Do patients’ perceptions of the quality of their relationships with clinicians mediate relationships between attachment style and distress in ocular melanoma patients?

Relationships between attachment style, distress and clinical relationships in oncology settings: A systematic narrative literature review Abstract Cancer diagnosis, treatment and prognosis is challenging to patients. Coping with stress is in part an interpersonal process, and patients’ capacities to form relationships with clinicians can influence their well-being. This systematic narrative review aims to understand how patient attachment style might predict dissatisfaction with clinical relationships and distress in cancer patients, and factors that mediate or moderate the effects of attachment style on these relationships. Four databases were systematically searched for relevant empirical papers published between 1969 and 2015, yielding nine studies which were quality assessed and reviewed. A narrative approach was used to synthesise the findings. The majority of studies employed cross-sectional or prospective survey designs, and focussed on several conceptualisations of attachment and clinical relationships. Mostly cross-sectional links were identified between attachment style and poorer patient perceptions of clinical relationships and distress, but these do not allow cause to be tested. Some evidence suggested that lower trust mediated relationships between insecure attachment and distress, but stronger evidence was found that trust moderated relationships between attachment style and perceptions of clinical relationships and distress. Further research using prospective designs and testing mediation will explain the relationships between attachment style and distress and their mechanisms. Do patients’ perceptions of the quality of their relationships with clinicians mediate relationships between attachment style and distress in ocular melanoma patients? Abstract Ocular melanoma (OM) patients experience emotional and practical challenges related to diagnosis, treatment and prognostication. Relationships with medical staff are important to patients living with cancer diagnoses and patients’ perceptions of the quality of relationships with clinicians might reduce their experiences of distress. Patients’ attachment styles predict lower distress, and may influence distress because attachment may help them to achieve subjectively good relationships with clinicians. The objective of this project was to test whether links between attachment and lower distress are mediated by patients’ perceptions of the quality of their relationships with consultants and nurses. A quantitative cross-sectional study of recently diagnosed OM patients using self-report questionnaires was used to examine attachment style, perceived quality of clinical relationships, anxiety, depression and potential covariates, including coping, social support and religious beliefs. Correlational analysis showed secure attachment was negatively related to anxiety and depression and positively related to patients’ perceptions of relationship quality. Mediational analysis showed no evidence that perceptions of professional relationships was a mediator. Secure attachment and perceived quality of relationships with medical staff independently predicted anxiety and depression. Further research is warranted to understand why perceptions of relationships with medical staff are important after diagnosis and how these might be improved.