The physical and mental well-being of people with cancer may be affected by how they feel about their relationship with their physician and by differences in attachment styles (how they rely and depend on others), finds a new study from General Hospital Psychiatry.
Patients who feel anxious and uneasy with their doctor may be impacted the most. "Anxiously attached patients may experience and report more physical and emotional problems when the relationship with their physician is perceived as less trusting," said Chris Hinnen, Ph.D., lead author and clinical psychologist at Slotervaart Hospital in Amsterdam, The Netherlands.
The researchers acknowledge that the issue of trust between patients and their doctors can be complicated, but observe that it's important to understand fears of rejection and abandonment that often exist in anxiously attached patients.
Hinnen and his colleagues analyzed questionnaire responses from 119 participants with breast, cervical, intestinal or prostate cancers at 3, 9 and 15 months after their diagnosis. Seventy-one percent of those surveyed were female and had an average age of 59 years old. Researchers used a shortened version of the Wake Forest Physician Trust Scale and the Revised Experiences in Close Relationships scale to determine 1) participants' trust in the physician most involved in treatment and 2) participants' attachment anxiety or avoidance at the 3 month mark and assessed their distress and physical limitations at three sequential time intervals. Lower levels of trust were associated with more distress at all periods and more physical limitations at three and nine months for anxiously-attached patients.
"In some people, early childhood experiences coupled with constitutional factors have led to an exaggerated desire for closeness and intimacy together with a high fear of rejection and abandonment," Hinnen noted. "Consequently, the feeling of not being able to rely on one's physician may be especially frightening and stressful for anxiously attached patients." People with less attachment anxiety may have better ways of coping with a less trusting physician relationship.
Michelle B. Riba, M.D., professor and associate chair for Integrated Medical and Psychiatric Services at the University of Michigan, noted doctor-patient relationships are very important, especially when the patient is confronted with cancer. "However, this study was not free from bias because it was primarily comprised of women who liked their doctors, and these women were already in a personal relationship which portended an attachment to a relationship with their physician."
Riba also noted the three-month time line when cancer patients in the study were asked about doctor-patient trust levels. "The problem is at three-months patients may be seeing a variety of physicians such as a surgeon, oncologist, medical oncologist or radiologist, not just one doctor," she said.
The study notes that it is important to take into account the fact that some patients don't feel connected to their doctor. These patients may be more at risk for emotional and physical adjustment problems associated with cancer diagnosis and treatment.
Riba added, "As physicians we try to place patients with doctors that match a patient's style, but that doesn't always happen. Instead, patients may move and look for other relationships on their own."
"Since the patient-physician relationship has such an impact on patient well-being," Hinnen said, "especially for those who are most vulnerable, limiting free choice of a [cancer] physician seems foolish."
- Chris Hinnen, Grieteke Pool, Nynke Holwerda, Mirjam Sprangers, Robbert Sanderman, Mariet Hagedoorn. Lower levels of trust in one's physician is associated with more distress over time in more anxiously attached individuals with cancer. General Hospital Psychiatry, 2014; 36 (4): 382 DOI: 10.1016/j.genhosppsych.2014.03.005
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