Family Focused Grief Therapy: A Model of Family-Centered Care during Palliative Care and Bereavement

By David W. Kissane; Sidney Bloch | Go to book overview

1 Family care and family grief

The experience of a life-threatening illness is a source of considerable stress not only to the patient but also to the carers, who share in the grief and associated psychological distress. The family most commonly fill the role of primary carers for the patient with advanced cancer or other progressive illness, especially during palliative care. In recent years, there has been growing recognition that the care of a patient with cancer should encompass treatment of his or her whole family. Indeed, Lederberg has gone so far as to depict family members as 'second-order patients' (Rait and Lederberg 1989). This attention to the family has been a striking development over the fifty years since the Sutherland group first described cancer in a family context, drawing attention to the intimate reciprocity of suffering (Sutherland 1956). The palliative care movement has embraced the desirability of family-centred care, but struggled to devise models to do this effectively.

Cancer inevitably affects the entire family. As caregiving has been progressively transferred into the living room, the role of family carers has become more pronounced. The principal caregiver is the spouse in 70 per cent of cases, children (daughters and daughters-in-law predominate) in 20 per cent, and approximately 10 per cent comprise friends or more distant relatives (Given and Given 1989; Ferrell et al. 1991). Whether through this caregiving or as a result of simply living with a sufferer, the distress of cancer reverberates throughout a family's intricate web of interdependence. A family-centred model of care is an essential requisite of responsible services seeking to meet the needs of both the patients and families and to maintain support into bereavement.

To achieve this, we need both conceptual and pragmatic methods of classifying families to guide our efforts at intervention. Historically, one

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