Complexity of the family unit

Families are complex, multi-faceted relationships that almost never look like a happy sit-com. Within the structure of the family unit are the archetypes which include leader, follower, rebel, dependent one or quiet participant.
When an illness as significant as cancer affects a member of the family unit, it often brings a flood of reactions and unexpected conflicts which can be difficult to cope with.
Depending on who is affected in the family, the reactions can often intensify archetypal role players or turn up the heat on a quietly simmering pot of prior conflicts. It isn’t always the case that everyone comes to together in a unifying force.

Personality archetypes

There are natural leaders in every family. They are strong persuasive individuals who imply that they know what is best by their air of authority. It isn’t always so. Conflict can arise when more sensitive, gentle types are feeling rail-roaded by decisions made about a loved one that they don’t agree with.
Older people may feel bullied by their children in decision making about their care. They are often weakened by their illness to the point of being unable to assert their rights and a situation arises where the sick person is pulled in opposing directions by the very people who love and care about them.
Those most at risk are dependent personalities; people who are too ill to speak up for what they want, or family members who are not perceived to have a voice.

Cultural and religious issues

Cultural considerations occur with regard to family heirarchy and gender dominance, while family obligation can cause stressful pressure. What is perceived reasonable by some may be considered an excessive demand by others in the family unit.
Religious beliefs may also be impacted. Some faiths prohibit cremation or the deceased person’s body being buried more than a certain distance from their place of death. And yet family members who don’t subscribe to these beliefs may try to impose their own ideas, there-by creating significant family conflict.

Unequal work-load sharing

The caring work-load may be seen as unequal amongst siblings caring for a sick parent. Resentment and arguments can ensue. Following the initial bad news that someone has cancer there may be an outpouring of help or offers of help. As time goes on however, there is often only a handful of true contributors.
The negatives of this situation can seem worse if there is ‘history’ between siblings or relatives.

Strategies to survive family conflict

Opening up a forum for family discussion and involvement from the outset of a diagnosis of cancer or other significant illness can set the tone for on-going equitable care.
Using a language of mutual respect and active listening will further enhance a more harmonious journey. This includes time spent listening to each other’s views and making an effort to see where each person is coming from. Bringing fears into the open and adopting a supportive role with each other, not just the affected individual, all leads to a significant reduction in family conflict.

Families being what they are, this is not always successful, particularly where there are strong personalities whose thoughts are out of sync with the rest of the family. But even so, if this process is instigated and pursued by several family members it will still help develop a unified approach to supportive care.

Respect for each other

Age or a weakened condition should not be used as a reason to discount someone else’s views, neither gender nor educational status.
Every individual is empowered when others show respect by listening patiently and considering their unique perspective. It applies to the patient as well, the one who may also be suffering as they witness how their illness has caused unwanted conflict and angst in the family.
If a particular relative is creating real turmoil in the family, it can be very helpful to involve the health care professionals responsible. An unbiased professional voice can provide the strength of reason and authority to support a patient’s wishes.

Use an Advance Care Directive

The process of creating an Advanced Care Directive can eliminate a certain amount of conflict by the affected individual stating what their wishes are if the disease progresses and it is likely that they will pass away.
This immediately stops any family members from forcing their own wishes on someone who may no longer be able to speak for themselves when the time comes. An example of this is if someone in the family wants the person to be resuscitated in the event of a cardiac arrest. The Advanced Care Directive allows health professionals to follow the wishes of the patient, not the relative. It also provides a legal platform for religious and cultural beliefs to be respected and adhered to.

The Directive is multi-faceted and covers a range of issues which empowers the person who has cancer to be in charge of their own pathways. Copies can be kept by several members of the family, the health care facilities and medical personnel involved in their care.
Information, a kit and application form can be found at:
advancecaredirectives.sa.gov.au

Appoint a spokesperson

The person who has cancer can appoint a spokesperson on their behalf who will ensure that family issues and conflicts do not undermine choices. This person acts as their advocate, a strong voice to ensure that needs and wishes are respected.

Family conflicts do not have to dominate a time when all the focus should be on giving someone love and support. These strategies can all help keep the family on the same page.

Erica Fotineas

2017