Physician Trust in the Patient: Development and Validation of a New Measure

Article Figures & Data

Table 1

Candidate Items for Trust in the Patient Scale

Item	Description (Root: “How confident are you that this patient will…”)
1	Provide all the medical information you need?^a
2	Answer your questions honestly?
3	Accurately report (not exaggerate or downplay) his or her symptoms?
4	Let you know when there has been a major change in his or her condition?^a
5	Tell you about all medications and treatments he or she is using?^a
6	Understand what you tell him/her?^a
7	Accept your medical judgment?
8	Believe what you say?
9	Follow the treatment plan you recommend?^a
10	Ask appropriate questions?
11	Be actively involved in managing his/her condition/ problem?^a
12	Tell you if he/she is not following the treatment plan?^a
13	Tell you if she/he has a problem with something you did?
14	Respect your time?^a
15	Respect personal boundaries?^a
16	Not make unreasonable demands?^a
17	Not manipulate the office visit for secondary gain (eg, for inappropriate disability certification or prescription of controlled substances)?^a
18	Keep his or her appointments?^a

Notes: Response scale: 1 = not at all confident; 2 = a little confident; 3=some-what confident; 4=mostly confident; 5=completely confident. Relationship of items to themes from the qualitative study: provide accurate and complete information (items 1–5), adhere to the agreed upon treatment plan (items 6–9), actively participate in his or her care (items 10–13), respect the physician (items 14–16), not manipulate for secondary gain (item 17), remain committed to the relationship (item 18).
↵a Items retained in final scale.

Table 2

Physician Trust in the Patient, Pratt Matrix D

Item	Description (Root: “How confident are you that this patient will…”)	P		S		C		D

		F1	F2	F1	F2	–	F1	F2
1	Provide all the medical information you need?	.85	.12	.92	.57	.85	0.92	0.08
4	Let you know when there has been a major change in his or her condition?	.91	−.10	.86	.38	.74	1.06	−0.05
5	Tell you about all medications and treatments he or she is using?	.83	.10	.89	.54	.80	0.93	0.07
6	Understand what you tell him/her?	.73	.09	.78	.47	.61	0.93	0.07
9	Follow the treatment plan you recommend?	.86	.08	.90	.53	.82	0.94	0.05
11	Be actively involved in managing his/her condition/problem?	.94	−.09	.89	.41	.80	1.05	−0.05
12	Tell you if he/she is not following the treatment plan?	.86	.00	.85	.45	.73	1.00	0.00
14	Respect your time?	.01	.89	.48	.89	.80	0.01	0.99
15	Respect personal boundaries?	.00	.95	.50	.96	.91	0.00	1.00
16	Not make unreasonable demands?	−.02	.99	.50	.98	.96	−0.01	1.01
17	Not manipulate the office visit for secondary gain (eg, for inappropriate disability certification or prescription of controlled substances)?	.12	.82	.55	.88	.79	0.08	0.92
18	Keep his or her appointments?	.69	.19	.79	.56	.65	0.84	0.16

C = communality (the percentage of variance in each item explained by the 2 factors); D = P × S/C (the Pratt D value, the proportion of the explained variance attributable to each factor; a measure of the relative importance of each factor to a given item); F1 = Factor 1; F2 = Factor 2; P = pattern coefficient (the equivalent of the standardized partial regression coefficient, ie, slope of a factor on the item); S = structure coefficient (the equivalent of the simple Pearson correlation between an item and each factor).
Note: Factor 1 (Patient Role) is composed of items 1, 4, 5, 6, 9, 11, 12, and 18; Factor 2 (Respect for Boundaries) is composed of items 14, 15, 16, and 17.

Table 3

Construct Validity: Mean Physician Trust Scores by Clinician-Reported Behaviors and Patient Diagnoses

		Full Scale^b		Factor 1: Patient Role^c		Factor 2: Respect for Boundaries^d

Variable	No.^a	Mean±SD	P Value^e	Mean±SD	P Value^e	Mean±SD	P Value^e
Clinician-reported behaviors^f
Ordered toxicology screen			<.001		.001		<.001
Yes	32	37.4±10.6		23.7±8.0		13.8±4.4
No	127	45.1±10.3		28.8±7.6		16.3±4.0
Discontinued opioid because violated agreement			.14		.13		.77
Yes	8	34.4±9.2		22.5±7.5		12.4±4.7
No	60	40.5±10.5		27.0±8.0		14.4±4.2
Did not prescribe opioid because concerned about misuse			<.001		<.001		<.001
Yes	26	34.3±10.6		22.3±7.7		12.0±4.7
No	137	45.1±9.9		28.6±7.7		16.4±3.7
Patient reported opioid lost or stolen			.008		.057		.003
Sometimes/often/very often	21	36.5±10.5		24.2±7.4		12.3±5.0
Never/rarely	87	43.7±10.6		27.9±8.1		15.8±4.1
Patient has used opioid to get high			<.001		<.001		<.001
Definitely/probably/maybe	37	36.5±10.0		23.4±11.0		13.2±4.0
Probably not/definitely not	73	44.8±10.4		28.8±7.8		16.0±4.1
Patient has sold, traded, stolen, given away opioid			<.001		<.001		<.001
Definitely/probably/maybe	46	36.3±9.5		23.0±7.1		13.2±4.8
Probably not/definitely not	64	46.2±10.1		29.8±7.6		16.4±3.7
Patient diagnoses
Diabetes			.53		.33		.78
Yes	19	44.9±13.8		29.4±10.1		15.6±4.4
No	146	43.2±10.1		27.4±7.6		15.8±4.0
Peripheral neuropathy			.87		.78		.26
Yes	77	43.4±11.3		27.9±8.3		15.5±4.5
No	79	43.2±10.4		27.3±7.9		15.9±4.0
History of cancer			.89		.95		.98
Yes	13	42.6±12.2		27.4±8.9		15.2±4.3
No	152	43.5±10.5		27.2±7.9		15.8±4.2

↵a Numbers of patients do not total to 168 because of missing data.
↵b Possible scores range from 0 to 60; higher scores indicate greater trust.
↵c Possible scores range from 0 to 40; higher scores indicate greater trust.
↵d Possible scores range from 0 to 20; higher scores indicate greater trust.
↵e P values were calculated by a generalized linear mixed model to account for clustering by clinician.
↵f In the past 12 months.