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Favez N, Antonini T, Delaloye JF, Notari SC. From breast cancer surgery to survivorship: Insecure attachment tendencies predict negative psychological outcomes. Health Psychol Open 2021; 8:2055102920987463. [PMID: 33598303 PMCID: PMC7863168 DOI: 10.1177/2055102920987463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Little is known about the variables explaining individual variability in the long-term adaptation of breast cancer survivors. Attachment tendencies have, however, been shown to explain negative psychological outcomes in the postsurgical period. The present study aimed to assess the continuing influence of attachment tendencies in the survivorship period. A sample of 28 women were surveyed 2 weeks, 3 months, 12 months, and 5 to 7 years after surgery. Attachment tendencies and psychological outcomes (distress, body image, sexuality) were assessed through questionnaires, and medical and sociodemographic data collected. Results show that insecure attachment tendencies predict negative body image and elevated distress.
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Hossain MS, Khan MJ, Yahya SB. Developing an occupational health service for health professionals: Management challenges. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1731176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Md Shamim Hossain
- Department of Management Studies, University of Rajshahi, Rajshahi, Bangladesh
| | - Mohammad Jamal Khan
- College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Sofri B. Yahya
- Graduate School of Business, Universiti Sains Malaysia, Penang, Malaysia
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Fyvie C, Easton P, Moreton G, McKeever J, Karatzias T. The Rivers Centre in Scotland: An Attachment-Based Service Model for People With Complex Posttraumatic Stress Disorder. J Trauma Stress 2019; 32:864-869. [PMID: 31730228 DOI: 10.1002/jts.22458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/02/2019] [Accepted: 09/07/2019] [Indexed: 11/09/2022]
Abstract
The Rivers Centre in Edinburgh, Scotland (United Kingdom) operated for nearly 20 years as a traditional specialist trauma service, delivering psychological therapies to an adult population affected by trauma. Embedded in a health and social care system whose characteristics were unhelpful for people with histories of insecure attachment experiences, the Rivers Centre aimed to find a different way of working, and in January 2017, it relaunched with a new model of service. The aim of this paper is to describe the new service model from an organizational perspective in the context of attachment theory. At the heart of the model is the premise that to be effective, a trauma service needs to provide people with an alternative model of attachment. Early signs from service audit data indicate that an attachment-based way of working can improve engagement and can provide a supportive and responsive environment in which people can learn to recover.
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Affiliation(s)
- Claire Fyvie
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom
| | - Paula Easton
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom
| | - Gill Moreton
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom
| | - Jenny McKeever
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom
| | - Thanos Karatzias
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, United Kingdom.,Edinburgh Napier University, School of Health & Social Care, Edinburgh, United Kingdom
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Guillemeney J, Clary B, Labadie-Fobis A, Oude Engberink A, Pavageau S. La théorie de l’attachement est une ressource pour la relation médecin-patient : méta-synthèse qualitative. ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2018.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wlodarczyk J, Lawn S, Powell K, Crawford GB, McMahon J, Burke J, Woodforde L, Kent M, Howell C, Litt J. Exploring General Practitioners' Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2763. [PMID: 30563256 PMCID: PMC6313450 DOI: 10.3390/ijerph15122763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/17/2022]
Abstract
The prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP⁻Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the quality of care that GPs provide, which is dependent on GPs' capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs' attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD.
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Affiliation(s)
- Julian Wlodarczyk
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
- Flinders Human Behaviour and Health Research Unit, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
| | - Kathryn Powell
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, Australia.
| | - Gregory B Crawford
- North Adelaide Palliative Care Service, Discipline of Medicine, University of Adelaide, Adelaide 5000, Australia.
| | - Janne McMahon
- Private Mental Health Consumer Carer Network (Australia) Ltd., PO Box 542, Marden 5070, Australia.
| | - Judy Burke
- Sanctuary BPD Carer Support, Adelaide 5001, Australia.
| | - Lyn Woodforde
- Carers SA, 338 Tapleys Hill Rd, Seaton 5023, Australia.
| | - Martha Kent
- Borderline Personality Disorder Centre of Excellence, Country Health SA Mental Health Services, 22 King William St, Adelaide 5000, Australia.
| | - Cate Howell
- Cate Howell, Cate Howell and Colleagues, 14 Hay St, Goolwa 5214, Australia.
| | - John Litt
- Department of General Practice, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, Australia.
