Patients' sense of relationship with breast cancer surgeons: the relative importance of surgeon and patient variability and the influence of patients' attachment style.

OBJECTIVE: We examined to what extent variability in breast cancer patients' sense of relationship with their surgeons was attributable to patient vs surgeon variation and we examined the role of one patient characteristic: attachment style.
METHODS: Women (N=133) due to undergo surgery for breast cancer with one of six surgeons self-rated their relationship with the surgeon, using the Working Alliance Inventory, and indicated their adult attachment style (secure vs insecure). Multilevel analysis of alliance scores quantified variance components at patient and surgeon levels and tested the relationship with attachment.
RESULTS: Variability in alliance was overwhelmingly at the patient level. Alliance was greater in securely than non-securely attached patients, although this influence was small.
CONCLUSION: Variability in quality of clinical relationships after breast cancer diagnosis largely reflects variation between individual patients, not surgeons. Although patients' attachment style is significant, its role is modest. More influential patient characteristics need to be identified. PRACTICE IMPLICATIONS: Breast cancer patients report a strong relationship with their surgeons. Because differences between surgeons make only a small contribution to variability in relationship, it should be a priority to identify and address the characteristics or behaviours at the level of individual patients that are associated with poorer relationships.