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The role of family caregivers for people with chronic illness.

A chronic disease (e.g., diabetes, cardiovascular disease, stroke, hypertension, dementia, some cancers, rheumatological diseases, human immunodeficiency virus) can occur and cycle in flare ups throughout the lifetime. Chronic illnesses, with their effect on the patient’s symptoms, mood, and need for emotional and physical support, exert a burden on family members. Additionally, families influence a patient’s psychological adjustment and management of the illness, adoption of behaviors that influence recovery, functioning and adherence to treatments. 5 The authors, a family physician and a clinical social worker, have been counseling patients and families in a variety of health care and educational settings for 30 years. We have led psycho-educational and medical groups involving patients (and their caregivers) with cancer, chronic pain, diabetes, cognitive impairment and childhood congenital and genetic illnesses. We have seen how the involvement of families and caregivers improves the quality of life for the patient, eases caregivers’ burden, encourages adherence to treatments and increases patients’ ability to cope with the illness. The clinician’s attention to the caregiver can potentially improve family relationships and, therefore, decrease anxiety in the patient and his/her caregiver. Family caregivers function as advocates and provide physical, emotional and financial support, frequently without any training, often without recognition or support, and rarely with financial reimbursement. Many people living with chronic illness could not live independently without family caregivers. Gail Sheehy, in Passages in Caregiving: Turning Chaos Into Confidence, described a want ad for a family caregiver in her wry yet poignantly accurate style: