Skip to main content
Top
Published in: Supportive Care in Cancer 7/2017

Open Access 01-07-2017 | Original Article

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

Authors: Anna Milberg, Maria Friedrichsen

Published in: Supportive Care in Cancer | Issue 7/2017

Login to get access

Abstract

Purpose

Attachment theory is currently receiving much attention in relation to how adults cope with severe illness. The study aims were using the experiences of patients and family members to explore attachment figures (a central concept within the theory) during palliative home care.

Methods

Twelve patients and 14 family members were interviewed during ongoing palliative home care. The interviews were analysed using qualitative content analysis.

Results

Four types of attachment figures were identified: (i) family and friends, (ii) health care practitioners, (iii) pets and (iv) God. Both non-physical and physical contact with the attachment figures facilitated a sense of security. In addition, the patient/family members and their attachment figures were described by some as a “we”, and when one part of the “we” felt insecure, this made the other also feel insecure. The patients’ unstable and progressing illnesses constituted a threat to the patients’ and family members’ sense of security. The availability of the attachment figures made them feel secure, and they could then divert their attention from the patients’ illnesses to other things in everyday life, e.g. socialising with family and friends. Some family members also had to cope with the loss of their own attachment figure, when the patient, who had previously been a source of security for them, was no longer able to offer protection and comfort due to the progression of the illness.

