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The Impact of Chronic Illness on Families: a Family Systems Perspective

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Joan M Patterson at University of Minnesota Twin Cities
Joan M Patterson
Ann Garwick at University of Minnesota Twin Cities
Ann Garwick
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Abstract

In this article, a family systems theoretical framework is described for understanding the reciprocal relationships between chronic illness in a family member and the structure and functioning of the family system. The reciprocal impacts between the illness, individual development, and family functioning continue dynamically in a circular pattern of effects over time. Well-adapted families are able to achieve balanced functioning by developing and maintaining their capabilities (resources and coping behaviors) for meeting the continually changing demands (stressors, strains, hassles, chronic illness hardships) they face. This effort to achieve balance is influenced by the meanings families attribute to their situation, as well as to their own identity as a family unit, and to their view of the world. Successful adaptation to chronic illness can best be promoted by focusing on the family system as the unit of intervention. When the family is healthy, the person with chronic illness does better. Families should be encouraged to balance illness needs with other family needs using a style of functioning that is consistent with their existing lifestyle and values.
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... In line with the family systems perspective (Patterson & Garwick, 1994), cancer is often described as a "family disease" affecting both the person with cancer and their family (Coyne et al., 2020). As the diagnosis of pediatric cancer poses a major stressor to the family system, many parents report stress and struggle with adapting to altered parenting and family responsibilities during and at the end of, or after, treatment (Conway Keller et al., 2020). ...
... These challenges may make parents of childhood cancer survivors prone to perceiving themselves as incompetent in adequately managing parenting tasks (Salvador et al., 2019). Importantly, a key element of how youth adjust to the long-term effects of surviving childhood cancer is how parents deal with this family stressor (Patterson & Garwick, 1994). Research in the general population found that parental sense of incompetence was associated with emotional and behavioral problems in youth, whereas parental competence was linked to higher socio-emotional adjustment (Jones & Prinz, 2005). ...
... Nevertheless, several hypotheses are forwarded based on theoretical models about family functioning and previous findings. First, based on the family systems perspective of Patterson and Garwick (1994), we expected the parental context to affect survivor functioning. More specifically, low parental sense of incompetence and better parenting quality (e.g., more responsiveness and less overprotection) are expected to predict positive survivor adjustment over time (Koutná et al., 2017;Okado et al., 2018). ...
Psychological Functioning of Childhood Cancer Survivors: Longitudinal Associations With the Parental Context
Article
Full-text available
  • Aug 2023
Objetivo: Los efectos psicológicos a largo plazo del cáncer infantil varían, con los sobrevivientes de cáncer infantil informando síntomas depresivos, miedo a la recurrencia del cáncer y descubrimiento de beneficios. Dado que el cáncer se considera una enfermedad familiar, la investigación del contexto de los padres puede proporcionar información sobre las diferencias individuales en el funcionamiento psicológico de los sobrevivientes. Este estudio examinó la direccionalidad de los efectos entre el sentido de incompetencia de los padres, las dimensiones de crianza (capacidad de respuesta, control psicológico, sobreprotección) y el funcionamiento psicológico del sobreviviente (síntomas depresivos, miedo a la recurrencia del cáncer, descubrimiento de beneficios). Métodos: Este estudio longitudinal de tres ciclos (que abarcó dos años) incluyó a 125 sobrevivientes de cáncer infantil de habla holandesa (de 14 a 24 años, 95,2% diagnosticados <18 años, tiempo desde el diagnóstico de 2 a 22 años), 114 madres y 91 padres. Los sobrevivientes informaron (SR) sobre su funcionamiento psicológico y la crianza percibida. Las madres (MR) y los padres (FR) informaron sobre la crianza y el sentido de incompetencia. Se estimaron modelos de panel cruzados para la perspectiva de cada informante sobre la crianza de los hijos por separado. Resultados: Se obtuvieron diferentes relaciones para cada informante. Principalmente se encontraron relaciones unidireccionales desde el sentido de incompetencia de los padres hasta la crianza desadaptativa (control psicológico entre los informantes y SR de sobreprotección materna) y desde la crianza hasta el funcionamiento del sobreviviente. La capacidad de respuesta materna y paterna SR predijo positivamente el hallazgo de beneficios de los sobrevivientes y predijo negativamente los síntomas depresivos de los sobrevivientes, respectivamente. La MR de capacidad de respuesta y la MR de sobreprotección predijeron positivamente el miedo de los sobrevivientes a la recurrencia del cáncer y los síntomas depresivos, respectivamente. Surgió una vía inversa consistente: la capacidad de respuesta materna y paterna SR predijo negativamente el sentido de incompetencia materno y paterno, respectivamente. Conclusión: Los resultados respaldan los procesos impulsados por los padres que afectan el funcionamiento psicológico de los sobrevivientes y enfatizan la necesidad de enfocarse en múltiples perspectivas al investigar la dinámica familiar.
