While We Are Dealing With This Cancer?

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 sup-port the patient, and each other, during the cancer cri-sis. 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 dis-cuss 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 your-self. 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.