Attachment Orientation and Relationships With Physicians and Nurses Among Israeli Patients With Advanced Cancer.

OBJECTIVES: To examine the association between attachment orientation and relationships with physicians and nurses among Israeli patients with advanced cancer. SAMPLE & SETTING: 52 patients with advanced cancer during active oncologic treatment. METHODS & VARIABLES: Eligible patients who agreed to participate in the study completed the Experience in Close Relationships Scale, Working Alliance Inventory-Short Revised, and a list of topics, which were defined by the research team as central and common to patients' coping. RESULTS: A correlation was found between avoidant attachment orientation and working alliance with nurses. In addition, patients' attachment orientation was found to be correlated with the type of topics they chose to share with the staff. IMPLICATIONS FOR NURSING: Knowledge regarding the theoretical concepts of attachment orientation may assist nurses in providing tailored and beneficial communication patterns with patients.

Perceptions of the working alliance among medical staff and cancer patients.

OBJECTIVE: A working alliance (WA) is considered an essential factor in therapeutic relationships, relating to the mutual and interactive aspects of the relationship. In the medical setting, a WA has been found to be related to various positive outcomes; however, it has previously been investigated solely from the patient's perspective. The aim of the current study was to measure the concept from both sides of the patient-medical staff interaction. METHOD: Physicians, nurses, and advanced cancer patients completed the Working Alliance Inventory-Short Revised. RESULTS: Some 32 physicians, 39 nurses, and 52 advanced cancer patients completed the study. Senior staff members rated the WA higher than trainees, both among physicians and nurses. Physicians and nurses rated the "bonds" subscale highest, while patients rated "goals" at the highest level. In addition, a significant difference was demonstrated between physicians and patients, with patients rating the WA higher. CONCLUSIONS: These preliminary findings demonstrate different perspectives among advanced cancer patients and medical staff interactions. Future studies should investigate the interactive aspects of the WA concept in the medical setting. SIGNIFICANCE OF RESULTS: Awareness of the working alliance in patient-staff interactions may improve the quality of treatment given to patients confronting cancer.

The association between the strength of the working alliance and sharing concerns by advanced cancer patients: a pilot study.

OBJECTIVES: A strong therapeutic alliance between cancer patients and medical staff is associated with treatment adherence, better health outcomes, and an emotional acceptance of a terminal illness. Given its significant role, the current study investigated the association between the working alliance and sharing concerns by advanced cancer patients. METHODS: Advanced cancer patients completed the Working Alliance Inventory-Short Revised and a checklist of topics in which they rated their degree of concern about the topics and the degree of sharing them with their physician/nurse. RESULTS: Fifty-two patients completed the study. The working alliance was found to be strong with respect to treating physicians and nurses. The four topics that concerned patients the most were family coping with their illness (81%), fear of future suffering (71%), symptom control (67%), and the oncological treatment (65%). Patients with a strong working alliance with their physician shared to a higher extent the personal and main concern regarding their family's coping, and a significant correlation was found between them (r = 0.53, p < .01). In addition, sharing fears of future suffering was also correlated with a strong working alliance with the physician (r = 0.28, p < .05). A strong working alliance with the nurse was correlated with discussing symptoms control (r = 0.30, p < .05). CONCLUSION: These findings provide preliminary support for an association between the strength of the working alliance and the type of concerns that advanced cancer patients choose to discuss with their medical staff and highlight the importance of follow-up studies to further explore this association.

Perceptions of a patient-staff-caregiver group among inpatients in a radiotherapy unit.

OBJECTIVE: Coping with cancer and its treatments has significant psychological implications for patients, and hospitalization can lead to emotional distress. Based on a community meeting (CM), a common therapeutic intervention in psychiatric wards, a unique patient-staff-caregiver group is held weekly on the radiotherapy unit of our hospital. The goals are to strengthen patient coping abilities and prompt open communications. The present study aimed at quantitatively estimating the effect of the community meeting by gauging the perceptions with respect to several therapeutic aspects. METHOD: A questionnaire was developed for patients who participated in CMs during their hospitalization based on four theoretical factors: illness perception, relations with the main caregiver, relations with other participants, and relations with unit staff. RESULTS: Participants' general satisfaction with the meetings was found to be positive. The most significant aspect of the meetings, as perceived by participants, was relationships with the staff. Patients born in Israel perceived relationships with other participants more positively. SIGNIFICANCE OF RESULTS: Attentive interaction with medical staff and open communications are highly important for patients and contribute to their general satisfaction with the meetings.

