Can patients be ‘attached’ to healthcare providers? An observational study to measure attachment phenomena in patient–provider relationships

Maunder, Robert G.; Hunter, Jonathan

doi:10.1136/bmjopen-2016-011068

Cited by 47 publications

(51 citation statements)

References 43 publications

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“…They have unique influences on the ways individuals behave in a close relationship (Mikulincer & Shaver, 2016), including patient-healthcare provider relationship (e.g., Maunder & Hunter, 2016). They have unique influences on the ways individuals behave in a close relationship (Mikulincer & Shaver, 2016), including patient-healthcare provider relationship (e.g., Maunder & Hunter, 2016).…”

Section: Attachment and Emotion Processingmentioning

confidence: 99%

“…These dimensions are believed to derive from different relationship dynamics and perceptions about attachment figure availability and responsiveness. They have unique influences on the ways individuals behave in a close relationship (Mikulincer & Shaver, 2016), including patient-healthcare provider relationship (e.g., Maunder & Hunter, 2016).…”

Section: Attachment and Emotion Processingmentioning

confidence: 99%

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Attachment and adaptation to breast cancer: The mediating role of avoidant emotion processes

2018

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Attachment insecurity is associated with difficulties in adapting to cancer. Accumulating evidence points to the influence of avoidant emotion processes in this association. This study explored this pathway by examining the association between attachment insecurity and quality of life in women with breast cancer, and by exploring the mediating role of two avoidant emotion processes in this association. Women with breast cancer (N = 155) completed measures of attachment, emotional suppression, emotional awareness and quality of life. Avoidance of attachment was positively associated with emotional suppression (β = .29, p < .01) and lack of emotional awareness (β = .27, p < .01), and negatively associated with quality of life (β = -.22, p < .05). Lack of emotional awareness partially mediated the relationship between attachment avoidance and quality of life (indirect effect β = -.12, p = .008). Attachment anxiety was not associated with any variable. Attachment avoidance may hinder the process of adaptation to breast cancer and difficulties in identifying and describing emotions may be partly responsible for this influence. Access to and ability to benefit from social and medical supports is likely to depend on being able to engage with others and recognise and process emotions effectively. Research and clinical implications are discussed.

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Section: Attachment and Emotion Processingmentioning

confidence: 99%

Section: Attachment and Emotion Processingmentioning

confidence: 99%

Attachment and adaptation to breast cancer: The mediating role of avoidant emotion processes

2018

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“…But limitations of both are already apparent. In clinical care, attachment relationships have to be asymmetric (the clinician cannot be as emotionally involved as the patient) and clinicians cannot be ‘non‐substitutable’ in the way that attachment figures in parental or romantic relationships are . Patients can feel protected by an efficient health care system and not just individual attachment figures within it .…”

Section: Limitations Of This Reviewmentioning

confidence: 99%

“…[101][102][103] There are, of course, important differences between adult and child attachments. [104][105][106] An infant can be reassured by proximity to an emotionally comforting caregiver, but adults are more likely to need evidence that a caregiver can, in fact, protect them. Adults can make use of symbolic representations of attachment figures, for example anticipating an impending meeting or knowing that they can contact the attachment figure if they need to, rather than needing physical proximity.…”

Section: Theory For a New Paradigmmentioning

confidence: 99%

“…In clinical care, attachment relationships have to be asymmetric (the clinician cannot be as emotionally involved as the patient) and clinicians cannot be 'non-substitutable' in the way that attachment figures in parental or romantic relationships are. 106 Patients can feel protected by an efficient health care system and not just individual attachment figures within it. 109 Viewing clinicians as goal directed leaves educators and researchers with considerable challenges in facilitating and changing clinicians' goals and we can only provide pointers here.…”

Section: Limitations Of This Reviewmentioning

confidence: 99%

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A new paradigm for clinical communication: critical review of literature in cancer care

Salmon

Young

2016

Med Educ

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ObjectivesTo: (i) identify key assumptions of the scientific ‘paradigm’ that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients’ own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better.MethodsA critical review, focusing on cancer care. We identified assumptions about patients’ and clinicians’ roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve.ResultsThe current paradigm constructs patients simultaneously as needy (requiring clinicians’ explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians ‘communication skills’ has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients’ vulnerability and clinicians’ goal‐directed expertise. Attachment theory provides a knowledge base to inform both research and education.ConclusionsResearchers will need to be alert to political interests that seek to mould patients into ‘consumers’, and to professional interests that seek to add explicit psychological dimensions to clinicians’ roles. New approaches to education will be needed to support clinicians’ curiosity and goal‐directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.

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When trust is threatened: Qualitative study of parents' perspectives on problematic clinical relationships in child cancer care

2017

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ObjectiveWe explored parents' accounts of the parent‐clinician relationship in childhood cancer to understand how parents who perceive threats to the relationship can be supported.MethodsMulticentre longitudinal qualitative study, with 67 UK parents of children (aged 1‐12 years) receiving treatment for acute lymphoblastic leukaemia. Analyses drew on the wider sample but focussed on 50 semistructured interviews with 20 parents and were informed by constant comparison.ResultsAll 20 parents described problems with clinical care such as inadequate information or mistakes by staff but varied in how much the problems threatened their sense of relationship with clinicians. Some parents saw the problems as having no relevance to the parent‐clinician relationship. Others saw the problems as threats to the clinical relationship but worked to “contain” the threat in ways that preserved a trusting relationship with at least one senior clinician. Parents' containment work protected the security they needed from the parent‐clinician relationship, but containment was a tenuous process for some. A few parents were unable to contain the problems at all; lacking trust in clinicians, these parents suffered considerably.ConclusionsGiven the complexity of childhood cancer care, problems with clinical care are inevitable. By engaging in containment work, parents met their needs to feel secure in the face of these problems, but the extent to which parents should have to do this work is debatable. Parents could benefit from support to seek help when problems arise which threaten their trust in clinicians. Attachment theory can guide clinicians in giving this support.

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Can patients be ‘attached’ to healthcare providers? An observational study to measure attachment phenomena in patient–provider relationships

Cited by 47 publications

References 43 publications

Attachment and adaptation to breast cancer: The mediating role of avoidant emotion processes

Attachment and adaptation to breast cancer: The mediating role of avoidant emotion processes

A new paradigm for clinical communication: critical review of literature in cancer care

When trust is threatened: Qualitative study of parents' perspectives on problematic clinical relationships in child cancer care

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