Guideline 13: Longstanding conflict within the family

Politely ask the daughter to either remain silent or wait outside for the remainder of the consultation.

Whilst this may be appropriate if , after trying other strategies, the carer is still extremely disruptive, excluding the family member this early in the consultation is likely to damage the clinician-patient-family carer relationship.

Talk through the issues in the mother and daughter's relationship to help resolve them.

Whilst it may be beneficial for the mother and daughter to talk through their issues, as an oncology clinician, it is not expected that you provide counselling. Acknlowledging that this is not your area of expertise is a good strategy to avoiding taking on the role of counsellor

Acknowledge and normalise the the conflict, and negotiate an appropriate approach to the family members involvement. Suggest that the patient and family member speak with a psychologist or counsellor.

Acknowledging the confict is an important step in resolving it. By negotiating a mutually agreeable approach to family involvement it is likely that the family carer can remain involved but be less disruptive. For longstanding conflict that is affecting the patient, referral to a counsellor is appropriate..

Try to minimise or if possible, ignore, the conflict and continue discussing the treatment options.

Ignoring the conflict may lead to escalating tensions and make it harder for the patient to make treatment decisions, and for the daighter to accept these decisions.