School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Psychooncology. 2021 Jul;30(7):1086-1094. doi: 10.1002/pon.5648. Epub 2021 Mar 8.
Patient-oncologist therapeutic alliance is a foundation of quality cancer care, although there is limited research demonstrating its relationship with patient outcomes. We investigated the relationship between therapeutic alliance and patient quality of life with a secondary goal of determining whether the association varied by patients' baseline level of psychological distress.
Cross-sectional analysis of baseline data from a randomized clinical trial of 672 patients with advanced cancer participating in a primary palliative care intervention trial. Patients completed baseline self-reported measures of therapeutic alliance (The Human Connection Scale, range: 16-64), overall quality of life (Functional Assessment of Cancer Therapy-Palliative Care, range: 0-184), and psychological distress (Hospital Anxiety and Depression Scale, range: 0-42). First, we determined the relationship between therapeutic alliance and quality of life using multivariable regression adjusting for confounders. We then examined if psychological distress was an effect modifier in this relationship by adding interaction effects of depression and anxiety symptoms on therapeutic alliance into the regression model.
Patients reported high levels of therapeutic alliance (56.4 ± 7.4) and moderate quality of life (130.3 ± 25.5). Stronger therapeutic alliance was associated with better quality of life after adjusting for other confounding factors (β = 3.7, 95% confidence interval = 2.1, 5.3, p < 0.01). The relationship between therapeutic alliance and quality of life was generally consistent regardless of psychological distress.
Collaborative, trusting relationships between patients with advanced cancer and their oncologists are associated with better patient quality of life. Future research should investigate the causal, longitudinal nature of these relationships.
医患治疗联盟是高质量癌症护理的基础，尽管有有限的研究表明其与患者结局之间存在关联。我们调查了治疗联盟与患者生活质量之间的关系，并确定这种关联是否因患者基线心理困扰水平的不同而有所不同。
对参加初级姑息治疗干预试验的 672 名晚期癌症患者的随机临床试验的基线数据进行横断面分析。患者完成了基线自我报告的治疗联盟量表（人际联系量表，范围：16-64）、总体生活质量（癌症治疗-姑息治疗功能评估量表，范围：0-184）和心理困扰（医院焦虑抑郁量表，范围：0-42）。首先，我们通过调整混杂因素的多变量回归来确定治疗联盟与生活质量之间的关系。然后，我们通过将抑郁和焦虑症状对治疗联盟的交互效应加入回归模型，检查心理困扰是否是这种关系的效应修饰因子。
患者报告了较高的治疗联盟水平（56.4±7.4）和中等水平的生活质量（130.3±25.5）。在调整了其他混杂因素后，较强的治疗联盟与更好的生活质量相关（β=3.7，95%置信区间=2.1，5.3，p<0.01）。无论心理困扰如何，治疗联盟与生活质量之间的关系总体上是一致的。
晚期癌症患者与其肿瘤医生之间的协作、信任关系与患者的生活质量有关。未来的研究应该调查这些关系的因果和纵向性质。
