{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T05:03:19Z","timestamp":1773118999572,"version":"3.50.1"},"reference-count":114,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":273,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S1478951525100783_sec1a\">\n\t    <jats:title>Background<\/jats:title>\n\t    <jats:p>The diagnosis of an advanced life-threatening illness brings with it existential challenges that activate the attachment system and different attachment styles influence coping with advanced illness.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100783_sec2b\">\n\t    <jats:title>Objectives<\/jats:title>\n\t    <jats:p>The objective of this work were (a) to analyze the influence of attachment styles of patients with advanced disease and their relatives on emotional distress and other psychological and existential aspects, and (b) to identify the most used assessment instruments to measure it, highlighting those with better psychometric properties in palliative care contexts.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100783_sec3c\">\n\t    <jats:title>Methods<\/jats:title>\n\t    <jats:p>Articles on attachment published from October 2005 to February 2025 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide (PRISMA) were identified by searching PubMed, PsycINFO, Google Scholar, SCOPUS, Dialnet, and the Web of Science databases.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100783_sec4d\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>Of 1847 studies identified, 24 were included (21 quantitative and 53 qualitative). Quality assessment revealed low risk of bias and high methodological quality. The main results indicated that a secure attachment style was associated with better coping, adaptation and adjustment strategies to the experience of illness, causing a buffering effect on suffering at the end of life. In contrast, patients with insecure attachment styles presented higher levels of emotional distress, demoralization, existential loneliness, death anxiety and showed a poorer psychological adaptation to cancer. Almost two-thirds of the studies (65.1%) used some version of Experiences in Close Relationships (ECR) scale.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100783_sec5e\">\n\t    <jats:title>Significance of results<\/jats:title>\n\t    <jats:p>The attachment theory appears to offer a valuable conceptual framework for understanding how individuals may respond to the emotional and relational demands associated with advanced illness and end-of-life care. Its contributions have been increasingly considered in literature addressing psychosocial adjustment and coping in palliative contexts<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S1478951525100783_sec6f\">\n\t    <jats:title\/>\n\t    <jats:p>For the assessment of attachment styles in a palliative context, the most used instrument is the original ECR-M16 scale or its iderived versions.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s1478951525100783","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T12:36:02Z","timestamp":1759322162000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Attachment at the end of life: A systematic review"],"prefix":"10.1017","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9161-6220","authenticated-orcid":false,"given":"Cruz","family":"S\u00e0nchez-Julv\u00e9","sequence":"first","affiliation":[{"name":"Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vall\u00e9s)"},{"name":"Consorci Sanitari Alt Pened\u00e8s-Garraf, Sant Pere de Ribes (Garraf)"},{"name":"Catalan-Balearic Society of Palliative Care"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Viel-Sirito","sequence":"additional","affiliation":[{"name":"Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vall\u00e9s)"},{"name":"Catalan-Balearic Society of Palliative Care"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0573-791X","authenticated-orcid":false,"given":"Joaqu\u00edn T.","family":"Limonero","sequence":"additional","affiliation":[{"name":"Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vall\u00e9s)"},{"name":"Catalan-Balearic Society of Palliative Care"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"S1478951525100783_ref115","unstructured":"Marrone, M (2001) La Teor\u00eda Del Apego. Un Enfoque Actual: Psim\u00e1tica"},{"key":"S1478951525100783_ref83","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.00058"},{"key":"S1478951525100783_ref79","doi-asserted-by":"publisher","DOI":"10.5944\/rppc.24367"},{"key":"S1478951525100783_ref21","doi-asserted-by":"publisher","DOI":"10.1080\/07347332.2014.936651"},{"key":"S1478951525100783_ref98","first-page":"1231","article-title":"The Family APGAR: a proposal for