How patients’ trust relates to their involvement in medical care

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Original Research

How patients’ trust relates to their involvement in medical care

J Fam Pract. 2005 April;54(4):344-352

By

Felicia Trachtenberg, PhD

Trust in the medical profession is associated with greater willingness to seek care and follow recommendations

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References

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Practice recommendations

Do not assume that assertive patient involvement indicates distrust. Patient preferences for participation vary, and it is important to communicate with them about their wishes.
Promoting trust is unlikely to result in a paternalistic relationship. Listen to patients carefully, give them as much information as they want, and involve them in decisions.

ABSTRACT

Methods: Data were collected from a national telephone survey of English-speaking adults (N=553) in 1999. Eligibility requirements were some type of public or private health care coverage and having seen a physician or other health professional at least twice in the past 2 years. Five questions on preferred role in medical care were asked. Trust in physicians and satisfaction with care were separately measured using validated scales.

Results: The most significant predictor of patients’ preferred role in medical care is trust in the medical profession. Views also varied by sex, age, health, education, income, number of visits/years with physician, past dispute with a physician, and satisfaction with care, but many of these bivariate associations were no longer significant in multivariate regression models. Views varied slightly by trust in the specific physician. There were no racial differences.

Conclusions: A strong connection exists between patients’ preferred involvement in medical care and trust in the medical profession, but only a slight connection with trust in their own physician. Increased trust in physicians generally is associated with greater willingness to seek care, to follow recommendations of physicians, and to grant them decisional authority. Higher trust in a specific physician is strongly associated only with greater reported adherence. Although higher trust in the medical profession appears to entail a more deferential role by patients, higher trust is also consistent with more active patient roles such as seeking care and adhering to treatment regimens.

It is widely perceived and documented that both of the following are valuable attributes of treatment relationships: 1) patients’ trust in physicians and in the medical profession,¹ and 2) patients’ active involvement in treatment seeking, decision making, and adherence.^2-8 Both patient trust and active patient involvement are desirable in their own right and because they are associated with improved health outcomes. Paradoxically, however, it might be thought that these 2 attributes are in sharp conflict.

Patient trust might be more consistent with a deferential style of patient-physician interaction in which patients are passive, in contrast to assertive patient questioning or limitation of physician authority which might be indicative of patient distrust. If so, then pursuing active patient involvement might lead to lower trust, or promoting trust might lead to more passive patients, either of which might compromise optimal treatment relationships and health outcomes. At a minimum, it is a conceptual puzzle how these 2 views of desirable attributes of medical relationships can coexist without each taking account of the other view. There certainly are skeptics of patient trust who warn that, contrary to conventional wisdom, too much trust might be negative and that patients, for their own good, should be encouraged to trust less to avoid the dangers of paternalistic medicine,⁹ especially in managed care settings. ^10,11

Numerous studies examine either patient trust or patients’ roles in seeking care, level of participation in medical decisions, and adherence to treatment. However, few studies examine both halves of these 2 sets of attitudes and behaviors, and none examine the full cluster. None of the leading studies of patients’ attitudes toward seeking care or participating in medical decisions include measures of trust. A few studies of care-seeking also examine attitudes similar to or overlapping with trust, such as confidentiality or competency,^12,13 but none of these use the trust concept itself or any of the validated instruments that measure trust. Among studies of trust, some have explored trust’s connections with adherence,¹⁴ preferred role in decision making,¹⁵ patients’ requests for specific services,¹⁶ or willingness to seek care,^17,18 but few studies simultaneously explore these measures,^17,18and only 1 study examines how they relate to trust in the medical profession, rather than trust in a specific physician.¹⁸ In general, these studies report that trust in a specific physician is associated with greater adherence to treatment recommendations, more willingness to seek care, and giving physicians more control over medical decisions.

Absent in this literature is any concurrent examination of how different types of trust relate to various aspects of patients’ views about their involvement in medical care. To advance understanding of these important connections, this study was designed to investigate whether patients’ trust in their primary physician and in the medical profession are related to their attitudes toward seeking care, preferred roles in medical decision making, and reported adherence to treatment recommendations.