Whitegate Health Centre, Blackpool, UK.
Patient Educ Couns. 2011 Apr;83(1):125-8. doi: 10.1016/j.pec.2010.04.023. Epub 2010 Jun 1.
We examined to what extent variability in breast cancer patients' sense of relationship with their surgeons was attributable to patient vs surgeon variation and we examined the role of one patient characteristic: attachment style.
Women (N=133) due to undergo surgery for breast cancer with one of six surgeons self-rated their relationship with the surgeon, using the Working Alliance Inventory, and indicated their adult attachment style (secure vs insecure). Multilevel analysis of alliance scores quantified variance components at patient and surgeon levels and tested the relationship with attachment.
Variability in alliance was overwhelmingly at the patient level. Alliance was greater in securely than non-securely attached patients, although this influence was small.
Variability in quality of clinical relationships after breast cancer diagnosis largely reflects variation between individual patients, not surgeons. Although patients' attachment style is significant, its role is modest. More influential patient characteristics need to be identified.
Breast cancer patients report a strong relationship with their surgeons. Because differences between surgeons make only a small contribution to variability in relationship, it should be a priority to identify and address the characteristics or behaviours at the level of individual patients that are associated with poorer relationships.
我们考察了乳腺癌患者与外科医生关系感的变异性在多大程度上归因于患者与外科医生的差异，并考察了患者特征之一：依恋风格的作用。
即将接受乳腺癌手术的女性（N=133）使用工作联盟量表（Working Alliance Inventory）对自己与外科医生的关系进行自评，并表示其成人依恋风格（安全型与不安全型）。对联盟评分的多层次分析量化了患者和外科医生层面的方差分量，并检验了与依恋的关系。
联盟的变异性主要在患者层面。与不安全型依恋的患者相比，安全型依恋的患者的联盟更强，尽管这种影响很小。
乳腺癌诊断后临床关系质量的变异性主要反映了个体患者之间的差异，而不是外科医生。尽管患者的依恋风格很重要，但它的作用是有限的。需要确定更具影响力的患者特征。
乳腺癌患者报告与外科医生关系密切。由于外科医生之间的差异对关系的变异性只有很小的贡献，因此应优先确定和解决与较差关系相关的个别患者的特征或行为。