Conclusion

Important aspects of attachment figures in the end-of-life context were identified, and their clinical implications will be discussed.
Literature
1.
go back to reference Bowlby J (1997, c 1969) Attachment and loss. Volume 1. Attachment, 2nd edn. Pimlico; London Bowlby J (1997, c 1969) Attachment and loss. Volume 1. Attachment, 2nd edn. Pimlico; London
2.
go back to reference Mikulincer M, Shaver PR (2007) Attachment in adulthood: structure, dynamics, and change. Guildford Press, New York Mikulincer M, Shaver PR (2007) Attachment in adulthood: structure, dynamics, and change. Guildford Press, New York
3.
go back to reference Rodin G, Walsh A, Zimmermann C, Gagliese L, Jones J, Shepherd FA, Moore M, Braun M, Donner A, Mikulincer M (2007) The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer. Psychooncology 16:1080–1091CrossRefPubMed Rodin G, Walsh A, Zimmermann C, Gagliese L, Jones J, Shepherd FA, Moore M, Braun M, Donner A, Mikulincer M (2007) The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer. Psychooncology 16:1080–1091CrossRefPubMed
4.
go back to reference Milberg A, Wahlberg R, Jakobsson M, Olsson EC, Olsson M, Friedrichsen M (2012) What is a 'secure base' when death is approaching? A study applying attachment theory to adult patients' and family members' experiences of palliative home care. Psychooncology 21:886–895CrossRefPubMed Milberg A, Wahlberg R, Jakobsson M, Olsson EC, Olsson M, Friedrichsen M (2012) What is a 'secure base' when death is approaching? A study applying attachment theory to adult patients' and family members' experiences of palliative home care. Psychooncology 21:886–895CrossRefPubMed
5.
go back to reference Milberg A, Friedrichsen M, Jakobsson M, Nilsson EC, Niskala B, Olsson M, Wahlberg R, Krevers B (2014) Patients' sense of security during palliative care-what are the influencing factors? J Pain Symptom Manag 48:45–55CrossRef Milberg A, Friedrichsen M, Jakobsson M, Nilsson EC, Niskala B, Olsson M, Wahlberg R, Krevers B (2014) Patients' sense of security during palliative care-what are the influencing factors? J Pain Symptom Manag 48:45–55CrossRef
6.
go back to reference Isaksson J, Salander P, Granstrom B, Laurell G (2014) Critical incidents reveal how patients with head and neck cancer construct their "secure base" as a "helping system". J Psychosoc Oncol 32:322–341CrossRefPubMed Isaksson J, Salander P, Granstrom B, Laurell G (2014) Critical incidents reveal how patients with head and neck cancer construct their "secure base" as a "helping system". J Psychosoc Oncol 32:322–341CrossRefPubMed
7.
go back to reference Mancini AD, Bonanno GA (2012) The persistence of attachment: complicated grief, threat, and reaction times to the deceased's name. J Affect Disord 139:256–263CrossRefPubMedPubMedCentral Mancini AD, Bonanno GA (2012) The persistence of attachment: complicated grief, threat, and reaction times to the deceased's name. J Affect Disord 139:256–263CrossRefPubMedPubMedCentral
8.
go back to reference Porter LS, Keefe FJ, Davis D, Rumble M, Scipio C, Garst J (2012) Attachment styles in patients with lung cancer and their spouses: associations with patient and spouse adjustment. Support Care Cancer 20:2459–2466CrossRefPubMedPubMedCentral Porter LS, Keefe FJ, Davis D, Rumble M, Scipio C, Garst J (2012) Attachment styles in patients with lung cancer and their spouses: associations with patient and spouse adjustment. Support Care Cancer 20:2459–2466CrossRefPubMedPubMedCentral
9.
go back to reference Calvo V, Palmieri A, Marinelli S, Bianco F, Kleinbub JR (2014) Reciprocal empathy and working alliance in terminal oncological illness: the crucial role of patients' attachment style. J Psychosoc Oncol 32:517–534CrossRefPubMed Calvo V, Palmieri A, Marinelli S, Bianco F, Kleinbub JR (2014) Reciprocal empathy and working alliance in terminal oncological illness: the crucial role of patients' attachment style. J Psychosoc Oncol 32:517–534CrossRefPubMed
10.
go back to reference Nicholls W, Hulbert-Williams N, Bramwell R (2014) The role of relationship attachment in psychological adjustment to cancer in patients and caregivers: a systematic review of the literature. Psychooncology 23:1083–1095CrossRefPubMed Nicholls W, Hulbert-Williams N, Bramwell R (2014) The role of relationship attachment in psychological adjustment to cancer in patients and caregivers: a systematic review of the literature. Psychooncology 23:1083–1095CrossRefPubMed
11.
go back to reference Hillen MA, de Haes HC, van Tienhoven G, Bijker N, van Laarhoven HW, Vermeulen DM, Smets EM (2015) All eyes on the patient: the influence of oncologists' nonverbal communication on breast cancer patients' trust. Breast Cancer Res Treat 153:161–171CrossRefPubMedPubMedCentral Hillen MA, de Haes HC, van Tienhoven G, Bijker N, van Laarhoven HW, Vermeulen DM, Smets EM (2015) All eyes on the patient: the influence of oncologists' nonverbal communication on breast cancer patients' trust. Breast Cancer Res Treat 153:161–171CrossRefPubMedPubMedCentral
12.
go back to reference Currier JM, Irish JE, Neimeyer RA, Foster JD (2015) Attachment, continuing bonds, and complicated grief following violent loss: testing a moderated model. Death Stud 39:201–210CrossRefPubMed Currier JM, Irish JE, Neimeyer RA, Foster JD (2015) Attachment, continuing bonds, and complicated grief following violent loss: testing a moderated model. Death Stud 39:201–210CrossRefPubMed
13.
go back to reference Bowlby J (1988/2003) A secure base: clinical applications of attachment theory. Brunner-Routledge, East Sussex Bowlby J (1988/2003) A secure base: clinical applications of attachment theory. Brunner-Routledge, East Sussex
14.
go back to reference Tan A, Zimmermann C, Rodin G (2005) Interpersonal processes in palliative care: an attachment perspective on the patient-clinician relationship. Palliat Med 19:143–150CrossRefPubMed Tan A, Zimmermann C, Rodin G (2005) Interpersonal processes in palliative care: an attachment perspective on the patient-clinician relationship. Palliat Med 19:143–150CrossRefPubMed
