Learning Objective #1: Describe the two poles of health care provider relationships experienced by women with chronic illness

Learning Objective #2: Discuss the particular vulnerability of women with chronic illness and the effect health care provider relationships have on health outcomes

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Purpose: Relationships between patients and health care providers are considered an integral component of health care. Considerable empirical research has examined elements of the relationship in order to predict which clinician behaviors enhance the relationship and thereby influence better health outcomes. However, holistic evaluation of the nature of the relationship, its meaning to women and what they believe is helpful has not been examined. This interpretive research investigated what the relationship meant to women and how they believed it affected their health.

Design and Method: Twenty-five women, 35 to 55 years, with chronic disease participated in two group interviews. Eleven of these were also interviewed individually. Hermeneutic phenomenology structured the design of the study as well as the narrative and thematic analysis of the data.

Findings: Women acknowledged a continuum of relations with health care providers (HCP) from connected to disconnected. Connected relationships were distinguished as partnered and personable. Abstract technical and scientific management of disease concerns was insufficient for the women to believe they were well cared for. Disconnection, in which the provider assumed a personally disengaged professional role, asserted unnecessary power and control in the relationship, or demonstrated clinical mismanagement left women feeling alone and fearful for their health. They experienced increased vulnerability because of the care their illness management demanded. Disruptions to the relationship increased their vulnerability.

Conclusions: Findings indicate a need for practice focused on the patient's illness experience and the meaning it has in daily life. Providers need to abandon aspects of professional roles that present barriers to authentic involvement with patients. Policy changes are required to address health care structures that bar engaged practice and create mutual distance and alienation in patients and providers alike.