Approach to Social Work Practice
As oncology social workers, we need to combine knowledge about medical conditions with social work skills and interventions in order to provide services to patients. Providing care to oncology patients can seem like a daunting task, but the Family Systems-Illness Model (FSIM), developed by psychiatrist Dr. John S. Rolland, provides a comprehensive framework to use in practice with our patients in a medical setting.
Major components of this model include understanding the type of illness and the phases a patient is experiencing while involving family members into the understanding and process. A key concept of this model is assessing and incorporating the patient's family into the patient's treatment process. A family unit is seen as a major resource during a cancer diagnosis and by preparing both the patient and the family, they can create meaning in the patient's illness and support as a whole family unit.
The model below shows three different dimensions needed to be factored into a patient's diagnosis and treatment process. You can listen to explanations of each factor by clicking the button next to each factor, or read along below.
This is a very brief summary and overview of the Family Systems-Illness Model. All adaptions and ideas regarding the Family Systems-Illness Model were derived from Rolland, J. S. (2019). Families, health, and illness. In S. Gehlert & T. A. Browne (Eds.), Handbook of Health Social Work (3rd edition), (pp. 331-357). John Wiley & Sons, Inc.
Overview of the Family Systems-Illness Model
The Family Systems-Illness Model is a framework developed by psychiatrist Dr. John Rolland that can be used by oncology social workers when working with patients and their family members. It combines medical facts and factors of someone’s cancer diagnosis with a psychosocial approach. This model suggests that family members are a huge resource in a person’s cancer journey, and their involvement and understanding have a really big impact on a patient’s overall success in treatment. Overall, this model identifies that if a person with cancer and their family members have a true understanding of the cancer diagnosis and all of the possibilities that come along with it, AND their family dynamics, roles, and past experiences are all factored into the patient’s care, then a social worker can assess the impact cancer may have on a patient and their family, and thus, allow the social worker to develop and implement interventions that work best for the patient and family. With this model, we use three main factors to provide an overall assessment and develop the best social work interventions. These factors include the illness type, the phases of the illness, and the key family components. We are looking at all of these factors through a psychosocial lens, meaning how do all of these possible factors effect a person and their family, not just medically, but physically, emotionally, and mentally. While this model can be applied to all medical conditions, here, we will be applying it to someone with a cancer diagnosis.
Types of Illness
First, we will discuss the psychosocial types of illnesses, which includes the onset, the course, the outcome, and possible disabilities associated with the condition. Onset The onset could be acute, meaning the condition happens very quickly and unexpectedly, or gradual, meaning something happens slowly over time. A cancer diagnosis could be either one of these depending on how the cancer is found and diagnosed. For example, a person could be admitted to the hospital with severe stomach pain which results in a diagnosis of an advanced stage cancer versus someone who went for a routine screening and ended up being diagnosed with an early-stage cancer. While any cancer diagnosis is unwanted, someone diagnosed during a routine screening may have more time to prepare for their upcoming appointments and needs Course Progressive – is this something that is expected to progress or worsen at all over time? A progressive course means the family may have to constantly prepare for changes in the person’s medical status which means on-going strain and stress on the family and patient. Constant – is the condition expected to be constant, meaning there will be a new baseline in someone’s medical status, causing an initial need for readjustment, but eventually a steady, new functional status? Episodic – does the condition mean episodic flare-ups or issues because of the condition? This can cause unpredictability in a patient and their loved ones’ lives. Cancer can be one or all of these. For example, a metastatic or advanced cancer is progressive because at some point, it is projected the cancer may spread or worsen. It can also be constant, in that people with cancer, especially an advanced diagnosis, may live with a very stable status for many years. The cancer can also be episodic, meaning it could cause medical complications at any time throughout someone’s treatment course. Cancer can also cause episodic flare-ups even after someone is considered “cured” because there could be on-going, residual side effects, such as neuropathy or long-term fatigue. Outcome Here, we are exploring what is the overall outcome of the person’s cancer diagnosis. Is the person expected to make a full recovery after the recommended treatment, or is the outcome expected to result in possible death and a shortened lifespan? Depending on the outcome, a social worker may need to help prepare a patient and their families for long-term planning, address anticipatory grief, and the overall effects it may have on their lives. Disability Next, we are exploring what possible disabilities or symptoms are expected because of a person’s cancer diagnosis. Cancer can cause a wide range of side effects and symptoms, both permanent and temporarily. For example, a person with cancer may lose physical abilities, have changes to their appearance, have surgical procedures such as colostomy bags placed or mastectomies, or possible loss of vision or ability to properly digest food. Every person with cancer has a unique combination of all of these factors. We need to use all of this information to educate the patient and their family, and prepare them for what the future may look like.
Time Phases of the Illness
Next, we will discuss the overall time phases of an illness, including the initial crisis phase, chronic phase, and the terminal phase, and what phase a person may be in. The Initial Crisis Phase is defined as the period of time leading up to a diagnosis until after the actual diagnosis is received and treatment planning occurs. During this time, patients and their family need to come together and realize the importance of the family unit. People are learning to cope with the disability or illness at this time, learning about the healthcare environment and treatments required, and connecting with the healthcare team. The patient and family are grieving the loss of their usual or normal lives. In terms of cancer, this would be the phase where people are undergoing a work-up for tests and scans that may not be considered normal, eventually receiving a diagnosis, and meeting with the medical team to plan to treatment. This period is full of uncertainty, fear, and anxiety. The Chronic Phase is the period after the readjustment period, but before potential issues related to death prevail. During this “the long haul” phase, families are adjusting to the “new normal” with the constant loom the knowledge the patient has cancer. A person with cancer may experience this phase when they are settled into their treatment routine, but can have complications or progression of their disease, which may lead them back to the “crisis phase”. It is important to note someone can go back and forth between these phases depending on the nature of their condition or cancer. The Terminal Phase can arise if a person’s cancer progresses to a point where death is inevitable. At this point, the patient and family are preparing for how someone’s death effects their lives, and also the family is mourning their loved one’s death. Families are trying to transform their mindset into “letting go” of their loved one and enjoying whatever time may be left. This is an important time to discuss end of life wishes, if they haven’t already been discussed earlier on with the patient and their family.
Key Family Components
With key family components, a social worker is exploring what family members are involved in the patient’s care (and those who aren’t), what roles the family members have within the family unit, and what their past experiences may be with cancer or other medical conditions. First, we want to see what support a patient has. Which family members are involved in their care, and who is being identified as having a complicated relationship? What life phases are each family member in? What else is happening in their lives that cancer is hindering? For example, did a patient just have a grandchild, and they are unable to hold the baby because of their illness? Furthermore, how is the patient’s cancer effecting their child and grandchild. We also want to look at the roles within the family units. For example, if the patient is the matriarch who usually is in control, what happens to the family when she is now sick and needs help and support? Who may possibly step in to take over that role? You also want to explore what other experiences the family may have together. What other losses have the family experienced as a unit and what coping strategies does each family member use? During an assessment or in on-going meetings with a patient and their family, the social worker can explore strength and vulnerabilities within the family system. Does the patient and family have an overall good experience with healthcare, or have they had past negative experiences which could shape how they approach care for the patient? In depth conversations and assessments with patients and their families can allow for the social worker to see the dynamics within the family, and by factoring in the illness stages and time phases of the patient’s cancer, ultimately assist the family with understanding and preparing for the cancer journey together.