Critical Incidents Reveal How Patients with Head and Neck Cancer Construct Their “Secure Base” as a “Helping System”

Abstract

Most studies of the psychosocial needs of patients with head and neck cancers (HNC) use predefined categories and explicitly ask for specified needs. These studies are important but should be complemented with inductive studies based on patients' own descriptions of experiences. This qualitative study is such a contribution. In repeated interviews positive and negative incidents were collected from 137 patients with HNC, and these experiences were categorized in dimensions expressing needs. A core category--"being included--neglected by a helping system"--emerged from the narrated incidents and was based on the dimensions engagement, competence, and information. The findings are easily related to attachment theory by stressing the significance of establishing trustful relationships with the health care staff, as attachment figures, who respond flexibly and sensitively to the patient's needs. In the constitution of health care as a helping system, all encounters between the patient and health care staff matters. Further research should preferably focus on the creation of guidelines for the constitution of health care as a helping system, that is, how the found factors of a helping system can be operationalized in clinical practice.

Attachment figures when death is approaching: a study applying attachment theory to adult patients’ and family members’ experiences during palliative home care

“…The results confirm previous findings of adults having multiple attachments, and that family and friends, health care practitioners, pets and God can be attachment figures in the end-of-life context [6, 15–21, 24–27]. Our findings can be interpreted in relation to attachment networks during adulthood.…”

“…It appears also that pets, God and deceased loved ones may become sources of attachment security [16, 18–23]. In addition, it has been proposed that health care practitioners in different settings can serve as attachment figures [6, 24–27], e.g. doctors to patients with cancer [26, 27].…”

Meaning of work and the process of returning after head and neck cancer

“…However, it is also quite evident that there are several barriers and challenges for HNC patients in the process of rehabilitation and resuming everyday life, including feelings of anxiety, potential job loss, pressure to return to work too early, feelings of loneliness, being poorly understood, and feeling abandoned. In order to avoid such experiences, it seems vital that the patients experience health care as a 'secure base' or a 'helping system/helping plan' [4,30], which, in turn, can facilitate the patients' 'biographical repair' [27], including the return to work. Because many HNC patients are affected by both physical and psychological distress, a rehabilitation plan provided by the health care system might be important in preventing job loss and in helping the individual to find strategies to be able to return to work as well as in strengthening the patients' feelings of security.…”

“…Only positive statements (30) were made about contacts with colleagues during sick leave. Visiting the workplace was stated to be important to allow one to keep in touch with colleagues and to receive their support and understanding.…”

The role of nature in cancer patients' lives: a systematic review and qualitative meta-synthesis

“…Drawing on Attachment theory [57], it is theorized that secure attachment to a supportive structure or “helping system” [58] can support patients’ stepwise process of accepting lives shaped by cancer. It is premised that when attached to a “secure base” [57], patients are enabled to risk exploring various real and imagined future scenarios and approach a shifting normality that now includes their cancer experiences.…”