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... For example, notions of developmental contextualism indicate that individual functioning and development across the lifespan is shaped by contextual factors such as one's significant other (Baltes & Carstensen, 1999;Ford & Lerner, 1992). Likewise, interpersonal theories of emotion (e.g., emotional transmission) as well as social ecology and family systems frameworks maintain that the development, maintenance, and spread of emotions are inextricably linked to an individual's relationships (Hatfield et al., 1992;Larson & Almeida, 1999;Patterson & Garwick, 1994; Crossover effects: Westman, 2001). Consistent with these conceptual accounts, spousal interrelations in PA and NA have been observed among older couples (Bookwala & Schulz, 1996;Schimmack & Lucas, 2010), indicating that older adults' affective well-being is indeed sensitive to and shaped by their spouse, making it possible that the health vulnerabilities of one's spouse also undermine older adults' affective well-being. ...
... Expectations regarding (d) within-partnership health sensitivity were based on a number of sources. First, theoretical notions of developmental contextualism indicate that emotional functioning across the lifespan is shaped by contextual factors such as one's significant other (e.g., Hoppmann & Gerstorf, 2009), and interpersonal theories of emotion, social ecology, and family systems frameworks indicate that the development, maintenance, and spread of emotions are inextricably linked to an individual's relationships (e.g., Hatfield et al., 1992;Larson & Almeida, 1999;Patterson & Garwick, 1994). The second source comes from health and clinical psychological perspectives which indicate that one's spouses' health problems impact one's affective experiences via pain behaviors (e.g., Cook & Kenny, 2005;Craig, 2009;Martire et al., 2019). ...
... Evidence of within-partnership health sensitivity empirically illustrates dyadic notions of emotion. For instance, interpersonal theories of emotion, social ecology, and family systems frameworks maintain that emotions are inextricably linked to close others, due to the intimacy, interdependence, and the close proximity of such relationships (e.g., Larson & Almeida, 1999;Patterson & Garwick, 1994). According to the health and clinical psychological literatures, within-partnership health sensitivity arises from spouses' communicating their discomfort via pain behaviours (Craig, 2009), or from the pain experience of one partner activating both partner's coping resources (Berg & Upchurch, 2007). ...
Associations between physical health and subjective well-being across adulthood and old age
Thesis
  • Nov 2022
Das subjektive Wohlbefinden (SWB) spiegelt die Gesamtbeurteilung des Lebens (globales SWB) und die Höhen und Tiefen des täglichen Lebens (erfahrungsbezogenes SWB) wider. Eine Fülle von Belegen deutet darauf hin, dass gesundheitliche Herausforderungen die langfristige Aufrechterhaltung des globalen SWB älterer Erwachsener sowie ihre Emotionsregulation vor Ort gefährden (Barger et al., 2009). Gleichzeitig behauptet die Lebensspannenpsychologie, dass sich das SWB als Ergebnis gesundheitlicher Anfälligkeiten entfaltet, die in ein System von Kontextebenen eingebettet sind, das vom Individuum bis zur Dyade reicht (Baltes & Smith, 2004). Allerdings haben nur wenige Studien mehr als eine Facette der Gesundheit oder des SWB untersucht, noch haben sie typischerweise individuelle Unterschiede (Persönlichkeit) oder sozial-kontextuelle Antezedenzien (z. B. die Gesundheit von signifikanten anderen Personen) untersucht. Um diese Lücken zu schließen, untersucht diese Dissertation: (i) die langfristigen Verläufe mehrerer Facetten des globalen SWB im Alter und ihre Vorhersage durch den objektiven Gesundheitszustand; sowie die kurzfristige Variabilität der Facetten des erfahrungsbezogenen SWB älterer Erwachsener als Ergebnis (ii) anlassbezogener Abweichungen des Gesundheitszustands und (iii) anlassbezogener Abweichungen des Gesundheitszustands des Ehepartners. In jeder Studie wird zusätzlich die Rolle des Neurotizismus untersucht. Zu diesem Zweck verwenden diese Studien fünf unabhängige Datensätze älterer Erwachsener, die objektive, leistungsbezogene und subjektive Maße der Gesundheit und des SWB über drei zunehmend feinere Zeitskalen erhoben haben. Die Ergebnisse dieser Dissertation zeigen, dass es älteren Erwachsenen gelingt, gesundheitliche Herausforderungen zu überwinden, um das SWB über kurze und lange Zeiträume aufrechtzuerhalten. Dabei werden die Kontexte hervorgehoben, in denen dieser Erfolg versagt (angesichts der gesundheitlichen Gefährdung des Ehepartners).
