Reducing Decision Stress when Caring for Loved Ones

By: Judi Brownell

You know you make good decisions most of the time.  Every day literally hundreds of issues arise, large and small, that require you to choose among numerous options.  And you do it—you stop at a quick-service restaurant rather than eating at home, you make a date for the oil change on Friday instead of Monday, you decide to try a new dentist rather than staying with someone who is difficult to reach.

No matter how many decisions you’ve made in the past, nothing prepares you for the difficult and complex choices you need to make about care for your loved ones.  This responsibility can cause a great deal of stress, particularly when the outcomes are critical and there is a great deal of uncertainty.

The complex role of caregiver isn’t easy.  It often involves a range of responsibilities, from household tasks to emotional support to medical assistance.  When caregivers were interviewed, 20 % reported that they felt their job was difficult and often overwhelming.  Nearly half found it emotionally difficult, and nearly all participants reported feeling exhausted, overwhelmed, and lacking time for themselves.  The greater the hands-on care, the higher the stress reported.  It’s obvious you’re not alone; other caregivers are also experiencing decision stress and trying to find ways to reduce it.

You probably feel confident about your decisions on all sorts of topics, but with little or no experience in a caregiving situation, and a lot of unknowns, making decisions for a family member often seems overwhelming.  You think about it one way, then another, and then you start all over again. Decisions are particularly stressful when the preferences and priorities of several people have to be taken into consideration.

Decision Stress and Family Dynamics

While you may be in an advisory role or serving as an advocate, it’s likely that you’re participating with other family members and health care providers to make choices about treatment, the location of care, legal options, and other elements.  All are important, all have the potential to create considerable stress.  Often, too, those involved in the decision-making process may have different values, preferences, personal agendas, perceptions, and goals.  This makes coming together on a single course of action particularly difficult—and stressful.

Family dynamics often change when everyone is under stress and when the outcomes have important and potentially unforeseen consequences.  You may not have anticipated the conflicts and challenges of family decision making because you may not have encountered a situation where individual differences had such a strong impact.  A person’s comfort with risk-taking, their cognitive style, self-efficacy, and other factors all contribute to the expression of different opinions and behaviors.  Even the patient or client herself contributes dramatically to your stress when she has preferences that are unrealistic or that can’t be met.  While the involvement of the patient in his or her own care is often desirable and positive, it isn’t always easy.

Decision Stress Reduction Strategies

There are a number of things you can do that will help reduce your stress and ensure that you are making the best choice possible.  As one health care provider put it, stress is like kryptonite for good decision making.  It destroys your ability to make wise choices.  You need to manage your stress to make effective decisions; don’t let stress interfere with your ability to think through your options.

See which of these stress-reduction strategies might work for you:

• Don’t assume there is only one “right” way to handle a particular issue. The truth is there is probably no clear, perfect answer to many of the dilemmas you confront.  Decisions are often messy, risky, and involve trade-offs.  Don’t get stuck in “getting it exactly right.”  Your goal is to find a reasonable, feasible, workable solution and move on.  Avoiding decision making, procrastinating, or denying that a decision even needs to be made only prolongs your stress and may make things worse.
• Not every decision is a crisis. Always ask yourself, What needs to happen right now?  What can wait until tomorrow, or next week?  What can I delegate—what can someone else do well without my continuous involvement?  If you can sequence decisions or share the burden, your stress level will decrease.
• When the decision is yours to make, be selective—you don’t need advice from everyone. There will be many well-intentioned friends who have “been through this” and who are more than happy to tell you exactly what you should do.  Keep in mind that every situation is unique and, while their ideas may be useful, you know what is best for your particular situation.  It’s important for you to trust yourself. 
• On the other hand, once a decision has been made, it may be helpful to run it by someone who can be objective and who understands the dynamics of the situation. You don’t have to take their advice but soliciting the perspective of a trusted friend can be comforting.  Perhaps one of your best options is to partner with healthcare workers. Studies have shown that family members make better decisions when they receive support from someone who is compassionate and experienced is by their side.
• Make sure your decisions align with your values. Ask yourself, what’s really important to accomplish?  Often the stress of the moment compels us to go along a path that may not feel comfortable or be in your loved one’s best interests long-term.
• Keep in mind that most decisions are not permanent. It may feel like this one decision is critical, but often a course of action can be changed or modified as more information becomes available.  Ask yourself, is this something that I can revisit later on? Continuously reassess the situation to make sure that you have all the necessary information, and then determine whether it would be beneficial to re-think your approach at a later time.
• Sort things out to determine what is truly important. Molehills become mountains in an instant when you’re stressed. You’re likely to feel pressure to “get it right” and perceive that if you don’t, something horrible will happen.  This is almost never the case.  Decisions are cumulative.  Take them one at a time.  Celebrate your progress and accomplishments.
• Use positive self-talk. The messages you send yourself have a significant impact on your stress level and your ability to make good decisions.  Your frame of mind also affects your loved ones. In some cases, we cause our own stress by only focusing on negative thoughts.

