Managing Conflict

*Names have been changed to protect privacy.*

Just three days after his ninth birthday, Steven Bellamy’s mother, Katrine Bellamy, learned what she’d already strongly suspected. Earlier she’d called her son’s physician insisting she be told the results of Steven’s MRI. Not tomorrow. Not in three hours. Now. Instead, the doctor told her to immediately take Steven to the hospital. In tremendous pain, he was admitted to a room where he quickly fell asleep. Katrine spotted an envelope containing MRI images. She couldn’t help herself. She had to open it. Her husband, Dan, who thought she’d spent the past three weeks being overly paranoid about their son’s vomiting spells and headaches, told her to wait for the doctor. I can’t, she told him. I need to know now. Dan left the room, and Katrine pulled out the slides. The baseball-sized mass on Steven’s brain was impossible to miss. Katrine didn’t need a neurosurgeon to explain that she was looking at a brain tumor.

For the Bellamy’s, a long and difficult cancer journey had begun. Their story, like that of many others, includes episodes of conflict between themselves, other family members, friends and medical staff. This article is about conflict and how to manage it. If cancer is “The Big C,” conflict is the “Not-so-little C” that is almost always part of a cancer journey.

What is Conflict?

To put it simply, conflict is a disagreement. For anyone dealing with cancer, conflict can occur over something mundane like deciding what’s for dinner to more difficult decisions involving care. For example, Katrine and Dan had very different ideas about letting their nine-year-old son have a say in treatment decisions. All options sounded terrifying – some could mentally impair their son, others could kill him. When Katrine was pregnant, Dan said he didn’t think he could handle having a child with Down Syndrome. Now he had a child with cancer and was terrified. Dan wanted to present Steven with his options. Katrine said that it would be too much of a burden on their child. After much discussion, Katrine and Dan concluded that “This is our cross to bear. “ Steven would not participate in the decision-making process. As parents, the burden was theirs. They would make the decision and “live with the consequences.”

An equally agonizing conflict occurred with the care of George Janosik, who had been diagnosed with terminal cancer. Janosik’s siblings and in-laws shared caregiving responsibilities which included giving him morphine to ease his excruciating pain. Janosik pleaded for a lethal dose. The caregivers were torn. Some felt it was cruel to let him suffer. For others, self-assisted suicide violated their religious beliefs. It was also against the law. No decision was ever made. Soon after, Janosik died.

These examples highlight how conflicts can emerge due to differences of opinion, beliefs, and communication style. In addition, personal values, stress, distrust, misunderstandings, personality clashes, and power struggles are common sources of disagreements.

How Do You Handle Conflict?

How we respond to disagreements is often based on how we’ve learned to communicate. Some families don’t talk; others settle every conflict by shouting about it. Power differences can also influence our responses. For example, some people respect authority figures, others question them. Experts say we can break negative communication patterns and better manage conflict by being aware of what factors trigger emotional responses and how we communicate. It also helps to recognize how others communicate. Maybe you have close friends who disappear from your life during a crisis, or a pushy doctor who quickly dismisses your questions.

Researchers who study conflict management have developed categories to describe different ways people deal with conflict. Read the statements below and decide which matches your conflict management “style.”

1. You’re not afraid of a good argument. Bring it on, because you’re ready to make your case, and usually you’re right.
2. All you want is peace. You’re willing to go along with others to make them happy.
3. It’s family discussion time when you’re around. You make sure everyone has a say. Better “out” than “in” when it comes to issues. Let’s make a decision that everyone agrees with.
4. Disagreements make you really uncomfortable. You tend to shut down or change the subject. You may even leave the room if you see red flags signaling argument ahead.

Dominating

If you answered A, then you may be a person who sees arguments from a win-lose perspective. You may argue strongly to win arguments, standing firm until decisions are made in your favor.

This was often the case with Katrine when she interacted with her son’s doctors. Katrine came to every appointment so well versed in research on brain tumors, treatments, and side effects she jokingly called herself an amateur pediatric oncologist. She routinely quizzed and questioned doctors. She countered what they told her with research she’d found. One day, after learning about the relapse of a little girl Katrine’s family had befriended and who was being treated by the same oncologist, Katrine grilled the doctor about his decisions. He slammed his hands on the desk in front of him asking if she just wanted definitive statements because he couldn’t give them. He told her that every time he looks at an MRI he makes a value judgment. A judgment. In other words, he’s not God. Katrine says she respects the oncologist for having so much patience with her, explaining, “I just want to understand.”

If you are a dominator, your strategies in conflict might be helpful when a quick decision is needed, such as in an emergency or when the outcome is critical. However, if this strategy is used at the wrong time, it can harm relationships, be seen as bullying, or be a barrier to resolving problems.

If you tend to dominate during conversations, try to:

• Open your mind to all possibilities, resolutions, and stories.
• Listen carefully to the other person.
• Respect what the other person is saying.
• Soften your tone of voice.
• Sit back with your hands folded in your lap. Avoid fast movements or stern looks.
• Take deep breaths to settle any rage.

If you are communicating with a dominating person:

• Don’t take the rage personally.
• Know they want to “win” the argument, acknowledge where you agree but stay strong with your beliefs and ask them to listen to your position.
• Keep calm. Don’t raise your voice, but state your position clearly.
• Let them know you understand they are frustrated, but point out how a decision involving collaboration or compromise can be beneficial for everyone.