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... Elements of mfgmcfzoMf j'm f/zeoA); feature in family stress theory which has been incorporated in several studies focussing on children with chronic illness (Venters, 1981;Patterson & McCubbin, 1983;Holiday, 1984;Patterson & Garwick, 1994). Central to symbolic interactionism and its use in family stress theory is the concept that meanings attributed to events are constructed from interpretation of the consequences of that event for those involved. ...
... The famHy stress FAAR model put forward by Patterson (1988;Patterson & Garwick, 1994) is helpful ill specifying a conceptual framework which suggests family coping is a key factor in family and child adjustment. ...
... Stresses engendered by condition category, for example, whether fatal or not, or features such as condition severity may produce differential consequences for individual family members in terms of stress management, family functioning and importantly, associated outcomes. As Patterson and Garwick (1994) suggest "There is httle empirical research that has systematically examined differential Behavioural difficulties include hyperactivity, poor concentration and / or conduct problems, such as disruption of school activities or for example, stealing. ...
Psychosocial adjustment in children and adolescents with chronic illness
Thesis
  • Jan 2000
p>This thesis contains a multi-site, cross-sectional study of young people with either asthma, diabetes mellitus, cystic fibrosis or epilepsy and their parents. Findings suggest that both categorical and non-categorical parameters are implicated in adjustment outcomes. However, the predictive utility of these parameters differed considerably by informant. Whereas parameters were highly instrumental in parent report of adjustment, this was not the case for child report. Nonetheless, parameters were related to child and parental management of chronic illness and suggested that non-categorical parameters were more influential. The risk resistance framework gained partial support, receiving confirmation of conceptual structure for selected pathways. However, the risk resistance moderating mechanism was not validated. Friendship intimacy and teacher report of peer relations were positively associated, although only increases in school adjustment, as reported by teachers were related to a decline in child report of overall and behavioural difficulties. In addition, lower levels of functioning were linked to decreases in school adjustment and to a lesser and non-significant degree to peer relations. Level of functioning was not however, related to friendship properties such as, play/association or intimacy. While emotional difficulties and level of functioning showed few effects in terms of the quality and properties of children's friendships, peer relations and school adjustment, higher levels of emotional difficulty and low functioning together were linked to less favourable school adjustment. To some extent, findings are consistent with previous research in that the experience of chronic illness for young people is more closely associated with emotional than behavioural difficulties. Other findings are new and require further studies to clarify the role of condition-related parameters and assess the impact of children's functional status on social functioning in relation to psychosocial adjustment.</p
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... Parenting a child with cancer may pose additional stressors related to the child's challenges in performing normal self-care activities and lack of understanding of the nature of the illness Hung et al., 2004). Family systems theories posit that chronic illness in childhood affects the entire family, disrupting normal family life (Patterson & Garwick, 1994). Due to increased demands of care, the role for parents of children with cancer is intensified. ...
... We also found a significant association between parenting stress and parental perceptions of child vulnerability, which is consistent with other study findings regarding parents of a child with cancer (Lemos et al., 2020;Vrijmoet-Wiersma et al., 2010) and other disabilities (Driscoll et al., 2018). As Patterson and Garwick (1994) explained using family systems theories, parental roles and obligations are reshaped with additional burden after a child's cancer diagnosis. If parents perceive that their child, whose vulnerabilities have been intensified by cancer, is struggling with behavioral or emotional challenges, this may lead to even more parenting stress. ...
