Like any family,we have members who don’t get along, complicated by long-term, unresolved problems, divorces, etc. Is there any way to minimize these tensions, at least while we are dealing with this cancer?

67. Like any family,we have members who
don’t get along, complicated by long-term,
unresolved problems, divorces, etc. Is there
any way to minimize these tensions, at least
while we are dealing with this cancer?

Mark’s comment:

The only thing you can really do is talk honestly with all
the people involved. If they’re not willing to put aside their
problems, at the very least, ask them not to aggravate the
situation by airing grievances in these circumstances. If
they must have a fight, they can have it somewhere other
than in front of the person who’s sick.

The emotional impact of the diagnosis sometimes
brings family members together in positive ways, even
those who previously did not get along well. Family
members express their hope that they can all put aside
their personal differences and come together to support
the patient, and each other, during the cancer crisis.
Often, this way of coping is ideal and is the hope
of patients who feel they have enough to worry about
with the cancer and do not want to have this crisis
complicated by family disagreements.

However, sometimes family members cannot put the
past behind them, and the family problems they had
before the diagnosis may continue or even increase during
the diagnosis and treatment. The stress of cancer and
treatments may worsen already strained relationships.

Modern families are also complicated by divorces,
remarriages, step-family members, and so forth, and
family roles can be confused. For example, an adult child
may feel that he should be the primary caregiver and
decision maker rather than a new spouse by remarriage.

Such tensions can be hard to resolve and may be impossible
to avoid. Open communication about each person’s
beliefs and feelings can sometimes reduce tensions. A
truce, of sorts, can often be arranged while important
medical decisions need to be made and/or the patient
would benefit from a united family support system.

Tensions may also arise if you think that others are not
doing enough or not providing needed support. It is
sometimes helpful to designate a “coordinator” of care.

Think about designating someone in the family who is
least caught up in the tensions and whom other family
members will most likely follow. This person can arrange
schedules for the rest of the family, including providing
transportation to and from appointments, preparing
meals, cleaning the house, going grocery shopping, and
helping the patient do activities such as getting a haircut,
attending church/religious services, going shopping or to
sports events. The patient may also serve in this role of
care organizer, if he or she wants to. Family members
who are willing and able to be involved can be included
in caregiving responsibilities, if this is what the patient
wishes. For example, a spouse may not be able to attend
all medical appointments with the patient. Perhaps other
family members can share in this responsibility by taking
turns driving and providing support to the patient. Allow
the patient to identify his or her needs, and then start
to assign tasks. This way everyone will feel he or she is
contributing.

Disagreement about medical decisions is another common
source of tension among family members. Family
members may disagree with who should do what, when,
and how. Every person, even if he or she grew up in the
same family, brings different perspectives and values to
making important decisions. The patient may seek family
input if a decision needs to be made, such as starting,
changing, or stopping treatment for the cancer. Emotions
run high during such times. However, keep in
mind that the patient is the one making the decisions. If
he or she seeks out one or two people with whom to
consult, honor this decision. If the patient makes choices
you personally do not agree with, you may want to discuss
this, calmly, but always remember that medical decisions
are up to the patient, not you or other family
members. Supporting decisions that the patient makes is
an important, yet sometimes difficult job for the family.

If the patient becomes unable to make decisions on her
behalf, a surrogate or healthcare proxy should have been
previously identified by the patient. This person has the
legal right to make decisions on behalf of the patient.

However, this does not mean that close family members
should not be involved in the decisions. Hopefully, the
patient has identified a surrogate/healthcare proxy and
discussed her wishes in advance, reducing possible tensions
among family members. Seeking out healthcare
professionals to help coordinate the decision-making
process often helps reduce frustration and conflict.

Refer to Question 94 to learn more about healthcare
proxies and surrogate decision making.

Keep in mind that your perceptions of a family member’s
reactions are colored by your past experiences
with that person. Try to start with a clean slate when
dealing with the diagnosis and subsequent family
input. Put the past aside as much as possible and realize
that each family member will react to the diagnosis
and the added responsibilities in different ways. Some
people may use denial and/or avoidance as their
method of coping—they simply may not be able to
handle the emotions as well as others. Speaking to
such a person compassionately may help him or her
feel better—maybe he or she can become more
involved by doing fun activities with the patient,
instead of staying for long visits at the hospital or
attending medical appointments—both of which may
be overwhelming.

Realize, however, that no matter how hard you try, you
may not be able to resolve tensions in the family or
change others’ reactions or behaviors. Focus on what
you can do to help the patient, your family, and yourself.

If you pay more attention to yourself and your
own reactions to stress, and think less about other people’s
reactions, they may bother you less often. Additionally,
tensions may ease if family members set an
example of putting the past behind them and focusing
on the present situation.