title: The lasting impact of the therapeutic alliance: Patient-oncologist alliance as a predictor of caregiver bereavement adjustment.
abstract: BACKGROUND
  Caregivers of patients with advanced cancer provide extensive care and experience high levels of psychosocial distress. The patient-oncologist therapeutic alliance may be a modifiable factor that can prevent or reduce negative caregiver outcomes.
  
  
  METHODS
  Coping with Cancer (CwC) was a prospective, longitudinal, multisite cohort study of terminally ill cancer patients (life expectancy ≤6 months) and their informal caregivers, who were followed into bereavement (n = 68). Trained raters interviewed patients and caregivers upon study entry and also interviewed caregivers 6 months after the patient's death. Patients answered quantitative questions assessing their perception of the patient-oncologist therapeutic alliance (The Human Connection scale), and caregivers completed a measure of health-related quality of life (Medical Outcomes Study Short Form-36). Interviewers rated caregivers' level of emotional well being. Associations between therapeutic alliance and caregiver outcomes were analyzed using univariate analysis of variance and logistic regression analyses, controlling for baseline caregiver measures and confounding sample characteristics.
  
  
  RESULTS
  A strong patient-oncologist therapeutic alliance was bivariately associated with caregiver self-report of less role limitation because of emotional problems, better social function and mental and general health-related quality of life, and better interviewer-rated emotional well being after the patient's death. After controlling for baseline measures and confounding sample characteristics, the correlation between patient-perceived therapeutic alliance and bereaved caregivers' mental health and interviewer ratings of bereaved caregivers' emotional well being remained significant.
  
  
  CONCLUSIONS
  The influence of the patient-oncologist alliance may generalize beyond the patient to positively impact the caregiver. By developing a strong relationship with the patient, the oncologist may benefit the caregiver and the patient. This caregiver benefit may extend into bereavement.
authors.affiliation: Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York.|Department of Medicine, New York Presbyterian Hospital, New York, New York.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Trevino
authors.affiliation: Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York.|Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Epstein
authors.affiliation: Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, New York.|Department of Medicine, New York Presbyterian Hospital, New York, New York.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010817:Physician-Patient Relations / Q000941:ethics*; D011446:Prospective Studies
keywords: bereavement; caregivers; mental health; neoplasms; physician-patient relationship