Perceptions of Child Vulnerability, Parental Overprotection, and Parenting Stress among Parents of a Child with Cancer
Article
Full-text available
  • Jun 2024
Parents of child with cancer often perceive their child as vulnerable and are at risk of overprotecting their child because of the challenges associated with the illness. We examined the relationships of perceived child vulnerability, parental overprotection, and parenting stress among Korean parents of a child with cancer. A sample of 163 parents of a child with cancer completed questionnaires. Perceived child vulnerability was associated with parenting stress. Parental overprotection was associated with parental distress and difficult child, but not dysfunctional parent–child interactions. This study emphasizes the need to consider parenting capacity variables in the context of childhood cancer.
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... de los padres utilizan varios tipos de apoyo como servicios psicológicos y psiquiátricos, grupos de apoyo, profesionales diversos y organizaciones voluntarias o sistema de educación especializada. A priori, los recursos parecen más necesarios cuando un niño pequeño presenta una DI, aunque el recurso a apoyos está condicionado por el grado de severidad de la discapacidad, los propios recursos internos de la familia, y los significados de la discapacidad y de la ayuda externa, entre otros (Patterson & Garwick, 1994;Rolland, 2000). Por ejemplo, en la comunidad africana de Malawi, los padres de niños con discapacidad vivencian múltiples retos en el hogar, la atención primaria de salud y la accesibilidad a los servicios. ...
... Sin embargo, no hubo diferencias significativas en la satisfacción familiar de hombres y mujeres ni hubo un efecto de interacción relacionada con la discapacidad.Los datos del presente estudio resultan positivos puesto que, tal y como indicaRolland (2000), la discapacidad puede suponer una amenaza a la estructuración familiar, especialmente para las familias con un bajo nivel de cohesión, al tiempo que pone a prueba la habilidad del sistema familiar para adaptarse a las exigencias que imponga el cuidado. La adaptabilidad familiar favorece la conciliación de los padres y la reorganización del sistema familiar en respuesta a las exigencias de la discapacidad(Barrientos, et al., 2015;Meral, et al., 2013; Villavicencio & López Larrosa, en prensa) y, como hemos visto, en este estudio no difiere de la adaptabilidad de las familias cuyos hijos preescolares no tienen discapacidad.En cualquier familia con niños pequeños, los apoyos familiares y extrafamiliares parecen ineludibles y esto se acentúa cuando el pequeño/a presenta una discapacidad; aunque el recurso a apoyos esté condicionado por el grado de severidad de la discapacidad, los propios recursos internos de la familia, y la ayuda externa, entre otros(Patterson & Garwick, 1994;Rolland, 2000). Estudios previos han informado de que en los grupos familiares hispanos el apoyo familiar es más alto que la ayuda de los amigos, y la cohesión familiar se relaciona con mayor apoyo familiar(Ekas et al., 2016) y con mayor satisfacción familiar(Rillotta, et al., 2012). ...
PADRES Y DISCAPACIDAD: CONCEPCIONES Y AFRONTAMIENTOS
Thesis
Full-text available
  • Mar 2024
Se sabe relativamente poco sobre el funcionamiento de las familias con hijos preescolares con discapacidad intelectual (DI) en Ecuador. Por ello, el objetivo principal de este estudio es comparar las dimensiones individuales de afrontamiento y control del estrés de padres y madres ecuatorianos de preescolares con y sin DI, así como las variables familiares (cohesión, adaptabilidad y satisfacción familiar) y los apoyos familiares y extrafamiliares que tienen. Se contó con 120 padres y madres de niños/as preescolares con DI, y 295 padres y madres de niños/as preescolares sin discapacidad. Los instrumentos utilizados fueron el Cuestionario para la Entrevista, el cuestionario de “Percepción Social para personas con síndrome de Down”, la escala de “Satisfacción familiar”, la “Escala de evaluación de la adaptabilidad y de la Cohesión familiar” y el “Inventario de Respuestas de Afrontamiento, CRI-A”. Los resultados indicaron que no había diferencias significativas en los acuerdos entre los progenitores de niños/as con y sin discapacidad intelectual excepto en los gastos económicos (de salud y educativos). Los progenitores de niños/as con DI tenían menos acuerdos que los progenitores de niños/as sin DI. No se hallaron diferencias significativas entre las dos muestras de progenitores en ninguna variable familiar (cohesión, adaptabilidad y satisfacción familiar). Los progenitores de niños/as con discapacidad intelectual percibían menos estrés, tenían un mayor control del estrés en situaciones relacionadas con sus hijos y usaban más estrategias de afrontamiento centradas en el problema comparados con los progenitores cuyos hijos no tenían DI.
