Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-10T12:28:29.826Z Has data issue: false hasContentIssue false
  • English
  • Français

Palliative care: A need for a family systems approach

Published online by Cambridge University Press:  18 June 2009

Anita Mehta ,
S. Robin Cohen  and
Lisa S. Chan
Anita Mehta*
Affiliation:
Psychosocial Oncology, McGill University Health Center, Montreal, Quebec, Canada
S. Robin Cohen
Affiliation:
Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada Lady Davis Institute, S.M.B.D. Jewish General Hospital, Montreal, Quebec, Canada
Lisa S. Chan
Affiliation:
School of Nursing, McGill University, Montreal, Quebec, Canada
*
Address correspondence and reprint requests to: Anita Mehta, McGill University Health Center, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC T6 310, H3G 1A4, Canada. E-mail: anita.mehta@muhc.mcgill.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

When a family member is faced with a terminal illness, the impending death presents a crisis and a challenge to the entire family as a system. This article highlights the importance of caring for a family when one member has a life-threatening illness, and describes the applicability of Family Systems Theory and its major tenets to the palliative cancer population.

Methods:

A MedLine and CINAHL search of Family Systems Theory related papers was conducted.

Results:

Research studies that have been done fail to capture the view of the entire family system, often limiting the perspectives of the family to one single member. The concepts of holism, balance, boundaries, and hierarchal subsystems must be addressed in the care of any family, including those who have a family member who is dying.

Significance of results:

A Family Systems Theory framework can be useful in helping health care providers, and particularly nurses, deliver optimal care to palliative cancer patients and their families and standardize the way research is done by providing an appropriate framework with which to study the family. In addition, the adoption of Family Systems Theory as the standard framework from which to study families in palliative care will provide consistency for future studies that is presently lacking. Finally, nursing interventions to care for the family are suggested based on Family Systems Theory.

