in Canada, depression and Chronic Obstructive Pulmonary Disease (COPD) afflicts women more than men. It is important to understand chronic illnesses from the perspective of gender because it explores how society deals with women suffering from such diseases, and how such individuals manage the uncertainty of their bodies in an environment that demands certainty.

Side effects management and contraindications is another key issue in the treatment of chronic illnesses because many medications used in treatment have adverse side effects. Monitoring of the patient after the commencement of treatment is important in recognizing reactions to medications. This will create an environment where the patient and the healthcare provider can collaborate in the treatment process. Some medications used in chemotherapy during cancer treatment causes severe side effects such as nausea and vomiting that require additional medications to manage them. Arthritis medications cause hair loss, blood problems, and sores in the mouth; hence, folic acid is used in its management. Medical providers must explain all the side effects to patients and members of their families to enable them understand their chronic condition and medications (Lubkin, 2013). A clear understanding of this will help in alleviating fears and in making informed and knowledgeable decisions regarding medications.

Standards of treatment

The long-term nature of chronic illnesses has widened treatment to incorporate management of the disease especially those that demand ongoing management. According to Cleveland et al (2011), fragmented medical care, limited hospital stays and temporary medical providers have contributed to families taking over more care-giving responsibilities. Despite their role as unofficial caregivers in medical environments, they play a significant role in the management of chronic illnesses because they experience the full course of the sickness. Cleveland et al (2011) propose that standards of care of chronic patients must involve recognized inclusion of family caregivers in management of a chronic illness and the necessary long-term care.  Inclusion of family members in the long-term care of patient suffering from chronic illnesses has shown observance of medication and treatment protocols, facilitated timely and reliable visits by healthcare providers, lowered dependence on emergency room care, and enhanced healthy attitudes. The two interventions that are useful in the management of chronic illnesses are psychotherapy and psycho education. Psycho education is the provision of support, skills training and education to family members to enhance partnership with medical professionals and their participation in disease management. The differences in these two interventions are in their delivery form, organization, deliverer of the intervention and focus of the intervention. Delivery is often in-group settings in primary or specialty health care environments, and is usually delivered in combination with telephone calls and in-home-care visits (Cleveland et al, 2011).

Compassionate witnessing and accompaniment should also be included as a standard of care because they are effective in teaching patients suffering from chronic illnesses about chronic sorrow and self-loss. Compassionate witnessing is being emphatically aware of the suffering of a patient and initiating actions that alleviate their suffering. It is paramount for a therapist to understand that chronically ill patient suffer from chronic disappointment, which may cause outrage and distress; therefore therapists should not term it pathological and shy away from it (Kaethe, 2012).

The onset of a chronic illness permeates all aspects of a person’s life, and since most of these diseases are terminal, they stress the individual and the people around. Having close relationships have been shown to help in managing chronic illnesses. Emotionally Focused Therapy (EFT) is one of the approaches used in managing chronic illnesses. Relationship status (married or unmarried), has been shown by various studies to safeguard against chronic illnesses. These studies have shown that married couples have a higher life expectancy and survival rate when confronted with a chronic illness. Married couple’s exhibit greater compliance to medication conditions than unmarried, separated, or divorced partners. Married partners have a higher immune response than divorced or unmarried couples do, and this helps in fighting the illness. Distress in a relationship can have negative impacts on responses to a chronic condition because couples will be limited in seeking medical assistance. Being single or unmarried contributes to loneliness or limited social circles and this plays a role in development of chronic diseases. The quality of the relationship is also vital because it has been shown to determine survival rates after a congestive heart failure. Poor relationships heighten distress, which in turn cause limited immune system function that is associated with negative health outcomes. Considering the long-term nature of chronic illnesses, coping is one of the strategies of managing it, but hostile interactions and critical remarks by an intimate partner undermines coping (Kowal & Johnson, 2003). Several studies have linked marital conflicts and criticism to various negative outcomes because they serve as risk factors.

EFT combines empirical and systemic approaches, and concentrates on intrapsychic processes such as how couples manage their emotional experiences. It also focuses on how marital partners integrate their interactions into their daily routines. Standards of treatment such as this deal with a patient and partner’s experience with the illness. Since EFT emphasizes on emotion, it is appropriate in handling couples grappling chronic illnesses. Emotions such as anger, guilt, and shame are common in a relationship where a partner is suffering from a chronic illness; therefore, EFT provides a functional framework for handling these emotions, which helps couples in managing a chronic illness (Kowal & Johnson, 2003). Detection of a chronic illness in a relationship is emotionally draining, but with EFT, each partner’s feelings can be authenticated, expanded, and reprocessed.

