title: Critical incidents reveal how patients with head and neck cancer construct their "secure base" as a "helping system".
abstract: Most studies of the psychosocial needs of patients with head and neck cancers (HNC) use predefined categories and explicitly ask for specified needs. These studies are important but should be complemented with inductive studies based on patients' own descriptions of experiences. This qualitative study is such a contribution. In repeated interviews positive and negative incidents were collected from 137 patients with HNC, and these experiences were categorized in dimensions expressing needs. A core category--"being included--neglected by a helping system"--emerged from the narrated incidents and was based on the dimensions engagement, competence, and information. The findings are easily related to attachment theory by stressing the significance of establishing trustful relationships with the health care staff, as attachment figures, who respond flexibly and sensitively to the patient's needs. In the constitution of health care as a helping system, all encounters between the patient and health care staff matters. Further research should preferably focus on the creation of guidelines for the constitution of health care as a helping system, that is, how the found factors of a helping system can be operationalized in clinical practice.
authors.affiliation: a Department of Social Work , Umeå University , Umeå , Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Isaksson
authors.forename: Pär
authors.initials: P
authors.lastname: Salander
authors.forename: Brith
authors.initials: B
authors.lastname: Granström
authors.forename: Göran
authors.initials: G
authors.lastname: Laurell
mesh_terms: D000368:Aged; D001294:Attitude to Health; D005260:Female; D006258:Head and Neck Neoplasms / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D033262:Narration; D020380:Needs Assessment; D009769:Object Attachment; D010361:Patients / Q000523:psychology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D011582:Psychological Theory; D036301:Qualitative Research; D035502:Trust
keywords: attachment theory; critical incidents; head and neck cancer; patient-perspective; psychosocial needs