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... This model, the family adjustment and adaptation response model, emphasises the complexity of family functioning, particularly principles of system theory, in attempting to explain the family's response to a member's experience of persistent pain (Patterson, 1988;Patterson, 1994). The cognitive-behavioural perspective, specifically as it has been informed by operant conditioning theory and to the extent that it emphasises the central role of pain-relevant communication has also been important. ...
CHRONIC PAIN IN SURVIVORS OF TORTURE – Psyche or Soma?
Article
  • Jul 2004
Persistent pain related to the musculo-skeletal system is the most frequent reported physical complaint in survivors of torture. In spite of a long-standing tradition of multidisciplinary rehabilitation, however, there is no consensus on how chronic pain and pain-related disability are best addressed within this clinical practice. Are pain problems in torture survivors to be viewed as a somatic problem and intensively investigated and managed as such, or assumed to be the presentation/concomitant of psychological disturbance such as depression, anxiety, posttraumatic stress disorder, or other trauma-related problem? The current paper is intended as an overview of chronic pain in torture survivors viewed from the perspectives offered by the interactive and multivariate theoretical models of pain. According to these models pain should be viewed not as the result of either solely physical or solely psychological causes, but rather as a set of bio-physiological, psychosocial and behavioural factors contributing to the total experience of pain. Consequently, appropriate assessment of chronic pain requires assessment of more than just the direct components of pain. Given the complexity inherent in the construct of subjective pain, there is a need to obtain a diversity of assessment information that must then be integrated to understand the individuals’ pain and to contribute to treatment decision-making. Overemphasising the importance of psychological aspects, however, may result in insufficient somatic pain diagnoses and reduced treatment efficacy. Basic knowledge of the physiology of pain is therefore a prerequisite when assessing, diagnosing, and managing individuals suffering from chronic pain conditions. A brief introduction to the physiology of pain has therefore been enclosed in this paper, focusing on chronic, persistent pain and the pain signalling system under abnormal conditions. Possible pain generating mechanisms in chronic post-torture pain are highlighted and how to use clinical information and an understanding of pain classification to identify these mechanisms. Clinically, a failure to appreciate the intricacies of the relation and co-occurrence of trauma-related problems and chronic pain carries a risk of poor clinical decision-making, selection for treatment, and design of therapeutic intervention. It is advocated that chronic post-torture pain should be viewed from the perspectives offered by the interactive and multivariate models of pain and stress, and that knowledge-based clinical guidelines for the assessment and interdisciplinary management emphasising biomedical, behavioural, and cognitive aspects of chronic pain and pain-associated disability in torture survivors should be developed based on these models.
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... Research involving nonmilitary populations also indicates that positive family responses are integral to the well-being of individuals with chronic illnesses (Årestedt et al., 2015;Knafl & Gilliss, 2002;Patterson & Garwick, 1994) and disabilities (Patterson, 1991). In these studies, low family conflict is positively related to children's adjustment through chronic illness, with family cohesion also having a positive effect (Knafl & Gilliss, 2002). ...
A qualitative study of the capabilities of family members of veterans living with operational stress injuries
Article
  • Nov 2022
Objective This qualitative study explores the experiences of 26 family members supporting Canadian Armed Forces veterans living with mental health problems including operational stress injuries (OSIs). Background The research focusing on military‐connected families emphasizes the impacts of service on the families. Little is known about how families impact military veterans, particularly those diagnosed with OSIs. This research addresses that gap by revealing the capabilities and demands characterizing their everyday lives. Method Semistructured interviews with 26 individuals identifying as family members of Canadian Armed Forces (CAF) veterans and three focus groups (three participants in each group for a total of nine) with family members of CAF veterans released within the preceding 10 years were conducted. The veterans were living with broadly defined diagnosed and undiagnosed mental health problems including OSIs. Using the family adjustment and adaptation (FAAR) model as an organizational framework, demands and capabilities embodied within the everyday lives of the family members were revealed. Results Monitoring the well‐being of the veteran, managing daily life, accessing and mobilizing resources, and caregiving were discussed as capabilities by participants in this study. These capabilities buffer the demands associated with the veteran's mental health problems. Conclusions Results of this study endorse recommendations for family‐centered program and service development, modeled on approaches that recognize the systemic and relational contexts instrumental in supporting positive outcomes for veterans with OSIs. Implications Further research exploring the complex, interdependent, and interactional role of families supporting veterans with OSIs is warranted.
