Patients' sense of relationship with breast cancer surgeons: the relative importance of surgeon and patient variability and the influence of patients' attachment style.
OBJECTIVE
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.


METHODS
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.


RESULTS
Variability in alliance was overwhelmingly at the patient level. Alliance was greater in securely than non-securely attached patients, although this influence was small.


CONCLUSIONS
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.


CONCLUSIONS
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.
Pegman
Sarah
S
Whitegate Health Centre, Blackpool, UK.
Beesley
Helen
H
Holcombe
Christopher
C
Mendick
Nicola
N
Salmon
Peter
P
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000601:surgery*; D003142:Communication; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008408:Mastectomy; D008875:Middle Aged; D009769:Object Attachment; D010358:Patient Participation; D010817:Physician-Patient Relations; D010820:Physicians; D013043:Specialties, Surgical