Accommodating

If you answered B, then you are probably the kind of person who is more concerned about making other people happy than yourself. You don’t like to focus on differences.

In the case of Jeannette Patterson, who was diagnosed with colon cancer in 2004, she allowed her husband to make most of her care and treatment decisions. She describes her husband as having a very argumentative personality but, with her memory issues and having recently suffered a heart attack, she also trusted more in his ability than her own to make sound medical decisions.

If you are an accommodator, you may like being a peacekeeper and creating goodwill and harmony. But sometimes, you may feel that others take advantage of you, that you do not get as much respect as you deserve, or that you are constantly sacrificing your own interests for the sake of others.

If you tend to accommodate during conversations, try to:

• Be assertive about your needs and your boundaries.
• Cooperate without surrendering to something that won’t satisfy your needs.
• Think of yourself as equally important as others.
• Communicate your thoughts or hurt feelings accurately.
• Pause and ask for a different deal or resolution if you are thinking, “Well, that wouldn’t be so bad as long as they are happy.”

If you are communicating with an accommodating person:

• Ask what they need and how much flexibility they have with their needs.
• Tell them it is okay to voice their opinions, and you will compromise either way.
• Reassure them that you both can be happy with a resolution.
• Keep checking in on the agreement. This person’s mind may change after the conversation is over.

Collaborating or Compromising

If you answered C, then you most likely seek the middle ground when it comes to conflict. You want to work out solutions and satisfy the concerns of everyone involved.

When Diane Martin’s husband, Nick, was diagnosed with Multiple Myeloma the whole family came together as a team to decide on his care and treatment. Diane and Nick strongly believed that cutting out the rest of the family from the decision-making process would create problems. So, they asked for the opinions of their two daughters, his parents, and siblings. Everyone had strong feelings about Nick’s care. “They helped us make the choices, and that helped them,” said Diane.

If you’re a compromiser, then you might prefer to solve conflicts quickly and easily even if coming up with a solution means giving up something. If you’re a collaborator, you may push for a team approach to solving problems no matter what the issue, including problems that may be trivial or need to be settled quickly. Compromise and collaboration are considered to be highly effective for resolving conflict, but deciding which to use should be based on the individuals involved, level of animosity or trust among those involved, how quickly the problem needs to be settled, long-term goals related to the conflict, and whether everyone is O.K. with losing a little.

If you tend to compromise or collaborate during conversations, try to:

• Make sure everyone understands the problem.
• Give everyone a chance to speak.
• Clarify what everyone believes is the most important issue.
• Avoid agreeing to disagree. This is fine if it involves something trivial but does not work when it comes to important decisions such as those you’ll encounter on a cancer journey.
• Explore options together.

If you are communicating with a compromising or collaborating person:

• Determine whether the situation needs to be resolved quickly.
• Determine the importance of the problem being discussed – is it a minor problem or something with long-term consequences.
• Ask yourself if compromising will be a quick fix or will provide a long-term solution to the problem.
• Clearly explain what you are willing or not willing to give up.

Avoiding

If you answered D, you might be the kind of person who puts off thinking about problems or sidesteps potentially uncomfortable situations.

Carl Patterson acknowledges up front, he prefers avoiding conflict. He was responsible for the medical decisions of both his father and his wife when they were diagnosed with cancer. In both situations, he encountered doctors he describes with a string of colorful profanity. In the case of his father, Carl talked with a hospitalist, which is a medical practitioner who works in a hospital setting but does not have an office practice. The hospitalist told Carl that his elderly father had lived past his life expectancy and the family should let him die in the hospital. Rather than argue, Carl refused to interact with him again. A similar incident occurred with his wife’s primary doctor who refused to tell them the results of the biopsy saying, “I don’t give people shitty reports.” Angered by the doctor’s attitude and words, Carl and his wife immediately found another primary physician.

If you’re an avoider, then you might easily become emotionally overwhelmed in situations involving conflict and choose to stay silent. However, in a conflict, you may end up feeling bullied. Communication needs to be open to resolve conflict, and clamming up can lead to anger and frustration.

If you’re an avoider, try to:

• Be more assertive. Come up with ways to say, “No” and tell or ask for what you want.
• Be aware of strong emotions like anger, sadness, and fear that you may be feeling.
• Breathe deeply to remain focused and relaxed in a stressful situation.

If you are communicating with an avoiding person:

• Speak calmly, be reassuring, and respond positively when an avoider speaks up. For example, you might say, “I am glad we’re talking about this and trying to come up with a solution.”
• Observe others’ behavior. Avoiders may show how they are feeling through their body language.
• Do not exaggerate, personally attack, or make accusations. This will discourage them from talking.
• Let them know their feedback is helpful. You might say, “It helps me to know why you are upset so that I can think about the situation differently.”

This research project was funded by a grant from the National Cancer Institute (CA144235; Dr. Wayne Beach, San Diego State University, Principal Investigator). Co-investigators included Dr. David Dozier from San Diego State University, and Mary Buller, Dr. Valerie Myers, and Dr. David Buller from Klein Buendel, Inc.