title: The intensity of breast cancer patients' relationships with their surgeons after the first meeting: Evidence that relationships are not 'built' but arise from attachment processes.
abstract: BACKGROUND
  Cancer clinicians are exhorted to build clinical relationships with their patients over time using patient-centred communication skills. An alternative view is that patients' sense of relationship is a response to clinicians' expertise and authority and therefore is normally present from the start.
  
  
  OBJECTIVE
  We measured the intensity of breast cancer patients' sense of relationship with their surgeon after their first brief, diagnostically focused meeting in order to compare it with published reports from patients in other types and stages of clinical relationship.
  
  
  METHODS
  Women (N = 133) over 18 years old and due to undergo surgery for primary breast cancer were recruited consecutively from pre-operative clinics.
  
  
  METHODS
  Patients reported the intensity of their relationship with the surgeon on a standardised questionnaire (Working Alliance Inventory). We compared their ratings with published reports over the last 15 years, in which patients in other types of clinical relationship completed the same questionnaire.
  
  
  RESULTS
  Patients' alliance with their surgeons was very high (mean 6.13, 95% CI: 5.99, 6.27, on a 1-7 scale), and at 90(th) percentile when compared with scores from other settings, including those characterized by many hours of talk addressing patients' emotional needs.
  
  
  CONCLUSIONS
  Patients with breast cancer feel an intense sense of relationship with the surgeon from the first meeting, consistent with the view that their sense of relationship arises primarily from their recognition of the surgeon's expertise and authority. The challenge for surgeons is therefore not usually to 'build a relationship' but to support the sense of relationship that patients have from the start.
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK; Liverpool Cancer Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. Electronic address: h.c.beesley@liv.ac.uk.
authors.forename: H
authors.initials: H
authors.lastname: Beesley
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK.
authors.forename: S
authors.initials: S
authors.lastname: Goodfellow
authors.affiliation: Breast Unit, Linda McCartney Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
authors.forename: C
authors.initials: C
authors.lastname: Holcombe
authors.affiliation: Division of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, UK.
authors.forename: P
authors.initials: P
authors.lastname: Salmon
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: Breast cancer; Patient doctor relationship; Working alliance