Guarded alliance: health care relationships in chronic illness

Image J Nurs Sch. Fall 1989;21(3):153-7. doi: 10.1111/j.1547-5069.1989.tb00122.x.


A multiphase, qualitative study of ongoing health care relationships from the perspective of the chronically ill patient and family confirmed that such relationships evolve over time through three predictable stages: naïve trust, disenchantment and guarded alliance. In the final stage, four patterns of health care relationships were identified: hero worship, resignation, consumerism and team playing. The configuration of these relationships in guarded alliance is explained by dimensions of the core variable of reconstructed trust--patients' trust in a health care professional and their trust in their own competence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chronic Disease / psychology*
  • Community Participation
  • Consumer Behavior
  • Humans
  • Physician-Patient Relations*
  • Professional-Family Relations