Families and Chronic Illness

Module Sections:

Illness Life Cycle

Rolland (1994) proposed that illnesses and a family’s reactions to illness are not static, unchanging states. Rather, they are dynamic and constantly changing. For example, it is common knowledge among caregivers of those who are ill that some days are better than others. Some days the patient experiences less pain and distress, whereas other days he/she may experience more. With regard to the changing experience of illness, by the patient and family, Rolland discusses three time phases of the illness. These are dynamic periods of time and are experienced differently by each unique family. Each phase presents with its own challenges. The time phases of the illness are:

  • Crisis stage. This is the period of time just before the diagnosis of an illness or health condition (perhaps when symptoms are starting to become more salient) or after the diagnosis. This is often “a time of excruciating vulnerability and uncertainty, in which all experiences seem heightened in intensity and family members grope for ways to reassert control” (Rolland, 1994, p. 44). In this stage there is a lot of stress as the family and patient try to make sense of what has just happened (i.e., the diagnosis).
  • Chronic stage. This phase of the illness is “the time span between the initial diagnosis and readjustment period and the terminal phase (below), when issues of related to death and dying predominate” (Rolland, 1994, p. 48). This stage is usually experienced when the health condition is ascertained to be chronic in nature and the patient and family deal with it day in and day out. This stage is generally not as unpredictable and stressful as the crisis stage. Usually in this phase more about the illness is known and families and patients learn to live with it.
  • Terminal stage. As aforementioned, this phase of the illness is wrought with plans and preparations for death and dying. This stage can be both stressful and extremely emotional. One of the key tasks of this phase is a shift of anticipation from the probability that the patient is nearing death, toward the inevitability of death (Rolland, 1994).

In the next section, you will have an opportunity to see how these two models have been integrated to provide a more specific framework for helping families affected by the illness of a family member. Before the integrated model is discussed, please take a few moments to read over the following vignette. You will later be applying what is presented in this module to the vignette.