Ciechanowski Paul, Katon Wayne J
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, 1959 NE Pacific, Seattle, WA 98195-6560, USA.
Soc Sci Med. 2006 Dec;63(12):3067-79. doi: 10.1016/j.socscimed.2006.08.002. Epub 2006 Sep 25.
Patients with chronic illness often face challenges navigating the US health care system because of the system's lack of coordination and continuity. Patients with more difficulty relying on others and with reluctance in engaging frequently or in-depth with providers, face even greater challenges obtaining optimal health care in this system. Using a self-report measure of attachment style, we selected patients with varying degrees of comfort and trust in relationships. We conducted qualitative semi-structured interviews with a purposive sample of 27 patients with type 2 diabetes attending the University of Washington Diabetes Care Center in Seattle to explore issues of trust and collaboration in the health care setting. We used a constant comparative approach in which contemporaneous data collection and analysis took place. A subset of patients with fearful and dismissing attachment style reported having low levels of trust and an inability to collaborate with others of longstanding duration. Many aspects of the current health care system, such as its rushed, impersonal nature and a perceived "wall" between providers and patients were frustrating for most study patients. Patients with fearful and dismissing attachment style reported that these aspects of the health care system often interfered with their ability to partner with providers but also reported that patient-centered attitudes and behaviors by providers could improve their trust and ability to engage in the health care system. Implications of using a conceptual model of attachment theory to improve patient-centered care and customer service are discussed.
慢性病患者在应对美国医疗保健系统时常常面临挑战，因为该系统缺乏协调性和连续性。那些在依靠他人方面更困难、且不愿频繁或深入与医疗服务提供者接触的患者，在这个系统中获得最佳医疗保健面临着更大的挑战。我们使用一种自我报告的依恋风格测量方法，挑选了在人际关系中具有不同程度舒适度和信任度的患者。我们对西雅图华盛顿大学糖尿病护理中心的27名2型糖尿病患者进行了定性半结构化访谈，这些患者是经过有目的抽样选取的，以探讨医疗保健环境中的信任与协作问题。我们采用了同步进行数据收集和分析的持续比较法。一部分具有恐惧型和疏离型依恋风格的患者报告称信任程度较低，且长期无法与他人协作。当前医疗保健系统的许多方面，比如其匆忙、缺乏人情味的特点以及医患之间存在的一种“隔阂”感，让大多数研究患者感到沮丧。具有恐惧型和疏离型依恋风格的患者报告称，医疗保健系统的这些方面常常妨碍他们与医疗服务提供者合作，但也表示医疗服务提供者以患者为中心的态度和行为能够增进他们对医疗保健系统的信任以及参与度。本文讨论了运用依恋理论概念模型来改善以患者为中心的护理和客户服务的意义。
