title: The association between the strength of the working alliance and sharing concerns by advanced cancer patients: a pilot study.
abstract: OBJECTIVE
  A strong therapeutic alliance between cancer patients and medical staff is associated with treatment adherence, better health outcomes, and an emotional acceptance of a terminal illness. Given its significant role, the current study investigated the association between the working alliance and sharing concerns by advanced cancer patients.
  
  
  METHODS
  Advanced cancer patients completed the Working Alliance Inventory-Short Revised and a checklist of topics in which they rated their degree of concern about the topics and the degree of sharing them with their physician/nurse.
  
  
  RESULTS
  Fifty-two patients completed the study. The working alliance was found to be strong with respect to treating physicians and nurses. The four topics that concerned patients the most were family coping with their illness (81%), fear of future suffering (71%), symptom control (67%), and the oncological treatment (65%). Patients with a strong working alliance with their physician shared to a higher extent the personal and main concern regarding their family's coping, and a significant correlation was found between them (r = 0.53, p < .01). In addition, sharing fears of future suffering was also correlated with a strong working alliance with the physician (r = 0.28, p < .05). A strong working alliance with the nurse was correlated with discussing symptoms control (r = 0.30, p < .05).
  
  
  CONCLUSIONS
  These findings provide preliminary support for an association between the strength of the working alliance and the type of concerns that advanced cancer patients choose to discuss with their medical staff and highlight the importance of follow-up studies to further explore this association.
authors.affiliation: Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. g_barsela@rambam.health.gov.il.|Division of Oncology, Rambam Health Care Campus, POB 9602, Haifa, 31096, Israel. g_barsela@rambam.health.gov.il.
authors.forename: Gil
authors.initials: G
authors.lastname: Bar-Sela
authors.affiliation: Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Sivan
authors.initials: S
authors.lastname: Yochpaz
authors.affiliation: Department of Psychology, University of Haifa, Haifa, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gruber
authors.affiliation: Division of Oncology, Rambam Health Care Campus, POB 9602, Haifa, 31096, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Lulav-Grinwald
authors.affiliation: Division of Oncology, Rambam Health Care Campus, POB 9602, Haifa, 31096, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Mitnik
authors.affiliation: Department of Psychology, University of Haifa, Haifa, Israel.|Division of Psychiatry, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Koren
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D057189:Checklist; D003299:Cooperative Behavior; D004644:Emotions; D005190:Family; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D010865:Pilot Projects
keywords: Cancer; Oncology; Patient-medical staff interaction; Sharing concerns; Working alliance