Family coping: helping families help themselves.

Abstract

D IRECT THOUGHTS about death or indirect thoughts about staying alive occupy more of a person’s time than any other subject.’ For the public and many professionals, the word cancer conjures up images of a relentless disease. Many illnesses with far worse prognoses are accepted with less dismay. The perception that cancer means death may precipitate a psychologic crisis that affects the entire family as well as the patient.2-5 At the time of diagnosis, emotional responses of anxiety, fear, depression, and helplessness surface. When a complication or a relapse occurs, especially if the patient becomes critically ill, the family members face not only the possible loss of a loved one but their own mortality as well. According to crisis theory, reactions are fashioned from 1 to 4 weeks after a diagnosis is confirmed.6 Strategies of coping surface and tend to persist and be reinforced throughout the clinical course of the illness.4 Adaptive coping results in quiescence or equilibrium.’ Coping includes achieving mastery, control, or resolution. Resolution refers to the degree to which the coping strategies succeed or fail. In the absence of adaptive coping, psychologic and, in some instances, physiologic deterioration develops.’ Therefore, support of family members in developing or capitalizing upon adaptive coping strategies is essential in order to avert a crisis state. Generally, a crisis state involves three factors.9 First, a hazardous event threatens an individual, such as a complication of cancer or its treatment. Second, the threat is interpreted in comparison with past experience, which may include any previous experiences related to cancer. Memories of past experiences may be a help or hindrance depending upon past success in resolving conflicts. Third, the strength of each person’s repertoire of coping strategies will influence the outcome. In dealing with the crisis precipitated by cancer,