title: Relationships with clinical staff after a diagnosis of breast cancer are associated with patients' experience of care and abuse in childhood.
abstract: OBJECTIVE
  Patients experiencing the crisis of the diagnosis and treatment of breast cancer need to form trusting and supportive relationships with clinical staff. However, adverse childhood experiences damage the ability to form supportive relationships as adults. We tested the prediction that women recalling childhood abuse and lack of parental care would experience poorer support from clinical staff caring for them around the time of diagnosis and surgical treatment of breast cancer.
  
  
  METHODS
  Two to 4 days after surgery, women with primary breast cancer (N=355) self-reported: childhood sexual, physical, and emotional abuse and parental care; perceived social support; support experienced from the surgeon and breast and ward nurses; and current emotional distress. Logistic regression analyses and covariance structure modeling tested the dependence of perceived professional support on childhood abuse and care and on current social support, controlling for emotional distress and age.
  
  
  RESULTS
  Women who reported feeling fully supported by clinical staff were more likely to recall no abuse and good parental care. The influence of parental care, but not abuse, was explained by its association with experiencing good social support generally, which was itself associated with feeling fully supported by clinical staff. These relationships were independent of current emotional distress.
  
  
  CONCLUSIONS
  Patients' ability to feel fully supported by clinical staff reflects not only how much support staff make available but also patients' experience of close relationships in childhood. We suggest that, whereas lack of parental care compromises adult supportive relationships in general, abuse specifically reduces support from clinical staff.
authors: Division of Clinical Psychology, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom. psalmon@liv.ac.uk
authors: Peter
authors: P
authors: Salmon
authors: Christopher
authors: C
authors: Holcombe
authors: Louise
authors: L
authors: Clark
authors: Rita
authors: R
authors: Krespi
authors: Jean
authors: J
authors: Fisher
authors: Jonathan
authors: J
authors: Hill
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D002650:Child Abuse, Sexual / Q000523:psychology*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000523:psychology; D015412:Mastectomy, Segmental / Q000523:psychology; D008875:Middle Aged; D008960:Models, Psychological; D009723:Nurse-Patient Relations; D009769:Object Attachment; D016487:Parenting / Q000523:psychology; D017060:Patient Satisfaction; D010555:Personality Inventory; D010817:Physician-Patient Relations; D012944:Social Support; D035502:Trust