a family function test and its use by physicians","volume":"6","author":"Smilkstein","year":"1978","journal-title":"The Journal of Family Practice"},{"key":"S1478951525100783_ref66","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951518000652"},{"key":"S1478951525100783_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-7753(00)71630-7"},{"key":"S1478951525100783_ref102","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2024.0070"},{"key":"S1478951525100783_ref44","doi-asserted-by":"publisher","DOI":"10.1177\/1049732302238251"},{"key":"S1478951525100783_ref81","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2009.08.006"},{"key":"S1478951525100783_ref13","volume-title":"V\u00ednculos afectivos: formaci\u00f3n, desarrollo y p\u00e9rdida","author":"Bowlby","year":"1986"},{"key":"S1478951525100783_ref49","doi-asserted-by":"publisher","DOI":"10.1002\/pon.965"},{"key":"S1478951525100783_ref7","first-page":"196","volume-title":"Handbook of Personality Disorders: Theory, Research and Treatment","author":"Bartholomew","year":"2001"},{"key":"S1478951525100783_ref2","volume-title":"Patterns of attachment: A psychological study of the strange situation","author":"Ainsworth","year":"1978"},{"key":"S1478951525100783_ref112","doi-asserted-by":"publisher","DOI":"10.3906\/sag-1210-28"},{"key":"S1478951525100783_ref75","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951510000660"},{"key":"S1478951525100783_ref29","first-page":"325","article-title":"The role of couples\u2019 attachment styles in patients\u2019 adjustment to cancer","volume":"92","author":"De Luca","year":"2017","journal-title":"Oncology (Switzerland)"},{"key":"S1478951525100783_ref71","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-056136"},{"key":"S1478951525100783_ref87","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-015-1589-y"},{"key":"S1478951525100783_ref60","doi-asserted-by":"publisher","DOI":"10.1159\/000276502"},{"key":"S1478951525100783_ref41","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.67.3.430"},{"key":"S1478951525100783_ref28","doi-asserted-by":"publisher","DOI":"10.1300\/J010v19n02_02"},{"key":"S1478951525100783_ref53","doi-asserted-by":"publisher","DOI":"10.1016\/j.anyes.2016.09.001"},{"key":"S1478951525100783_ref113","doi-asserted-by":"publisher","DOI":"10.1177\/1359105317721307"},{"key":"S1478951525100783_ref10","volume-title":"Royal Holloway","author":"Bifulco","year":"1998"},{"key":"S1478951525100783_ref86","doi-asserted-by":"publisher","DOI":"10.1521\/jaap.2008.36.1.181"},{"key":"S1478951525100783_ref103","doi-asserted-by":"publisher","DOI":"10.4067\/S0717-92272019000300238"},{"key":"S1478951525100783_ref76","doi-asserted-by":"publisher","DOI":"10.1159\/000090957"},{"key":"S1478951525100783_ref4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2016-001277"},{"key":"S1478951525100783_ref99","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2009.12.007"},{"key":"S1478951525100783_ref93","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2021.0491"},{"key":"S1478951525100783_ref52","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.006"},{"key":"S1478951525100783_ref17","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.57.2198"},{"key":"S1478951525100783_ref19","first-page":"46","volume-title":"Attachment theory and close relationships","author":"Brennan","year":"1998"},{"key":"S1478951525100783_ref16","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1988"},{"key":"S1478951525100783_ref50","doi-asserted-by":"publisher","DOI":"10.1177\/082585971202800107"},{"key":"S1478951525100783_ref34","doi-asserted-by":"publisher","DOI":"10.33898\/rdp.v27i103.104"},{"key":"S1478951525100783_ref80","doi-asserted-by":"publisher","DOI":"10.1111\/pere.12330"},{"key":"S1478951525100783_ref37","doi-asserted-by":"publisher","DOI":"10.1080\/14616730010024771"},{"key":"S1478951525100783_ref92","first-page":"1","article-title":"A qualitative examination of attachment styles in women with advanced cancer receiving palliative care","volume":"13","author":"Shahvaroughi-Farahani","year":"2019","journal-title":"International Journal of Behavioral Sciences"},{"key":"S1478951525100783_ref40","doi-asserted-by":"publisher","DOI":"10.1159\/000505120"},{"key":"S1478951525100783_ref5","first-page":"505","article-title":"C\u00e1ncer y familia: aspectos te\u00f3ricos y terap\u00e9uticos","volume":"3","author":"Baider","year":"2003","journal-title":"International Journal of Clinical and Health Psychology"},{"key":"S1478951525100783_ref3","volume-title":"Patterns of attachment: A psychological study of the strange