Abstract
Background
We sought to characterize surgeon perceptions of patient attachment-related behaviors relative to patient-centered approaches during treatment decision-making within the clinical encounter.
Methods
An online survey including clinical vignettes was sent to board-certified surgeons to assess their approach to patient-centered treatment decision-making. Within these vignettes, patient behaviors associated with attachment styles (secure vs 3 insecure subtypes: avoidant, anxious, and fearful) were fixed and patient factors (age, race, occupation, and gender) were randomized. Analysis included repeated measures mixed-effects linear regression.
Results
Among the 208 respondents, the majority were male (65.4%) and White/Caucasian (84.5%) with an average age of 51.6 years (SD = 9.9). Most surgeons had been in practice for more than 10 years (66.8%) and treated adult patients (77.4%). Surgical specializations included breast (27.2%), HPB (35.0%), and broad-based/general (21.8%). Patient race, age, and gender did not impact surgeons’ patient-centered approach to treatment decision-making (all ps > 0.05). However, when the “patient” had a white collar occupation and were securely attached, surgeons reported a greater likeliness to spend equal time presenting all treatment options (p = 0.02 and p < 0.001, respectively) and believe the patient wanted an active role in decision-making (p = 0.01 and p < 0.001, respectively). Surgeons reported being least likely to agree with a patient’s treatment decision (p < 0.001) and an increased likelihood of being directive (p = 0.002) when patients exhibited behaviors associated with avoidant attachment.
Conclusion
Attachment-related behaviors were associated with differences in surgeon approaches to patient-centered decision-making. Attachment styles may offer a framework for providers to understand patient behaviors and needs, thereby providing insight on how to tailor their approach and provide optimal patient-centered care.
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References
Cancer Treatment Surgery | MD Anderson Cancer Center. https://www.mdanderson.org/treatment-options/surgery.html. Accessed July 30, 2018.
Sepucha KR, Fowler FJ, Mulley AG. Policy Support For Patient-Centered Care: The Need For Measurable Improvements In Decision Quality Documenting gaps in patients’ knowledge could stimulate rapid change, moving decisions and care closer to a patient-centered ideal. Heal Affiars. 2004;23. doi:https://doi.org/10.1377/hlthaff.var.54
Braddock C, Hudak PL, Feldman JJ, et al. "Surgery is certainly one good option": quality and time-efficiency of informed decision-making in surgery. J Bone Joint Surg Am. 2008;90(9):1830-1838. doi:https://doi.org/10.2106/JBJS.G.00840
Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. Patient-physician concordance: Preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol. 2004;22(15):3091-3098. doi:https://doi.org/10.1200/JCO.2004.09.069
Agha AZ, Werner RM, Keddem S, Huseman TL, Long JA, Shea JA. Improving Patient-centered Care: How Clinical Staff Overcome Barriers to Patient Engagement at the VHA. Med Care. 2018;56(12):1009-1017. doi:https://doi.org/10.1097/MLR.0000000000001007
Palmer Kelly E, Tsilimigras DI, Hyer JM, Pawlik TM. Understanding the use of attachment theory applied to the patient-provider relationship in cancer care: Recommendations for future research and clinical practice. Surg Oncol. 2019. doi:https://doi.org/10.1016/j.suronc.2019.10.007
Hooper LM, Tomek S, Newman CR. Using attachment theory in medical settings: Implications for primary care physicians. J Ment Heal. 2012;21(1):23-37. doi:https://doi.org/10.3109/09638237.2011.613955
Ainsworth MS, Bowlby J. An ethological approach to personality development. Am Psychol. 1991. doi:https://doi.org/10.1037/0003-066x.46.4.333
Thompson D, Ciechanowski PS. Attaching a New Understanding to the Patient-Physician Relationship in Family Practice. J Am Board Fam Med. 2009;16(3):219-226. doi:https://doi.org/10.3122/jabfm.16.3.219
Holwerda N, Sanderman R, Pool G, et al. Do patients trust their physician? the role of attachment style in the patient-physician relationship within one year after a cancer diagnosis. Acta Oncol (Madr). 2013;52(1):110-117. doi:https://doi.org/10.3109/0284186X.2012.689856
Maunder RG, Hunter JJ. Can patients be “attached” to healthcare providers? An observational study to measure attachment phenomena in patient-provider relationships. BMJ Open. 2016;6(5). https://doi.org/10.1136/bmjopen-2016-011068
Evans SC, Roberts MC, Keeley JW, et al. Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies. Int J Clin Heal Psychol. 2015. doi:https://doi.org/10.1016/j.ijchp.2014.12.001
Agarwal AK, Murinson BB. New Dimensions in Patient–Physician Interaction: Values, Autonomy, and Medical Information in the Patient-Centered Clinical Encounter. Rambam Maimonides Med J. 2012. doi:https://doi.org/10.5041/rmmj.10085
Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: A prospective validation study of 3 methods for measuring quality. J Am Med Assoc. 2000. doi:https://doi.org/10.1001/jama.283.13.1715
Converse L, Barrett K, Rich E, Reschovsky J. Methods of Observing Variations in Physicians’ Decisions: The Opportunities of Clinical Vignettes. J Gen Intern Med. 2015. doi:https://doi.org/10.1007/s11606-015-3365-8
Bachmann LM, Mühleisen A, Bock A, Ter Riet G, Held U, Kessels AGH. Vignette studies of medical choice and judgement to study caregivers’ medical decision behaviour: Systematic review. BMC Med Res Methodol. 2008. doi:https://doi.org/10.1186/1471-2288-8-50
Cassedy HF, Enander RA, Robinson RC, et al. Attachment Theory as a Model of Doctor-Patient Interaction. J Appl Biobehav Res. 2015;20(4):151-178. doi:https://doi.org/10.1111/jabr.12036
Deniz ME. An investigation of decision making styles and the five-factor personality traits with respect to attachment styles. Educ Sci Theory Pract. 2011;11(1):105-113.
Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013. doi:https://doi.org/10.1007/s11606-013-2441-1
Hughes TM, Palmer EN, Capers Q, et al. Practices and Perceptions Among Surgical Oncologists in the Perioperative Care of Obese Cancer Patients. Ann Surg Oncol. 2018;25(9):2513-2519. doi:https://doi.org/10.1245/s10434-018-6564-9
Seo J, Goodman MS, Politi M, Blanchard M, Kaphingst KA. Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients. Med Decis Mak. 2015;36(4):550-556. doi:https://doi.org/10.1177/0272989X16632197
Krumpal I. Determinants of social desirability bias in sensitive surveys: A literature review. Qual Quant. 2013;47(4):2025-2047. doi:https://doi.org/10.1007/s11135-011-9640-9
Evans SC, Roberts MC, Keeley JW, et al. International Journal of Clinical and Health Psychology Vignette methodologies for studying clinicians’ decision-making: Validity, utility, and application in ICD-11 field studies. Int J Clin Heal Psychol. 2015;15:160-170. doi:https://doi.org/10.1016/j.ijchp.2014.12.001
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Example vignette of patient with anxious attachment style. (PNG 594 kb)
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Palmer Kelly, E., Hyer, M., Paredes, A.Z. et al. Comparing Surgeon Approaches to Patient-Centered Cancer Care Using Vignette Methodology. J Gastrointest Surg 25, 1307–1315 (2021). https://doi.org/10.1007/s11605-020-04661-z
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DOI: https://doi.org/10.1007/s11605-020-04661-z