Brenk-Franz Katja, Strauß Bernhard, Tiesler Fabian, Fleischhauer Christian, Schneider Nico, Gensichen Jochen
Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany.
Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany.
J Psychosom Res. 2017 Jun;97:131-135. doi: 10.1016/j.jpsychores.2017.04.007. Epub 2017 Apr 19.
The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases.
209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management.
The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence.
A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients.
依恋理论的概念模型已被应用于理解患者在医疗护理中的易感性以及医患关系。在慢性病患者中，不安全依恋与较差的自我管理相关。医患关系与一系列健康相关结果和自我管理技能有关。我们确定了医患关系的质量是否在患有多种慢性病的初级护理患者的成人依恋与自我管理之间的联系中起中介作用。
APRICARE队列研究纳入了来自八个全科诊所的209名年龄在50至85岁之间、患有至少三种慢性病（包括II型糖尿病、高血压和至少一种其他慢性病）的患者。通过自我报告（ECR-RD）测量成人依恋，通过FERUS测量自我管理技能，通过PRA-D测量医患关系。健康状况和慢性病情况由全科医生评估。使用多重中介分析来检验医患关系的各个方面（沟通、信息、情感）是否是成人依恋与自我管理之间关联的中介因素。
分析表明，医患关系的质量在患有多种慢性病的患者中中介了依恋对自我管理的影响。特别是治疗过程中的沟通和信息质量具有显著的中介影响。
一种个性化的、与依恋相关的方法，促进医患之间积极的沟通并向患者提供有关治疗的信息，可能会提高患者的自我管理技能。