situation","author":"Ainsworth","year":"1978"},{"key":"S1478951525100783_ref25","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.58.4.644"},{"key":"S1478951525100783_ref33","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.78.2.350"},{"key":"S1478951525100783_ref65","first-page":"507","article-title":"Elaboraci\u00f3n y propuesta de un instrumento para la detecci\u00f3n de malestar emocional en enfermos al final de la vida","volume":"6","author":"Mat\u00e9","year":"2009","journal-title":"Psicooncolog\u00eda"},{"key":"S1478951525100783_ref24","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.43.3.206"},{"key":"S1478951525100783_ref72","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3664"},{"key":"S1478951525100783_ref91","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psychotherapy.20190050"},{"key":"S1478951525100783_ref69","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951509990976"},{"key":"S1478951525100783_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2012.10.001"},{"key":"S1478951525100783_ref46","doi-asserted-by":"publisher","DOI":"10.1207\/s15327965pli0501_1"},{"key":"S1478951525100783_ref47","doi-asserted-by":"publisher","DOI":"10.3109\/09638237.2011.613955"},{"key":"S1478951525100783_ref54","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2020-002608"},{"key":"S1478951525100783_ref106","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.12842"},{"key":"S1478951525100783_ref15","volume-title":"El apego","author":"Bowlby","year":"1998"},{"key":"S1478951525100783_ref42","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317722123"},{"key":"S1478951525100783_ref32","doi-asserted-by":"publisher","DOI":"10.1037\/1089-2680.4.2.132"},{"key":"S1478951525100783_ref48","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-23300-0_2"},{"key":"S1478951525100783_ref43","first-page":"912","article-title":"The quality of dying and death","volume":"168","author":"Hales","year":"2008","journal-title":"Internal Medicine"},{"key":"S1478951525100783_ref18","first-page":"2907","article-title":"Depression, hopelessness and desire for hastened death in terminally ill patients with cancer","volume":"84","author":"Breitbart","year":"2020","journal-title":"JAMA Internal Medicine"},{"key":"S1478951525100783_ref59","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5354"},{"key":"S1478951525100783_ref20","doi-asserted-by":"publisher","DOI":"10.1089\/109662102753641278"},{"key":"S1478951525100783_ref109","doi-asserted-by":"publisher","DOI":"10.20473\/jn.v15i1Sp.18894"},{"key":"S1478951525100783_ref82","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.00058"},{"key":"S1478951525100783_ref97","doi-asserted-by":"publisher","DOI":"10.1016\/j.copsyc.2018.06.008"},{"key":"S1478951525100783_ref100","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-23300-0_4"},{"key":"S1478951525100783_ref57","doi-asserted-by":"publisher","DOI":"10.1017\/S0144686X09990201"},{"key":"S1478951525100783_ref45","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.52.3.511"},{"key":"S1478951525100783_ref30","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0543"},{"key":"S1478951525100783_ref39","doi-asserted-by":"publisher","DOI":"10.1016\/j.medcli.2012.06.027"},{"key":"S1478951525100783_ref26","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.58.4.644"},{"key":"S1478951525100783_ref105","first-page":"1005","article-title":"Attachment orientations of Greek cancer patients in palliative care: a validation study of the Experiences in Close Relationships scale (ECR-M16","volume":"21","author":"Tsilika","year":"2016","journal-title":"Journal of BUON: Official Journal of the Balkan Union of Oncology"},{"key":"S1478951525100783_ref107","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2018.11.018"},{"key":"S1478951525100783_ref77","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5640"},{"key":"S1478951525100783_ref110","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2019.101691"},{"key":"S1478951525100783_ref88","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951517000281"},{"key":"S1478951525100783_ref14","volume-title":"El apego. El apego y la p\u00e9rdida 1","author":"Bowlby","year":"1993"},{"key":"S1478951525100783_ref11","doi-asserted-by":"publisher","DOI":"10.2190\/KQYE-P3EN-XATC-PWB7"},{"key":"S1478951525100783_ref58","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1417"},{"key":"S1478951525100783_ref95","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2018.10.001"},{"key":"S1478951525100783_ref89","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-04744-x"},{"key":"S1478951525100783_ref96","first-page":"161","article-title":"Assessment of the psychometric properties of the scale of detection of existential loneliness in patients with advanced diseases","volume":"16","author":"Sirito","year":"2019","journal-title":"Psicooncolog\u00eda"},{"key":"S1478951525100783_ref64","first-page":"303","article-title":"\u00bfA