Determine If Any of the Following is Familiar:

Shoulds: Do you tell yourself what you “ought” to do – “I’d like to take the kids to the park but I should go visit mother this weekend.”

Criticism: You are hard on yourself – “I know I’m always too impatient with Dad, I’m just not very good with older adults.”

Blame: You blame yourself rather than solving the problem – “I’m upset because mom is so depressed. I know it’s my fault because I don’t get her out of the house enough.”

Negative expectations: You give up too soon – “I’ve tried but I just can’t get Emily to take her medication.”

Cant’s: You convince yourself that you are probably going to fail – “I don’t think my siblings are going to pay any attention to me, I’m never going to get them to agree to renting a lift chair.”

The Big Picture in Reducing Decision Stress

In addition to the suggestions above, there are three keys to reducing the daily stress of caring for a loved one so that you can make more thoughtful and objective decisions in managing their care.

1.  Be an Active Stress Manager, Not a Victim.

Adopt the attitudes and behaviors of an active stress manager. You are not a victim of circumstance.  You have choices, and it is essential that you stay focused and positive.  Just as a patient’s attitude significantly impacts his or her wellness and healing, your attitude and self-efficacy have a tremendous influence on your level of stress.

You might begin by seeking a role model; observe someone you feel handles similar situations effectively.  Although we each have our own style and strengths, a role model helps you envision possibilities and realize that you can manage care in many healthy and productive ways.  Make sure, too, that your goals are realistic; as mentioned above, partnering with a health care professional or someone you admire who has expertise and experience is often the best way to begin.

2.  Keep Lines of Communication Open

You can’t not communicate.  Even if you’re silent, even if you avoid confrontation, you are still sending strong messages to others about your attitude, your level of interest, your comfort with the situation.  So, it’s better to express your thoughts clearly and directly rather than give subtle cues that may easily be misinterpreted. In order to problem solve, you first have to understand the perspectives of others involved in your loved one’s care.  It’s very likely that they are stressed, too.

Keeping lines of communication open is no easy task, but having access to accurate and timely information can help you reduce your stress and make better decisions.  There are at least three main “stakeholders” involved; your family, your healthcare specialists, and your loved one.  How do you communicate with each?  Which communications are the most stressful?  Who has information that will help you make the best decision?  Patient-centered care requires effective partnerships and continuous communication with everyone involved. 

3.  Take Care of Yourself

Decision fatigue is real.  Decisions take a huge amount of mental energy. When you avoid the decision or procrastinate, it only complicates the situation.  You can’t make a good decision unless you are rested and committed to taking care of yourself.

Your loved one will ultimately suffer if you don’t keep yourself in good health both mentally and physically.  The best thing you can do is to make sure you stay rested and that you find some time to do the things you love.  Giving up important components of your life is likely to result in resentment later on; besides, your loved one wouldn’t want you to make that kind of sacrifice unnecessarily.  If care continues over a long period of time, create new routines.  You may have to compromise—go to the gym twice a week rather than four times a week, or go out with your friends every other week rather than every week—but it’s important to find a way to sustain yourself so that you are better able to care for others.

While decision stress may at times feel consuming, you can learn ways to reduce it and feel more confident about your role in the caregiving process.  Not all strategies work for everyone, but if you take time to reflect on your situation and get in touch with the attitudes and behaviors that are contributing to your stress, you will be able to identify ways to handle even the most important decisions without feeling overwhelmed.  Take decisions one at a time, be patient, and follow the principles of an active stress manager.  You’ll find that you can not only reduce your own stress but that when you are more relaxed you will have a positive impact on everyone involved.