Table 1.

Comparison of Three Emerging Models for Programs to Increase Family Support for Patients with Chronic Illness

	Family Members Set Patient Support Goals	Family Training in Supportive Communication Techniques Two Subtypes		Clinical Care Support Roles for Family
Behavioral or Illness Care Theory	goal-achievement theory, motivational interviewing	coping theory	autonomy support	draws on the Chronic Care Model of integrated care support
Most Appropriate Setting	behavior change, especially for behaviors that affect the whole family	ongoing symptoms or activity limitations	change and maintenance of healthy behaviors	during provider visits, between-visit clinical monitoring and care coordination
Example	Patients in a self-management course set goals for behavior change during each week of the course. A participating family member selects a weekly concrete action that will help the patient achieve his or her goals.	Family members practice prompting or suggesting symptom adaptation techniques	Family members practice motivating and responding to patients facing challenging self-management situations without use of control or criticism	A family member is trained in the proper technique for measuring blood pressure. He or she maintains a blood pressure log to bring to the patient’s provider during visits and advises the patient to call the provider if blood pressure rises above specific parameters.
Advantages	Concrete goals make family roles clear	Skills can be used in changing situations over time		Potential to enhance the reach of and reduce inefficiencies in clinical care, potential to detect clinical changes earlier
Disadvantages	Goal setting may not continue, Goal set for a specific situation may not help family increase support in other care domains	Applies to limited patient situations, not ideal for supporting healthy behavior maintenance	May be difficult or ineffective in families with underlying strained relationships.	Potential for interference with patient-provider relationship, increased clinician burden.
Strength of evidence	Mixed results for patients with rheumatologic disease, not evaluated in trials addressing other chronic illnesses	Less pain and improved physical function in two arthritis studies, equivocal findings in a third	Improved dietary adherence among heart failure patients in one study	One pilot intervention to date, although observational evidence supports the benefits of family-centered clinical care.
Randomized controlled trials/pilot interventions underway	Hyperlipidemia, Diabetes		Two heart failure trials	Heart failure, Diabetes