qu\u00e9 se atribuye que los enfermos oncol\u00f3gicos de una unidad de cuidados paliativos mueran en paz?","volume":"5","author":"Mat\u00e9","year":"2008","journal-title":"Psicooncolog\u00eda"},{"key":"S1478951525100783_ref90","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(02)00335-5"},{"key":"S1478951525100783_ref56","doi-asserted-by":"publisher","DOI":"10.1017\/sjp.2014.35"},{"key":"S1478951525100783_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.05.010"},{"key":"S1478951525100783_ref74","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4057"},{"key":"S1478951525100783_ref1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.172.1.64"},{"key":"S1478951525100783_ref51","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000455"},{"key":"S1478951525100783_ref94","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2016.08.024"},{"key":"S1478951525100783_ref84","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2008.10.037"},{"key":"S1478951525100783_ref63","doi-asserted-by":"publisher","DOI":"10.4067\/S0718-22282005000100014"},{"key":"S1478951525100783_ref23","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1390"},{"key":"S1478951525100783_ref78","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.07.026"},{"key":"S1478951525100783_ref31","doi-asserted-by":"publisher","DOI":"10.3332\/ecancer.2021.1256"},{"key":"S1478951525100783_ref36","unstructured":"George, C , Kaplan, N and Main, M (1996) Adult attachment interview. Unpublished manuscript."},{"key":"S1478951525100783_ref8","first-page":"7","article-title":"Aproximaci\u00f3n a la historia y perspectivas de la Psicolog\u00eda del sufrimiento y de la muerte en Espa\u00f1a","volume":"100","author":"Bay\u00e9s","year":"2013","journal-title":"Informaci\u00f3n Psicol\u00f3gica"},{"key":"S1478951525100783_ref104","doi-asserted-by":"publisher","DOI":"10.11648\/j.ajpn.20190704.15"},{"key":"S1478951525100783_ref101","doi-asserted-by":"publisher","DOI":"10.1191\/0269216305pm994oa"},{"key":"S1478951525100783_ref73","doi-asserted-by":"publisher","DOI":"10.1186\/2050-7283-2-19"},{"key":"S1478951525100783_ref85","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1186"},{"key":"S1478951525100783_ref27","doi-asserted-by":"publisher","DOI":"10.1037\/int0000078"},{"key":"S1478951525100783_ref6","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.61.2.226"},{"key":"S1478951525100783_ref38","volume-title":"The Adult Attachment Projective Picture System: Attachment theory and assessment in adults","author":"George","year":"2012"},{"key":"S1478951525100783_ref67","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-200107000-00006"},{"key":"S1478951525100783_ref68","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011068"},{"key":"S1478951525100783_ref108","unstructured":"Viel, S (2019) La soledad existencial al final de la vida (Tesis doctoral) Universitat Aut\u00f2noma de Barcelona."},{"key":"S1478951525100783_ref114","first-page":"436","volume-title":"Handbook of attachment: Theory, research, and clinical applications","author":"Zeifman","year":"2008"},{"key":"S1478951525100783_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(01)00084-3"},{"key":"S1478951525100783_ref70","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-017-3634-7"},{"key":"S1478951525100783_ref61","first-page":"66","volume-title":"Growing points in attachment theory and research (Monographs of the Society for Research in Child Development, Serial no. 209","volume":"50","author":"Main","year":"1985"},{"key":"S1478951525100783_ref111","first-page":"95","volume-title":"S Y\u00e1rnoz (Comp.) La Teor\u00eda Del Apego En la Cl\u00ednica. Evaluaci\u00f3n Y Cl\u00ednica","author":"Y\u00e1rnoz","year":"2008"},{"key":"S1478951525100783_ref55","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaceta.2011.07.016"}],"container-title":["Palliative and Supportive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1478951525100783","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T12:36:08Z","timestamp":1759322168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1478951525100783\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":114,"alternative-id":["S1478951525100783"],"URL":"https:\/\/doi.org\/10.1017\/s1478951525100783","relation":{},"ISSN":["1478-9515","1478-9523"],"issn-type":[{"value":"1478-9515","type":"print"},{"value":"1478-9523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is used to distribute the re-used or adapted article and the original article is properly cited. The written permission of Cambridge University Press must be obtained prior to any commercial use.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e181"}}