Keywords

Family Systems TheoryPalliative careCancerEnd of life
Type
Review Articles
Information
Palliative & Supportive Care , Volume 7 , Issue 2 , June 2009 , pp. 235 - 243
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aranda, S. & Hayman-White, K. (2001). Home caregivers of the person with advanced cancer: An Australian perspective. Cancer Nursing, 24, 300–307.CrossRefGoogle ScholarPubMed
Aranda, S. & Kelso, J. (1997). The nurse as coach in care of the dying. Contemporary Nurse, 6, 117–122.CrossRefGoogle ScholarPubMed
Artinian, N.T. (1994). Selecting a model to guide family assessment. Dimensions of Critical Care Nursing, 14, 4–12.Google Scholar
Blatt, L. (1999). Working with families in reaching end-of-life decisions. Clinical Nurse Specialist, 13, 219–233.Google Scholar
Boss, P.G., Dohery, W.J., LaRossa, R., et al. (1993). Sourcebook of Family Theories: A Contextual Approach. New York: Plenum Press.CrossRefGoogle Scholar
Bottomly, A. (1997). To randomize or not to randomize: Methodological pitfalls of the RCT design in psychosocial intervention studies. European Journal of Cancer Care, 6, 222–230.CrossRefGoogle Scholar
Boyle, D.K. (2005). Communication and end-of-life care in the intensive care unit: Patient, family, and clinician outcomes. Critical Care Nursing Quarterly, 28, 302–316.CrossRefGoogle ScholarPubMed
Brumfield, R. (1997). A family systems approach to case management in a rural community setting. Home Care Provider, 2, 180–183.CrossRefGoogle Scholar
Canadian Hospice and Palliative Care Association. (2003). Family or informal caregivers. http://www.chpca.net/family_caregiver_portal.html.Google Scholar
Cohen, S.R. (2001). Defining and measuring quality of life in palliative care. In Topics in Palliative Care (vol. 5), Bruera, E. & Portenoy, R.K. (eds), pp. 137–156. New York: Oxford University Press.Google Scholar
Cummings, J.M. (2002). Exploring family systems nursing and the community children's nurse's role in caring for children with cystic fibrosis. Journal of Child Health Care, 6, 120–132.Google Scholar
Davies, B. (1994). Family functioning and its implications for palliative care. Journal of Palliative Care, 10, 29–36.CrossRefGoogle ScholarPubMed
Davies, B., Collins, J.B., Steele, R., et al. (2003). The impact on families of a children's hospice program. Journal of Palliative Care, 19, 15–26.Google Scholar
Drayton-Hargrove, S. (2000). Assessing abuse of disabled older adults: A family system approach. Rehabilitation Nursing, 25, 136–140, 158.CrossRefGoogle Scholar
Epstein, N.B., Baldwin, L.M. & Bishop, D.S. (1983). The McMaster family assessment device. Journal of Marital and Family Therapy, 9, 171–180.Google Scholar
Ferrell, B.R., Cohen, M.Z., Rhiner, M., et al. (1991). Pain as a metaphor for illness. Part II: Family caregivers' management of pain. Oncology Nursing Forum, 18, 1315–1321.Google Scholar
Flannery, J. (1991). FAMLI-RESCUE: A family assessment tool for use by neuroscience nurses in the acute care setting. Journal of Neuroscience Nursing, 23, 111–115.Google Scholar
Given, A., Given, C.W. & Kozachik, S. (2001). Family support in advanced cancer. Cancer Journal for Clinicians, 51, 213–231.Google Scholar
Goodell, T.T. & Hanson, S.M.H. (1999). Nurse-family interactions in adult critical care: A Bowen family systems perspective. Journal of Family Nursing, 5, 72–91.Google Scholar
Hamilton, G.P. (1989). Using a family systems approach to prevent elder abuse. Journal of Gerontological Nursing, 15, 21–26.CrossRefGoogle ScholarPubMed
Kaakinen, J.R. & Hanson, S.M.H. (2004). Theoretical foundations for family health nursing practice. In Promoting Health in Families: Applying Family Research and Theory to Nursing Practice (3rd ed.), Bomar, P.J. (ed.), pp. 93–116. Philadelphia: Saunders/Elsevier Science.Google Scholar
King, D.A. & Quill, T. (2006). Working with families in palliative care: One size does not fit all. Journal of Palliative Medicine, 9, 704–715.Google Scholar
King, I.M. (1981). A Theory for Nursing: Systems, Concepts, Process. New York: Wiley.Google Scholar
Knapp, E.R. & DelCampo, R.L. (1995). Developing family care plans: A systems perspective for helping hospice families. The American Journal of Hospice and Palliative Care, 12, 39–47.CrossRefGoogle Scholar
Kristjanson, L.J. (1992). Conceptual issues related to measurement in family research. Canadian Journal of Nursing Research, 24, 37–51.Google Scholar
Luker, K.A., Austin, L., Caress, A., et al. (2000). The importance of ‘knowing the patient’: Community nurses' constructions of quality in providing palliative care. Journal of Advanced Nursing, 31, 775–782.CrossRefGoogle ScholarPubMed
McBride, J. & Simms, S. (2001). Death in the family: Adapting a family systems framework to the grief process. The American Journal of Family Therapy, 29, 59–73.CrossRefGoogle Scholar
McClement, S.E. & Woodgate, R.L. (1998). Research with families in palliative care: Conceptual and methodological challenges. European Journal of Cancer Care, 7, 247–254.Google Scholar
McClowry, S.G. (1992). Family functioning during a critical illness: A systems theory perspective. Critical Care Nursing Clinics of North America, 4, 559–564.CrossRefGoogle ScholarPubMed
Mehta, A. & Ezer, H. (2003). My love is hurting: The meaning spouses attribute to their loved ones' pain during palliative care. Journal of Palliative Care, 19, 87–94.Google Scholar
Meleis, A.I. (1997). On the way to theoretical nursing: Stages and milestones. In Theoretical Nursing: Development and Progress (3rd ed.), pp. 25–48. Philadelphia: Lippincott.Google Scholar
Moos, R.H. & Moos, B.S. (1976). A typology of family social environments. Family Process, 15, 357–371.Google Scholar
Murtonen, I., Kuisma, M., Paunonen, M., et al. (1998). Family dynamics of families with cancer in Finland. Cancer Nursing, 21, 252–258.Google Scholar
Nadeau, J.W. (2001). Meaning making in family bereavement: A Family Systems Approach. In Handbook of Bereavement Research, Stroebe, M.S., Hansonn, R.O., Stroebe, W., et al. (eds.). Washington: American Psychological Association.Google Scholar
Neuman, B. (2002). The Neuman Systems Model. New Jersey: Prentice Hall.Google Scholar
Olson, D.H. (1986). Circumplex model VII: Validation studies and FACES III. Family Process, 25, 337–351.Google Scholar
Rosen, E.J. (1990). Families facing death. Lexington, MA: Lexington Books.Google Scholar
Sholevar, G.P. & Perkel, R. (1990). Family systems intervention and physical illness. General Hospital Psychiatry, 12, 363–372.Google Scholar
Syren, S.M., Saveman, B-I. & Benzein, E.G. (2006). Being a family in the midst of living and dying. Journal of Palliative Care, 22, 26–32.Google Scholar
Tomlinson, P.S. & Harbaugh, B.L. (2004). Assessing ambiguity at the family-nurse boundary interface in pediatric health crisis. Journal of Pediatric Nursing, 19, 399–410.Google Scholar
Walsh, F. & McGoldrick, M. (2004). Living beyond Loss: Death in the Family. New York: W.W. Norton.Google Scholar
Williams-Burgess, C. & Kimball, M.J. (1992). The neglected elder: A systems approach. Journal of Psychosocial Nursing, 30, 21–25.Google Scholar
Wilson, V. (1999). Palliative care: Meeting the needs of the dying patients and their carers. Journal of Cancer Nursing, 13, 1–12.Google Scholar
Woods, N.F. & Lewis, F.M. (1992). Design and measurement challenges in family research. Western Journal of Nursing Research, 14, 397–403.CrossRefGoogle ScholarPubMed
World Health Organization. (2002). WHO definition of palliative care. Retrieved April 5, 2005, from http://www.who.int/cancer/palliative/definition/en/.Google Scholar
Wright, K. & Dyck, S. (1984). Expressed concerns of adult cancer patients' family members. Cancer Nursing, 6, 371–374.Google Scholar
Wright, M. & Leahey, M. (2005). Nurses and Families. A Guide to Family Assessment and Intervention. (4th ed.) Philadelphia: F.A. Davis.Google Scholar
Young, E., Seale, C. & Bury, M. (1998). It's not like family going is it? Negotiating friendship boundaries towards the end of life. Mortality, 3, 27–42.Google Scholar