Attachment is one aspect of an intimate relationship, but during a chronic illness, it may become distressing. In a case where a relationship is insecurely, attached, negative health effects may be experienced. According to Kowal & Johnson (2003), EFT aids couples to securely attached, where each partner feels the other as a source of security, comfort and protection. Insecure attachment may be associated with extensive use of external regulators such as drug abuse and over eating. Another reason that makes EFT a suitable approach to managing a chronic illness is the way the problems in a relationship are conceptualized in terms of patterns of communication. With EFT, couples are able to manage their negative feelings by seeking comfort and safety in the other partner. Simply put, this framework aids couples in externalizing their disagreements without viewing it as a problem of one partner or both. EFT is also effective in helping parents with chronically ill children. The possibility of loss, fear, and uncertainty associated with chronic illnesses can create attachments needs, and with EFT such parents can develop secure attachments that have been associated with resilience and the capacity to manage stress.

Family support should be integrated in the treatment of chronic illnesses. An example of a chronic illness that has been managed by incorporating family is Chronic Fatigue Syndrome (CFS). The form of support that is mainly cited in this condition is that of the patient’s partner. A number of studies have shown that family support helps patients to recover from illness or injury and exhibit better psychological coping to their condition (Kowal & Johnson, 2003). Other longitudinal studies and controlled studies propose that poor interpersonal relationships are a key risk factor that contributes to higher morbidity and mortality. Therefore, limited social support has a significant influence on the general mental and physical well-being (Cleveland et al, 2011). Members of a family with a patient suffering from a chronic illness also experience psychological symptoms that can be portrayed in the form of anxiety, muscle tension, and anxiety. This means that while providing care to chronically ill patients, support must also be extended to family members to help them cope with the condition.

Conclusion

It is clear that chronic illnesses are conditions that require patients and caregivers to adopt coping strategies because they are long-term in nature. Since chronic illnesses not only affect the patient physically, but also emotionally, it s important to provide interventions that help them manage the condition. Chronic illnesses also have far-reaching impacts on family and spousal relations, which if not managed carefully can have disastrous consequences. Culture, gender, and contraindications are some of the considerations when choosing treatment for chronic illnesses. Emotionally focused therapy is the most effective intervention that helps patients and family members cope with the demands of chronic illnesses.

References

Anderson, G. (2004). Chronic conditions: making the case for ongoing care. Baltimore, MD: John Hopkins University.

Centers for Disease Control and Prevention (CDC). (2006). Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation‚ÄĒUnited States, 2003‚Äď2005. MMWR 2006;55:1089‚Äď1092. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5540a2.htm

Centers for Disease Control and Prevention (CDC). (2007). Prevalence of self-reported physically active adults‚ÄĒUnited States. MMWR 2008;57:1297‚Äď1300. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5748a1.htm

Cleveland, G., Finley, M., Chawla, N., & Meadors, S. (2011). Couple and family interventions in health problems. Journal of Marital and Family Therapy, Vol. 38, No. 1, 265‚Äď280

Kaethe, W. (2012). Sorrow: A Therapist‚Äôs Reflection on the Inevitable and the Unknowable. Family Proccess, Vol ¬†51:440‚Äď455.

Kowal, J. & Johnson, S.M. (2003). Chronic illness in couples: a case for emotionally focused therapy. Journal of Marital and Family Therapy , VOl. 29, NO. 3,299-310

Leahey, M., & Wright, L.R. (2005).“Families & Life-Threatening Illness”. New York: SAGE

Lubkin, I., (2013). Chronic illness: Impact and interventions. 5th ed. Sudbury, Mass: Routledge

Roland, S.J., (1994). In sickness and in health: the impact of illness on couples’ relationships. Journal of Marital and Family Therapy, Vol. 20, No.4, 327-347

Webster, K, Odom, L, Peterman, A, Lent L, & Cella, D. (1999). The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: Validation of version 4 of the core questionnaire. Qual Life Res, Vol 8(7):604.

Wu, S.Y., & Green, A. (2000). Projection of chronic illness prevalence and cost inflation. Santa Monica, CA: RAND Health.