Patient Perspectives on the Interpersonal Processes of Cancer Care Transitions: An Attachment Perspective

Purpose:  After cancer treatment completion, patients must shift from actively managing their cancer to establishing a new ‘normal’ for their lifestyles. This requires adapting emotionally, physically, and socially to life after cancer treatment. Approaches to this phase of care emphasize preparing patients with information to facilitate their transfer between providers. This frequently overlooks patients’ emotional experience related to the changing relationships with their cancer providers, including the sense of attachment.  Attachment is the emotional bond between two people based on expectations of protection during a time of need, which fosters (or inhibits) a sense of security. This qualitative study uses the sensitizing lens of attachment theory to explore patients’ perspectives and experiences of care transitions from their oncologists into survivorship clinics and primary care settings.

Methods:  Sample. Semi-structured, in-depth interviews were conducted with early stage breast (n=24) and prostate patients (n=18) at least 2 years post active treatment.  Patients were recruited from two National Cancer Institute-designated cancer centers and six community hospitals.  A purposive sample of adult cancer survivors (47- 80 years old) was stratified by age, race, treatment facility type, and years post active treatment.  Data Analysis.  An immersion/crystallization approach was used.  Interviews were transcribed and managed using ATLAS.ti software. The analytic approach included cycles of reading, summarizing and re-reading data.  Data were analyzed by two clinically trained social workers (D.M.O and H.S.L.) that separately and independently applied codes to each transcript. Analytic discrepancies were resolved through discussion and group consensus.

Results:  Patients relate to their oncology team differently based on individual and environmental circumstances.  The intensity of oncologist-patient bond varies by patient’s experience of support during the active treatment phase including managing physical and psychosocial side effects throughout the cancer treatment experience.  Many patients expressed a desire to remain connected to the initial cancer treatment team and described a sense of loss upon actual or anticipated termination.

Conclusions and Implications:  Findings from this study support the need to expand the emphasis from information exchange during post-treatment transitions to include attending to the inter-personal dynamics that shift between patients and their oncologists.  This study illustrates how the ambiguity of the transition process can impact patients’ experience of this phase of care.  Additionally, it is a starting point for understanding how providers’ inconsistent recognition that an important relationship is changing might leave patients feeling that they are being abandoned rather than prepared for a new phase of care.