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A teoria da vinculação, a relação médico-doente e a utilização dos cuidados de saúde : uma revisão narrativa
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Objetivo: A teoria da vinculação permite refletir sobre as razões por detrás das diferentes relações que os doentes têm com os cuidados de saúde. Este trabalho tem o objetivo de realizar uma revisão narrativa da literatura sobre o estilo de vinculação, a relação médico-doente a confiança no profissional de saúde, os outcomes terapêuticos e a utilização dos cuidados de saúde. Metodologia: Foi realizada uma pesquisa dos termos attachment style, insecure attachment, healthcare, patient-doctor relationship e adherence nas bases de dados PubMed, Science Direct, LILACS, SciELO, EBSCO, Web Of Science e PsycINFO. Foram selecionados os artigos de língua inglesa e portuguesa publicados entre janeiro de 2012 e fevereiro de 2022 e posteriormente aplicados os critérios de seleção definidos. Resultados: De um total de 293 artigos foram selecionados 26. Vários estudos demonstraram o impacto do estilo de vinculação na relação médico-doente, tendo os doentes com vinculação evitante menos confiança no médico, pior aderência terapêutica e piores outcomes terapêuticos. A vinculação preocupada correlaciona-se com uma maior sobreutilização dos serviços de saúde e com maior sofrimento psicológico com a doença. A qualidade da relação médico-doente demonstrou ser o fator mais importante na moderação do impacto do estilo de vinculação na utilização dos cuidados de saúde. Conclusão: O estilo de vinculação tem um impacto na relação que os doentes têm com os cuidados de saúde e como tal deve ser integrada no modelo da medicina centrada no doente de forma a melhorar a relação médico-doente e os outcomes terapêuticos.
Objective: Attachment theory allows us to reflect on the reasons behind the different relationships patients have with healthcare. This work intends on doing a narrative review of the literature of the last decade about the relationship between attachment style, the trust in the healthcare provider, the patient's outcomes, and healthcare utilization. Methodology: A search of multiple databases including PubMed, Science Direct, LILACS, SciELO, EBSCO, Web Of Science, and PsychInfo was conducted using variations and combinations of the keywords attachment style, insecure attachment, healthcare, patient-doctor relationship and adherence. Only articles in the English and Portuguese languages published between January 2012 and February 2022 were selected. The defined selection criteria were later applied. Results: Of a total of 293 articles only 26 were selected for this narrative review. Various studies showed an impact of the attachment style on the patient-doctor relationship. The patients with a dismissive-avoidant style had less trust in their physicians and worse treatment adherence and disease outcomes. The patients with a preoccupied attachment style had higher rates of healthcare use and distress caused by the disease. The quality of the patient-doctor relationship was the biggest moderating factor on the impact of the patient's attachment style. Conclusion: The attachment style impacts the relationship a patient has with healthcare and must be integrated into the patient-centered approach with the intent to better the health outcomes of said patient.
Objective: Attachment theory allows us to reflect on the reasons behind the different relationships patients have with healthcare. This work intends on doing a narrative review of the literature of the last decade about the relationship between attachment style, the trust in the healthcare provider, the patient's outcomes, and healthcare utilization. Methodology: A search of multiple databases including PubMed, Science Direct, LILACS, SciELO, EBSCO, Web Of Science, and PsychInfo was conducted using variations and combinations of the keywords attachment style, insecure attachment, healthcare, patient-doctor relationship and adherence. Only articles in the English and Portuguese languages published between January 2012 and February 2022 were selected. The defined selection criteria were later applied. Results: Of a total of 293 articles only 26 were selected for this narrative review. Various studies showed an impact of the attachment style on the patient-doctor relationship. The patients with a dismissive-avoidant style had less trust in their physicians and worse treatment adherence and disease outcomes. The patients with a preoccupied attachment style had higher rates of healthcare use and distress caused by the disease. The quality of the patient-doctor relationship was the biggest moderating factor on the impact of the patient's attachment style. Conclusion: The attachment style impacts the relationship a patient has with healthcare and must be integrated into the patient-centered approach with the intent to better the health outcomes of said patient.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Teoria da vinculação Vinculação insegura Relação médico-doente saúde Psicologia