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Two is a perfect number: Patient–doctor relationship and patient attachment style in palliative care. J Health Psychol 2017; 24:549-560. [DOI: 10.1177/1359105317721307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We tested the association between the palliative patient’s attachment style and the patient–doctor relationship, by means of Revised Adult Attachment Scale and a self-designed, patient–doctor relationship questionnaire. The study included 110 (52 M, 58 F) cancer, hospice patients, aged 36–80 years. We observed 54 percent of secure, 18 percent of dismissive, 9 percent of preoccupied, and 19 percent of fearful styles. Securely attached patients developed significantly ( p < .05) better relationships with doctors than insecure patients. There was no difference in the quality of the patient–doctor relationship among dismissive versus preoccupied versus fearful patients. We argue that attachment theory should be applied in palliative care to improve patients’ quality of life and dying.
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Cliff C, McGraw C. The conduct and process of mental capacity assessments in home health care settings. Br J Community Nurs 2016; 21:570-577. [PMID: 27809588 DOI: 10.12968/bjcn.2016.21.11.570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The assessment of capacity to consent to treatment is key to shared practitioner-patient decision-making. It is the responsibility of the person closest to the decision being made to carry out the assessment. The aim was to examine the factors that influence mental capacity assessments in home health care settings and identify the facilitators and inhibitors to the conduct and process of assessments as perceived and experienced by non-medical health practitioners providing generalist community services. Semi-structured interviews with a purposive sample of community nurses, community physiotherapists and community occupational therapists in one NHS Trust in London. Data were analysed thematically. The main themes were issues relating to: intrinsic patient factors and behaviours; recognising, managing and utilising the influence of the family; practitioner motivation and competence; working together as a team to optimise shared decision making, and; the importance of place. While some issues appear germane to both hospital and home health care settings, others are unique to - or manifest very differently in - home health care settings. The findings suggest that the influence of family members, long-term practitioner-patient relationships and physical distance from co-workers make the conduct and process of mental capacity assessments in home health care settings an inherently complex endeavour.
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Affiliation(s)
- Charlotte Cliff
- Senior Nurse Practitioner, Guys and St Thomas' NHS Foundation Trust
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Depression, patient characteristics, and attachment style: correlates and mediators of medication treatment adherence in a racially diverse primary care sample. Prim Health Care Res Dev 2015; 17:184-97. [DOI: 10.1017/s1463423615000365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BackgroundThe depth and breadth of problems related to depressive symptomatology and optimal treatment outcomes, including medication treatment adherence, have long been documented in the literature. Missing are clear explanations as to what factors and patient characteristics may account for lack of medication treatment adherence.ObjectivesThe two objectives of the current study were to examine the predictive strength of depression, patient characteristics, and patient attachment style regarding medication treatment adherence and to consider the extent to which attachment styles mediate the relation between depression and medication treatment adherence.MethodParticipants in the present study were 237 racially diverse American primary care patients with a diagnosis of hypertension who were participants in a clinical trial. Depression, patient characteristics, attachment style, and medication treatment adherence were assessed.ResultsPartly consistent with our four hypotheses, the following results were found: (a) Black American, younger, never married, and poorer patients had lower medication treatment adherence (b) depression was significantly associated with lower self-reported medication adherence; (c) insecure–dismissing attachment style was related to lower medication adherence; and (d) insecure–dismissing attachment style mediates the relation between depression and medication treatment adherence by exacerbating the negative association.ConclusionPhysicians and other primary care providers should consider how depressive symptomatology, patient characteristics, and attachment style may inform the treatment plans they put forward and the extent to which patients may adhere to those treatment plans.