Cultural differences in spiritual care: findings of an Israeli oncologic questionnaire examining patient interest in spiritual care.

BACKGROUND: As professional spiritual care (chaplaincy) is introduced to new cultures worldwide, it bears examining which elements of screening and care are universal and, for those elements showing cultural difference, to study them in each culture. No quantitative spiritual care patient study had previously been done in Israel. Our objectives were twofold: 1) to examine who wants spiritual care in Israel, including demographic and clinical variables, and to compare against other results worldwide to further develop universal screening protocols 2) to see what patients want from spiritual care specifically in the Israeli setting. METHODS: Self-administered patient questionnaire examining spirituality/religiosity, interest in spiritual care (subdivided by type of care), and key demographic, social, and clinical data. The study setting was an Israeli oncology center at which spiritual care had been recently introduced. RESULTS: Data from 364 oncology patient questionnaires found 41% interest in spiritual care, as compared to 35%-54% in American studies. Having previously been visited by a spiritual caregiver predicted patient interest in further spiritual care (AOR 2.4, 95% CI 1.2-4.6), suggesting that the new service is being well-received. Multivariate stepwise logistic regression analysis identified additional predictors of openness to receiving spiritual care: self-describing as somewhat/very spiritual vs. not spiritual (adjusted odds ratio [AOR] 3.9 and 6.3, 95% CI 1.8-8.6 and 2.6-15.1) or traditional/religious vs. secular (AOR 2.2 and 2.1, 95% CI 1.3-3.6 and 1.1-4.0); and receiving one visit a week or less from family and friends (AOR 5.6, 95% CI 2.1-15.1). These findings are in line with previous American studies, suggesting universality across cultures that could be utilized in screening. Differences in demographic data and medical condition were not significant predictors of patient interest, suggesting a cultural difference, where age and education were predictors in the American context. Levels of interest in explicitly religious or spiritual support such as prayer or addressing religious/spiritual questions were much lower than in other cultures. CONCLUSIONS: Results illustrate the demand for and satisfaction with the new Israeli service. The cross-cultural comparison found both culture-dependent and possibly universal predictors of patient interest, and found lower interest in Israel for explicitly religious/spiritual types of support.

Illness perception differences between Russian- and Hebrew-speaking Israeli oncology patients.

Illness perception influences health and illness behaviors. This study was designed to estimate illness perception differences between Russian-speaking and Hebrew-speaking Israeli oncology patients. Changes in illness perception associated with time spent in Israel among Russian-speaking patients were also evaluated. Additionally, we evaluated differences in illness perception of patients exposed to Chernobyl's consequences. A total of 144 oncology patients (77 Hebrew-speaking, 67 Russian-speaking) completed personal data questionnaires and The illness perception questionnaire revised, translated into Russian for this study. Significantly more Russian-speaking oncology patients perceived their illness as chronic and having negative consequences on life (p < .01). Russian-speaking oncology patients tend to have a more negative perception of cancer compared to Hebrew-speaking patients. Time spent in Israel may create more positive perceptions of cancer among these patients. No illness perception differences were found concerning Chernobyl consequences.

"Balint group" meetings for oncology residents as a tool to improve therapeutic communication skills and reduce burnout level.

Medical training, particularly residency, may pose many challenges and may lead to burnout. Oncology training may be more stressful, given the prolonged exposure to death and dying. Balint group is an intervention method common in medical training, aimed at improving communication skills and strengthening doctor-patient relationships. We arranged for our oncology residents, guided by a senior oncologist and a clinical psychologist, to meet monthly for a discussion of personal cases from the residents' experiences. At the beginning of the year, higher measures in two burnout parameters were found in junior residents compared to senior residents. At the end of the year, the gap in Maslach Burnout Inventory scores between junior and senior residents had decreased, while burnout level decreased slightly during the year in junior residents. It was felt that participation in a Balint group could improve communication abilities of residents and contribute to their feelings of self-accomplishment as doctors.