Families are complex systems built around relationships and life histories. Conflicts arise for many reasons, especially at difficult times. Unresolved issues (which exist in every family) are often played out during periods of stress. Jealousies and rivalries come to the fore, painful issues from the past re-surface and people are confronted with sensitive subjects, exposing feelings of vulnerability and fear.

When a person is diagnosed with a life-limiting illness, the equilibrium of the family is upset and everyone is affected. Relationships within the family change and interactions with the external world are coloured by the new set of circumstances.

A research study carried out (Humana et al 2018) with families of patients with cancer found that the predicting factors of conflict were: family members asserting control over decision making and communication constraints.

Poor communication is frequently implicated as an underlying factor that causes conflict. Even if the conflict has originated from an identifiable issue, not talking openly is certain to exacerbate the disagreement or make it likely that an impasse will occur.

Individuals within the family may have differing constructions of the key issue; people may speak and act at cross purposes without realising that their perspective is at odds with the perspectives of others in the family. Being able to communicate effectively, expressing respective points of view and feelings, helps to create a shared understanding and puts everyone ‘on the same page’. This is a much better basis for problem-solving and making decisions.

Tips for improving communication:

1. Focus on the current situation and the key decisions that have to be made, try to avoid bringing up issues from the past (unless they are directly relevant)
2. Listen attentively to each others’ points of view, be open to hearing everyone’s different perspectives
3. Allow space and time for feelings to be expressed
4. Avoid blaming
5. Be aware of unresolved family issues and their potential impact
6. Pace the discussion and allow everyone to have their say
7. Breathe
8. Set some ground rules

Convening a gathering of family members or holding a family meeting can be a useful way to clear the air and facilitate shared decision-making. People are usually happy to help if they are given clear guidance and defined tasks. In the context of care-giving, family consensus in creating a plan for the future can be hugely helpful in preventing conflict occurring or recurring and empowering for the primary family carer.

After holding a family meeting at the suggestion of her Admiral Nurse, a family carer reflected: “It was so helpful and has given us a clear way forward which we all agree with. Everyone at the meeting really listened and, for the first time since my mother’s diagnosis, I felt supported and understood”.

Disagreements commonly arise around ‘what is to be done’ to enable a family member with dementia to be cared for in the best possible way. When an individual family member takes control of decision-making without deference to the person with dementia and other family members, conflict is frequently the result.

The study (mentioned above) with families of cancer patients cited ‘control of decision-making’ as being a precipitating factor of conflict. Ideally the person with the condition remains in charge, however with dementia, the person with dementia may not be in a position to make choices. Family members must then ‘stand in the shoes’ of the person with dementia and make decisions in that person’s best interests. This is further complicated by the mismatch that can occur between the needs of the person with dementia and those of the family carer.

It helps families enormously if some of the difficult conversations about what the person with dementia would want, in the event of different prospective scenarios, can take place in advance, whilst the person with dementia has capacity to express his/her views, personal choices and preferences. Family members are then equipped and the potential for future conflict between family members is minimised.

Sometimes compromise is necessary. A recent experience of one family carer, Caroline, who  cares for her mother and father (both with dementia) along with her two teenage children, was forced to re-evaluate her situation after becoming unwell with physical health issues, stress and exhaustion. A family meeting with Caroline’s three siblings and their partners led to a plan being put in place to engage a live-in carer to support her and her parents. Caroline was insistent that she wanted to carry on caring for her mother and father in their jointly owned home, but accepted that she could not continue to manage the demands on her own. Family members agreed that live-in care was the best option and they helped Caroline to make arrangements. A rota was also drawn up for each sibling in turn to stay with their parents for one weekend a month, allowing Caroline some time away to recuperate and to spend time with her husband, alleviating the strain on the marriage.

If you have experiences of family conflicts around care-giving, please get in touch: barbara@livebetterwith.com

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