Do patients trust their physician? The role of attachment style in the patient-physician relationship within one year after a cancer diagnosis (original) (raw)
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Using attachment theory in medical settings: Implications for primary care physicians
Journal of Mental Health, 2012
Background: Mental health researchers, clinicians and clinical psychologists have long considered a good provider-patient relationship to be an important factor for positive treatment outcomes in a range of therapeutic settings. However, primary care physicians have been slow to consider how attachment theory may be used in the context of patient care in medical settings. Aims: In the current article, John Bowlby's attachment theory and proposed attachment styles are proffered as a framework to better understand patient behaviors, patient communication styles with physicians and the physician-patient relationship in medical settings. Conclusion: The authors recommend how primary care physicians and other health care providers can translate attachment theory to enhance practice behaviors and health-related communications in medical settings.
2015
Attachment style has been highlighted as a potential influence over cancer patients’ willingness to access services, and their perception of support available. The object of this review is to systematically review and synthesise published literature relating to the relationship of cancer patients’ attachment style and adjustment to cancer. Methods: Electronic database and reference searches were conducted to identify published literature relating to the review’s objective. Search terms were simply “Attachment” and “Cancer”. Results: A total of 3,831 papers were identified, with 25 papers meeting criteria and included in the review. Papers were filtered through by hand, eliminating: duplications; non experimental studies; articles not published in peer review journals; articles relating to medical (e.g. cell attachment) and non-human attachment; participant samples who were not adult cancer patients; and studies which did not use an adult attachment measure. Conclusion: Due to hetero...
When people become patients: fluctuations in trust from the cancer patient’s perspective
Chinese Journal of Communication, 2018
This study explores the trust relationships between cancer patients and their physicians by discussing the concept of trust and the collection of patients' medical experiences before and after being diagnosed with cancer. The purpose of the study is to determine changes in patients' trust during this process. This ethnographic study was conducted from 2009 to 2014 on doctor-patient relationships under the coverage of the National Health Insurance (NHI) in Taiwan. Under the NHI, patients may access physicians and acquire treatment at low cost. In this study, the sample comprised 12 female cancer patients. Data were collected in in-depth interviews with six patients. With the bloggers' consent, data were collected from six blogs. These data were analyzed to determine how these cancer patients constructed and altered their opinions during their diagnosis and treatment. The results are discussed according to the calculative trust that was constructed based on information collected and/or impressions developed during their initial visits. The findings showed that relational trust was developed and (dis)evolved through interactions and experiences with medical staff. In addition, calculative trust was generated based on the following: eliminating institutions or physicians with which the patients had negative experiences; feeling and perceiving caring and professional competence; yielding to cancer and respecting professional reputations. Relational trust was derived from the following: the doctors' ability to sooth patients' anxieties and explain uncertainties; the compatibility of expectations in information sharing between physicians and patients. The results showed that in the early stage of developing a doctor-patient relationship, calculative and relational trusts were intertwined. As the doctor-patient relationship developed, the patients' relational trust increased. The findings of this study contribute to the knowledge concerning the coconstruction of patients' trust in physicians in medical systems through communication between patients and medical staff.
Physicians’ difficulty with emergency department patients is related to patients’ attachment style
Social Science & Medicine, 2006
Doctors experience 10-20 percent of patient interactions as being personally difficult, but the sources of difficulty are incompletely understood. In particular, physician-perceived difficulty has not been studied from the perspective of an established model of interpersonal relationships. Our objective was to determine whether a relationship exists between patients' attachment style and the degree of difficulty experienced by their attending physician in an Emergency Department in Pretoria, South Africa. Patients of an Emergency Department (n=165) completed the Experiences in Close Relationships-Revised Questionnaire to measure attachment anxiety and attachment avoidance. Their physicians (n=26), blind to the attachment measure, rated perceived difficulty using the Difficult Doctor-Patient Relationship Questionnaire. Four categories of attachment style were identified by cluster analysis of attachment scores. Patients were divided into difficult and non-difficult groups using a cut-off score. Two percent of patients with a secure attachment style were experienced as difficult, whereas the prevalence of difficulty in the insecure styles was 'preoccupied' 17 percent, 'dismissing' 19 percent and 'fearful' 39 percent (χ 2 =16.383, df=3, p=0.0009), supporting the hypothesis that the physician's perception of patient difficulty is related to the patient's attachment style. The degree to which physicians serve attachment functions for patients in crisis merits further investigation.
Disentangling cancer patients' trust in their oncologist: a qualitative study
Psycho-Oncology, 2012
Patients' trust in their physician is crucial for optimal treatment. Yet, among oncology patients, for whom trust might be especially important, research into trust is limited. A qualitative interview study was carried out to investigate 1) to what extent aspects of trust important to cancer patients reflect the aspects described in other patient populations, and 2) which additional themes emerge. Methods In-depth, semi-structured interviews were performed with a purposefully selected heterogeneous sample of 29 cancer patients. Transcribed interviews were analyzed using MAXqda. Data were clustered across interviews to derive common themes related to trust. Results Three commonly described aspects, i.e., Fidelity, Competence, and Honesty, were strongly reflected in patients' accounts of trust in their oncologist. Confidentiality was irrelevant to many. An additional aspect, labeled Caring, was distinguished. Central to the accounts of these patients was their need to trust the oncologist, arising from the severe and life-threatening nature of their disease. This necessity to trust led to the quick establishment of a competence-based trust alliance. A deeper, more emotional sense of trust was developed only after repeated interaction, and seemed primarily based on the oncologist's interpersonal skills. Conclusions The need for trust encountered in this study underscores the power imbalance between cancer patients and their oncologist. Additionally, these results imply that, when aiming to measure cancer patients' trust, what we might actually be assessing is patients' intention and determination to trust their oncologist. personal relevance. Interviews took approximately one hour. Interviews were conducted between February and September 2009 by two of the authors (M.H. and A.O.), both with a background in psychology and trained in qualitative interviewing. The hospital's Medical Ethics Committee provided an exemption for the study to seek formal approval.
Journal of Psychosocial Oncology, 1994
To determine physicians' perceptions of the effects that the companions of cancer patients have on physician-patient communication, semistructured interviews were conducted with 12 oncologists (6 medical, 4 surgical, and 2 radiation) from a total population of 21 oncologists. The physicians estimated that threefourths of their patients brought companions with them to consultations and said that these consultations were more complex for the physician. The behaviors of the companions varied from domination to passive note taking, and the companions who were young professional men or older women who accompanied their husbands were the most assertive and asked the most questions. All possible coalitions were observed during medical visits. The physicians perceived that companions and patients often had different agendas and noted differences in the companions' behaviors according to their gender and whether they lived in rural or urban areas.
Difficult doctor–patient interactions: applying principles of attachment-based care
2016
here is significant literature on 'difficult patients' presenting for health care, who have been given many names, including 'manipulative', 'demanding', 'complaining', 'needy', 'frequent flyers', 'heartsink' and even 'hateful'. 1 The range of 'difficulties' demonstrated by these patients generally fall into the following groups: • have repeated visits with little apparent benefit, especially when it is difficult to conclude the interview, sometimes with excessive dependence on and flattery of the doctor • have unreliable attendance and poor adherence to advice and treatment • make complaints that seem to have no medical explanation or are significantly out of proportion with the physical findings • display intense negative affect (i.e. patients who are unduly demanding, angry, defensive, frightened or aggressive). Although doctors can experience these patients as emotionally draining, intimidating or simply hard to relate to, the degree of perceived difficulty varies from one doctor to another and can reflect differences in experience and the personal