15.
go back to reference Mikulincer M, Shaver PR (2007) Boosting attachment security to promote mental health. Prosocial Values, and Inter-Group Tolerance Psychological Inquiry 18:139–156CrossRef Mikulincer M, Shaver PR (2007) Boosting attachment security to promote mental health. Prosocial Values, and Inter-Group Tolerance Psychological Inquiry 18:139–156CrossRef
16.
go back to reference Doherty NA, Feeney JA (2004) The composition of attachment networks throughout the adult years. Pers Relat 11:469–488CrossRef Doherty NA, Feeney JA (2004) The composition of attachment networks throughout the adult years. Pers Relat 11:469–488CrossRef
17.
go back to reference Petersen Y, Koehler L (2006) Application of attachment theory for psychological support in palliative medicine during the terminal phase. Gerontology 52:111–123CrossRefPubMed Petersen Y, Koehler L (2006) Application of attachment theory for psychological support in palliative medicine during the terminal phase. Gerontology 52:111–123CrossRefPubMed
18.
go back to reference Beck M, Madresh EA (2008) Romantic partners and four-legged friends: an extension of attachment theory to relationships with pets. Anthrozoos 21:43–56CrossRef Beck M, Madresh EA (2008) Romantic partners and four-legged friends: an extension of attachment theory to relationships with pets. Anthrozoos 21:43–56CrossRef
19.
go back to reference Granqvist P, Mikulincer M, Shaver PR (2010) Religion as attachment: normative processes and individual differences. Personal Soc Psychol Rev 14:49–59CrossRef Granqvist P, Mikulincer M, Shaver PR (2010) Religion as attachment: normative processes and individual differences. Personal Soc Psychol Rev 14:49–59CrossRef
20.
go back to reference Field NP, Orsini L, Gavish R, Packman W (2009) Role of attachment in response to pet loss. Death Stud 33:334–355CrossRefPubMed Field NP, Orsini L, Gavish R, Packman W (2009) Role of attachment in response to pet loss. Death Stud 33:334–355CrossRefPubMed
21.
22.
go back to reference Rochman D (2013) Death-related versus fond memories of a deceased attachment figure: examining emotional arousal. Death Stud 37:704–724CrossRefPubMed Rochman D (2013) Death-related versus fond memories of a deceased attachment figure: examining emotional arousal. Death Stud 37:704–724CrossRefPubMed
23.
go back to reference Cicirelli VG (2004) God as the ultimate attachment figure for older adults. Attach Hum Dev 6:371–388CrossRefPubMed Cicirelli VG (2004) God as the ultimate attachment figure for older adults. Attach Hum Dev 6:371–388CrossRefPubMed
24.
go back to reference Adshead G (1998) Psychiatric staff as attachment figures. Understanding management problems in psychiatric services in the light of attachment theory. Br J Psychiatry 172:64–69CrossRefPubMed Adshead G (1998) Psychiatric staff as attachment figures. Understanding management problems in psychiatric services in the light of attachment theory. Br J Psychiatry 172:64–69CrossRefPubMed
25.
go back to reference Spetz A, Henriksson R, Salander P (2008) A specialist nurse as a resource for family members to patients with brain tumors: an action research study. Cancer Nurs 31:E18–E26CrossRefPubMed Spetz A, Henriksson R, Salander P (2008) A specialist nurse as a resource for family members to patients with brain tumors: an action research study. Cancer Nurs 31:E18–E26CrossRefPubMed
28.
go back to reference Hsieh H-F, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288CrossRefPubMed Hsieh H-F, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288CrossRefPubMed
30.
go back to reference Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 24:105–112CrossRefPubMed Graneheim UH, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 24:105–112CrossRefPubMed
31.
go back to reference Malterud K (2001) Qualitative research: standards, challenges, and guidelines. Lancet 358:483–488CrossRefPubMed Malterud K (2001) Qualitative research: standards, challenges, and guidelines. Lancet 358:483–488CrossRefPubMed
32.
go back to reference Luke MA, Sedikides C, Carnelley K (2012) Your love lifts me higher! The energizing quality of secure relationships. Personal Soc Psychol Bull 38:721–733CrossRef Luke MA, Sedikides C, Carnelley K (2012) Your love lifts me higher! The energizing quality of secure relationships. Personal Soc Psychol Bull 38:721–733CrossRef
33.
go back to reference Freeman H, Brown BB (2001) Primary attachment to parents and peers during adolescence: differences by attachment style. Journal of Youth and Adolescence 30:653–674CrossRef Freeman H, Brown BB (2001) Primary attachment to parents and peers during adolescence: differences by attachment style. Journal of Youth and Adolescence 30:653–674CrossRef
34.
go back to reference Lo C, Walsh A, Mikulincer M, Gagliese L, Zimmermann C, Rodin G (2009) Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief experiences in close relationships scale. Psychooncology 18:490–499CrossRefPubMed Lo C, Walsh A, Mikulincer M, Gagliese L, Zimmermann C, Rodin G (2009) Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief experiences in close relationships scale. Psychooncology 18:490–499CrossRefPubMed
35.
go back to reference Mikulincer M, Shaver PR, Rom E (2011) The effects of implicit and explicit security priming on creative problem solving. Cognit Emot 25:519–531CrossRef Mikulincer M, Shaver PR, Rom E (2011) The effects of implicit and explicit security priming on creative problem solving. Cognit Emot 25:519–531CrossRef
Metadata
Title
Attachment figures when death is approaching: a study applying attachment theory to adult patients’ and family members’ experiences during palliative home care
Authors
Anna Milberg
Maria Friedrichsen
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 7/2017
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-017-3634-7

Other articles of this Issue 7/2017

Supportive Care in Cancer 7/2017 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine