Details

Autor(en) / Beteiligte

• Guillemeney, Josselin
• Clary, Bernard
• Labadie-Fobis, Annie
• Oude Engberink, Agnès
• Pavageau, Sylvain

Titel

La théorie de l’attachement est une ressource pour la relation médecin-patient : méta-synthèse qualitative

Ist Teil von

• Annales médico psychologiques, 2019-04, Vol.177 (4), p.335-341

Ort / Verlag

Elsevier Masson SAS

Erscheinungsjahr

2019

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Explorer la relation médecin-patient dans les études qualitatives traitant de la théorie de l’attachement, qui en apportent une compréhension en médecine générale. Méta-synthèse : méthode d’analyse secondaire d’études qualitatives. Revue de littérature, analyse thématique, translation et synthèse. La relation médecin-patient était une relation d’attachement nécessaire au patient pour se sentir apaisé en situation de vulnérabilité. Les stratégies de régulation des émotions négatives du patient et du médecin guidaient les comportements de santé. Le propre style du médecin conditionnait la qualité de la relation. Le médecin, « base sécure », exerçait un effet régulateur des émotions négatives du patient. La confiance mutuelle était thérapeutique dans une approche « liée-patient ». La théorie de l’attachement est utile pour l’étude de la relation médecin-patient. Explore the physician-patient relationship through the qualitative studies about attachment theory, to allow its understanding in general practice. Meta-synthesis is a method of secondary analysis of qualitative studies. The studies had to be about attachment theory, applied to the framework of the physician-patient relationship in general practice. Studies were identified and selected in MEDLINE, EM Premium, Banque de Données en Santé Publique, PsyclINFO, PsycARTICLES, Web of Science. The quality of the studies was evaluated thanks to the CASP qualitative research checklist. Three researchers performed a thematic analysis and then a reciprocal translation of different themes across studies. A triangulation was performed at every step. The synthesis was written according to the ENTREQ reporting guidelines. 14 studies have enabled a lines-of-argument synthesis with 6 master themes. The physician-patient relationship in general practice was an attachment relationship. This relation was necessary for the patient to feel safe in a situation of distress. The physician and his patient had strategies of regulation of negative emotions. These internal working models guided health-behaviours, like the engagement in their relationship and the approach of each of them. The own physician's attachment style on the one hand, and his reflexive function on the other hand, influenced the quality of the relationship with his patient, favoring therapeutic alliance. Being a secure base for the patient involved the regulation of his negative emotions. Patient-centered care could be revisited as informed by adult attachment theory. The approach including a patient's attachment style, but also that of a physician, has been defined as “an approach linked to the patient”. The mutual trust in each other was therapeutic. General practice could inspire itself from this useful framework to understand interpersonal difficulties and improve care. More research is needed to explore specific components, such as doctor's attachment style, its complementarity with patients’ styles, or the reflexive function as a mediator of this relationship.