Breast Unit, Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital Trust, L7 8XP Liverpool, UK.
Gen Hosp Psychiatry. 2011 Nov-Dec;33(6):579-86. doi: 10.1016/j.genhosppsych.2011.07.007. Epub 2011 Sep 9.
In a previous report, breast cancer patients reporting a history of childhood abuse were less likely to feel fully supported in their relationships with clinical staff than were patients who did not report an abuse history. Our aims were to replicate this effect, to test whether surgeons' difficulties in these relationships mediated the relationship of abuse to patients feeling less supported, and to test whether patients' attachment style mediates the influence of abuse on patients' or surgeons' experience of the relationship.
Women with primary breast cancer (N = 100) completed self-report questionnaires around the time of surgery to assess: emotional distress; adult attachment (models of self and other); sexual, physical and emotional abuse before age 16; and childhood parental care. After consultation three weeks post-operatively patients and surgeons completed self-report questionnaires to measure, respectively, patients' perceptions of support from the surgeon, and surgeons' perceptions of difficulty in their relationship with the patient.
Patients recalling abuse were more than seven times more likely to feel incompletely supported by the surgeon than those not recalling abuse, after controlling for emotional distress. Surgeons reported greater difficulty in relationships with patients recalling abuse than with non-abused patients. Attachment (poor model of self) mediated the relationship of abuse with patient perceptions of incomplete support, but not the relationship with surgeon ratings of difficulty.
The damaging effects of childhood abuse on adult relationships extend to relationships with surgeons in cancer care. While effects of abuse on attachment can explain the damage that patients experience, mediators of the difficulty that surgeons experience need further research.
在之前的一份报告中，报告有儿童期虐待史的乳腺癌患者与临床工作人员的关系中感到得到充分支持的可能性低于没有报告虐待史的患者。我们的目的是复制这一效应，检验这些关系中外科医生的困难是否在虐待与患者感到支持不足的关系中起中介作用，以及检验患者的依恋风格是否在虐待对患者或外科医生对关系的体验的影响中起中介作用。
100 名原发性乳腺癌女性患者在手术前后完成了自我报告问卷，以评估：情绪困扰；成人依恋（自我和他人的模式）；16 岁前的性、身体和情感虐待；以及儿童期父母关怀。术后三周咨询时，患者和外科医生分别完成了自我报告问卷，以衡量患者对外科医生支持的感知，以及外科医生对与患者关系的困难程度的感知。
在控制情绪困扰后，回忆起虐待的患者感到得到外科医生不完全支持的可能性是未回忆起虐待的患者的七倍以上。回忆起虐待的外科医生报告与患者的关系更困难，而未虐待的患者则更困难。依恋（自我模式差）在虐待与患者感知的不充分支持之间起中介作用，但与外科医生评定的困难之间没有关系。
儿童期虐待对成人关系的破坏性影响延伸到癌症护理中与外科医生的关系。虽然虐待对依恋的影响可以解释患者所经历的伤害，但外科医生所经历的困难的中介因素需要进一步研究。
