Psychosocial morbidity associated with patterns of family functioning in palliative care: baseline data from the Family Focused Grief Therapy controlled trial

Abstract

Family Focused Grief Therapy (FFGT) is a new model of brief intervention, which is commenced during palliative care for those families shown to be at high risk of poor adaptation, and continued preventively into bereavement with the aim of improving family functioning and reducing the morbid consequences of grief. In this paper, baseline data on 81 families (363 individuals) selected by screening from a palliative care population are explored to confirm our previously reported observation that high levels of psychosocial morbidity are positively associated with worsening family dysfunction. The Family Relationships Index (FRI) was used for screening and the Family Assessment Device (FAD) as an independent family outcome measure. The Beck Depression Inventory (BDI), Brief Symptom Inventory (BSI) and Social Adjustment Scale (SAS) were the psychosocial measures. Families were classified according to their functioning based on the FRI. To allow for correlated family data, statistical analyses employed the generalized estimating equation (GEE) method, controlling for gender and depression (BDI). Screening of 257 families (701 individuals) revealed 74 (29%) well-functioning families and 183 (71%) at some risk of morbid outcome. Of the latter, 81 (44%) gave informed consent to enter a randomized controlled trial of FFGT. Patients had a mean age of 57 years, 51% were male and they suffered from cancer, with a median length of illness from diagnosis to death of 25 months. In accordance with the FFGT model, their family types were identified as Intermediate 51%, Sullen 26% and Hostile 23%. These were significantly associated with steadily increasing levels of distress (BSI) and poor social adjustment (SAS). The FAD confirmed the concurrent accuracy of the FRI. As significantly greater levels of psychosocial morbidity were present in families whose functioning as a group was poorer, support was generated for a clinical approach that screens for families rather than individuals at high risk. The predictive validity of the FRI as a screening measure was confirmed. Overall, these baseline data point to the importance of a family-centred model of care.

Family focused grief therapy: The therapy of choice in palliative care

“…Autor FFGT-a je sa grupom kolega publikovao rezultate višegodišnjeg istraživanja porodica koje se suočavaju s teškom i progresivnom bolešću jednog člana porodice (Kissane et al, 2003).Rezultati upućuju na to da su veći psihosocijalni problemi u disfunkcionalnijim porodicama i da je u tzv. neprijateljskim porodicama identifikovan viši nivo distresa, lošije socijalno prilagođavanje i značajno više članova koji imaju psihološke probleme (depresivnost, anksioznost, opsesivno-kompluzivni poremećaj i zloupotreba alkohola).…”

“…Mračne porodice 6 imaju više nivoe ljutnje a dobijeni su i značajno viši skorovi na supskalama psihoze i paranoidne ideacije. Disfunkcionalnije porodice imaju značajno lošije opšte, socijalno funkcionisanje, kao i funkcionisanje u vezi sa kućnim obavezama i provođenjem slobodnog vremena na porodičnom nivou (Kissane et al, 2003).…”

“…Istraživanja su pokazala da psihocijalni problemi i individualna disfunkcija članova porodice (depresivnost, anksioznost,opsesivni poremećaji i zloupotreba alkohola) pozitivno koreliraju s lošijim porodičnim funkcionisanjem,što posebno dolazi do izražaja u stresnoj porodičnoj situaciji koja se odnosi na tešku bolest s neminovnim smrtnim ishodom (Kissane, McKenzie, McKenzie, Forbes, O'Neill, & Bloch, 2003;Kissane, McKenzie, Bloch, Moskowitz, & McKenzie, 2006). Porodični konflikti utiču na prolongiranje komplikovanog tj.…”

Depression in Cancer Patients

“…Prognozla ilişkili faktörler ise ailesel yatkınlık, depresif hastalık öyküsü, tümörde ileri evre, cinsiyet (kadın/erkek oranı 2/1), alkol bağımlılığı, hormon bozuklukları, ailesel veya sosyal alanda sorunlar gibi akut veya kronik streslerdir. [33] İşlevselliklerinde sınırlıklar yaşayan ve sürekli şiddetli ağrısı olan kanser hastalarında depresyon görülmesi oldukça yüksek bir olasılıktır. [26] Diğer yandan açık bir yarası olan (kolostomi vs.) veya tedavi altında olma-kemoterapi, radyasyon tedavisi veya cerrahi müdahaleler vs-karşısında bireylerin gösterdiği tepkiler kronik stres reaksiyonu olarak değerlendirilir.…”

Primer impacto: programa de detección de distrés y atención psicosocial para paciente recién diagnosticado y sus familiares

“…A pesar de que existen marcadas diferencias entre ellos, la mayoría de los modelos incluyen tres etapas consecutivas de desarrollo: administración del examen de detección, puntaje y derivación. La mayor parte de los protocolos desarrollados, hasta el momento, han sido enfocados hacia el paciente; sin embargo, ya se están formulando algunos procedimientos de detección de distrés dirigidos a los familiares (18) . En el presente trabajo expondremos la guía de intervención del programa de detección de distrés psicosocial para pacientes recién diagnosticados de cáncer y sus familiares que llevamos realizando desde hace dos años en la Asociación Española Contra el Cáncer (AECC).…”