The role of patient attachment and working alliance on patient adherence, satisfaction, and health-related quality of life in lupus treatment

Objective: Researchers tested the hypothesis that patients' working alliance with their physicians, and patients' attachment styles would predict patients' adherence, satisfaction, and health-related quality of life. Methods: One hundred ninety-three patients diagnosed with lupus participated in an online survey. They completed measures of the Physician-Patient Alliance Inventory, Experiences in Close Relationships Scale, SF-36, General Adherence Inventory, and the Medical Patient Satisfaction Questionnaire. Results: Working alliance was significantly and positively associated with all three outcome variables of adherence, satisfaction, and quality of life. Attachment avoidance was significantly and negatively related to adherence, and attachment anxiety was significantly and negatively related to health-related quality of life. Conclusions: A working alliance between physician and patient, characterized by agreement communication on goals and tasks of treatment, along with trust and patient liking of his/her doctor, predicts patient adherence, satisfaction, and quality of life. Psychological dimensions of attachment also predict patient adherence and quality of life. Practice implications: Doctors and other health service providers ought to actively set goals and tasks of treatment, and foster patient trust and liking. A strong relationship with patients can increase treatment efficacy and effectiveness and improve outcomes for individuals with debilitating chronic illnesses such as lupus. (C) 2010 Elsevier Ireland Ltd. All rights reserved.