title: Do childhood experiences and insecure attachment style in women with gynaecological cancer affect trust in care?
Creators: name: Larham, Bethany
Publisher: name: University of Liverpool Repository
Year: 2014

description: This volume presents the research carried out in partial fulfilment of the Doctorate in Clinical Psychology at the University of Liverpool. It contains three papers, addressing the area of cancer patients‘ trust in care. In times of distress, patients engaged in a course of psychological therapy wish to feel safe, contained and to trust that the clinician is working in their best interests. The same holds true in a medical setting, where being diagnosed with a life-threatening illness such as cancer evokes feelings of vulnerability, helplessness and intense fear. Clinicians can be viewed as attachment figures in this time of stress, being the cancer patient‘s main hope for creating safety in the face of threat. Whilst a relationship with the clinician characterised by trust is beneficial at this time, unfortunately not all patients experience the relationship in this way. Before we can suggest means to improve cancer patients‘ sense of trust in the clinician, we need to understand the factors which prevent patients from developing trust in their clinician. Unlike the field of psychotherapy, where patient factors influencing the relationship with the therapist have been extensively researched, the medical field has focused its efforts on attempting to highlight the contribution of the clinician. This thesis aims to address this current dearth of literature, and focus on patient factors which could impede them from having trust in cancer care. Paper 1: Literature review The review paper provides the backdrop for the research. A specific sub-section of the background literature that informed the development of the research is considered here. A general review of current knowledge relating to all aspects of cancer patients‘ experiences highlighted an area of relative dearth in research. From this, a specific research question was developed: what is the role of patients‘ experiences in trust in cancer care? A focussed literature review was conducted in response to this pre-determined question, investigating whether patient factors of trauma, abuse and attachment style shape patients‘ trust in cancer care. The review adopted a structured approach to interrogating the evidence base, and the search terms and eligibility criteria for inclusion of papers are outlined. This section presents the identified papers, comparing and contrasting aims, design, methodology and findings, and explores the key themes that arose. The collective limitations, inconsistencies and gaps in this literature base are explored, and future directions to address these points are suggested. The review paper presents a picture of the current knowledge in this area, enabling the reader to locate the research study in its broader context. Paper 2: Empirical paper Building upon paper one, the second paper describes the main features of the research study, presented according to author guidelines set out for the journal Psycho-Oncology (Appendix A). Whilst a trusting patient/clinician relationship is repeatedly highlighted as important in healthcare, there is a tendency in the research to neglect the patient‘s contribution to this interaction. Attempts to identify individual patient factors that contribute to the sense of clinical relationship are dwarfed by extensive research focussing upon the clinician‘s competence, skill, communication and interpersonal style. The little research that has been carried out in this area has predominantly sampled women with breast cancer, leaving unexplored questions about the generalisability to other populations. In an attempt to redress balance, this research investigated patient factors which affect trust in the clinician, in a sample of gynaecological cancer survivors. The process of developing and conducting the study took two and a half years, whilst recruitment commenced after ethical approval was sought, and spanned 52 weeks. The key features of the study are outlined in this section. Paper 3: Concluding discussion The third section draws out the main findings of the research, and discusses the wider relevance. Further attention is given to the relative strengths and weaknesses of the study, and the study‘s applicability to clinical practice is considered. A short lay summary is presented, which was written for dissemination of the research to the participants who had requested feedback. This discusses the key contributions of the research to the literature base, and states what will be done with the findings. Finally, a research proposal describing a possible follow up study is outlined, taking into account the limitations of this research and considering how it can be extended. This concludes the thesis.