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A qualitative exploration of the recovery experiences of consumers who had undertaken shared management, person-centred and self-directed services. Int J Ment Health Syst 2014. [DOI: 10.1186/1752-4458-8-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Peterson S, Buchanan A, Falkmer T. The impact of services that offer individualised funds, shared management, person-centred relationships, and self-direction on the lived experiences of consumers with mental illness. Int J Ment Health Syst 2014; 8:20. [PMID: 24944564 PMCID: PMC4061914 DOI: 10.1186/1752-4458-8-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health service providers across Australia, including Western Australia (WA), have begun to offer individualised funds, shared management, person-centred and self-directed (SPS) services. No research exists on the impact of SPS services on the lived experiences of these particular consumers. This study explored the impact of a SPS service offered for the first time in WA to consumers with mental illness. METHODS Data on sixteen consumers' lived experiences were analysed using an abbreviated grounded theory approach. These data had been developed by the consumers, Guides (staff) and an independent evaluator, and most of it had been collected in the past prior to the commencement of the study. RESULTS Three over-arching categories, and related subcategories, emerged indicating that 1) access to individualised funds enabled practical and psychological benefits to consumers; 2) consistent contact in shared management and person-centred relationships enhanced the provision of timely and meaningful staff support to consumers; and 3) high quality shared management and person-centred relationships with staff and the opportunity to self-direct enabled consumers' change and growth. CONCLUSIONS SPS services enhanced consumers' lived experiences and enabled staff to provide and consumers to experience timely access to recovery resources, consistent contact, responsive and high quality support, and self-direction of services. In this, consumers changed, grew and achieved desired recovery experiences. The overall impact of the SPS service seemed to be founded on the goodness of fit between person characteristics of staff and consumers, which enabled rich support that provided for corrective emotional experiences. This enabled consumers to build meaningful and hopeful lives where they started to live with, and beyond, their mental illness.
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Affiliation(s)
- Sunila Peterson
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Angus Buchanan
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Torbjorn Falkmer
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Department of Medicine and Health Sciences (IMH), Rehabilitation Medicine, Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, UHL, County Council, Linköping, Sweden
- School of Occupational Therapy, La Trobe University, Melbourne, Vic, Australia
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Nunes J, Ventura T, Encarnação R, Pinto PR, Santos I. What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study. MENTAL HEALTH IN FAMILY MEDICINE 2013; 10:67-79. [PMID: 24427173 PMCID: PMC3822638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/01/2013] [Indexed: 06/03/2023]
Abstract
Context Medically unexplained physical symptoms (MUPS) are frequently encountered in family medicine, and lead to disability, discomfort, medicalisation, iatrogenesis and economic costs. They cause professionals to feel insecure and frustrated and patients to feel dissatisfied and misunderstood. Doctors seek answers for rather than with the patient. Objectives This study aimed to explore patients' explanations of the medically unexplained physical symptoms that they were experiencing by eliciting their own explanations for their complaints, their associated fears, their expectations of the consultation, changes in their ideas of causality, and the therapeutic approach that they considered would be useful. Methodology A qualitative analysis was under-taken of interviews with 15 patients with MUPS in a family medicine unit, 6 months after diagnosis. Results Experience is crucial in construction of the meaning of symptoms and illness behaviour. Many patients identify psychosocial causes under-lying their suffering. These patients received more medication and fewer requests for diagnostic examinations than they had expected. Normalisation is a common behaviour in the clinical approach. Normalisation without explanation can be effective if an effective therapeutic relationship exists that may dispense with the need for words. Listening is the procedure most valued by patients. Diagnostic tests may denote interest in patients' problems. The clinician's flexibility should allow adaptation to the patient's phases of acceptance of the significance of their physical, emotional and social problems. Conclusion Patients with MUPS have explanations and fears associated with their complaints. The patient comes to the consultation not because of the symptom, but because of what he or she thinks about the symptom. The therapeutic relationship, therapeutic listening, and flexibility should be the basis for approaching patients with MUPS. Patients do not always expect medication, although it is what they most often receive. Diagnostic tests, although used sparingly, can be a way to maintain and build a relationship. Drugs and tests can be a ritual statement of clinical interest in the patient and their symptoms.
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Affiliation(s)
- José Nunes
- Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Teresa Ventura
- Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Ricardo Encarnação
- Department of Mental Health, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Patrícia Rosado Pinto
- Head of Medical Education Department, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
| | - Isabel Santos
- Department of Family Medicine, Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
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Hooper LM, Tomek S, Newman CR. Using attachment theory in medical settings: Implications for primary care physicians. J Ment Health 2011; 21:23-37. [DOI: 10.3109/09638237.2011.613955] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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