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... Applying the double ABCX model to the family of a child with 10 and severe physical disability, the family may need assistance in caregiving in order to maintain the child in the home (aA), the family's ability to adjust their schedules, negotiate roles and tasks and demonstrate the flexibility needed to have other caregivers in the home, may depend on the quality of relationship and level of cohesion that exist in the family (bB); how the family defines the event; the child's disability, their need to learn new skills, the need for support services, will give meaning to this life event for them (cC). Individual families will respond differently to ABC resulting in positive adaptation and change or a family crisis (X) (Keller, 1999). in a family member (Patterson & Garwick, 1994). ...
The well-being of mothers of children with intellectual disabilities in Saudi Arabia
Thesis
  • Jan 2005
p>The aims of this thesis were threefold. First, an exploratory study of the Saudi mothers’ stress, mental health status, ways of coping, social support provided to them and type of family structure preferred by them, which was achieved by recruiting twenty mothers of children with various Intellectual Disabilities (ID), (Study 1). Second, translating and modifying the original English measures, testing the psychometric properties and finding the new factors of the translated scales by recruiting sample of mothers with Typically Developing (TD) children (N=504) and mothers of ID children (N=513), (Studies 2 & 3). The first set of studies focused mainly on the development of measures that were translated into Arabic. The reliability and validity of all the measures were acceptable. Inserting tow additional religious coping items into the Brief COPE did not jeopardise the psychometric properties of the measures, but rather added to its predictive and construct validity. The third aim of this thesis, which was divided into two sub-studies (Chapters 9 and 10) focused on testing the hypothesised model of adjustment to ID by testing all mediating and moderating possibilities. Multiple regression modelling procedures permitted the identification of indirect and direct effects. Results revealed that mothers of children with ID showed higher levels of stress, anxiety and depression than mothers of TD children. In addition, Behavioural Disorders (BD) were significantly stronger than IQ in predicting maternal outcome and only some child and families characteristics have an effect on maternal well-being. Results also provided general support for the proposed model. Religious coping had a moderating effect between BD and maternal stress, between BD and maternal anxiety and between IQ and maternal anxiety. Emotion-focused coping showed a significant moderating effect on BD and maternal anxiety. Regarding social support, satisfaction with support (SPS) showed a nearly significant moderating effect between BD and maternal anxiety. The helpfulness of social support (FSS) showed a nearly significant effect between IQ and maternal stress. Whereas, network size (FSS2) had a significant moderating effect between IQ and maternal stress.</p
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Rubbish sick and the dancing devil: Illness, alterity, and narrative sensemaking in Vanuatu
Article
  • Sep 2023
How are the historically fraught contexts of alterity that define postcolonial settings generated and negotiated in the context of medical uncertainty? What role does narrative play in the lived experience of such uncertainty and alterity? Focusing on a single “diagnostic odyssey” of childhood illness, this article examines the relationship between chronic uncertainty, alterity, and narrative sensemaking in the highly dynamic and pluralistic healthcare setting of Vanuatu. It demonstrates how close examination of cultural metaphors relating to sickness can reveal deep insights into the lived experience of illness, health seeking, and caregiving. In doing so, it highlights the role of narrative in rendering otherwise unfathomable circumstances sensible on cultural and existential terms, including by engendering a sense of intersubjective stability in the face of trauma.
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Development and preliminary validation of a health-related family quality of life instrument
Article
  • Apr 2023
  • Health Care Women Int
The researchers' aims for this preliminary study was to develop an instrument, guided by the Theory of Health-related Family Quality of Life, to measure health-related family quality of life (HR-FQoL) as perceived by women with cancer. The researchers used a two phase design for instrument development: (1) establishing face validity of a 38-item instrument with an expert panel and patient review, and (2) focusing on the internal structure and construct validity of the instrument with responses from female patients (N = 236) with a cancer diagnosis (breast, gynecologic). The researchers identified a final 25-item HR-FQoL instrument with four sub-scales that each captured multiple concepts within the Theory of HR-FQoL. The resulting instrument maybe used by researchers and clinicians to assess various aspects of health-related family quality of life among female breast and gynecological cancer survivors.
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