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Research ArticleMethodology

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

David H. Thom, Sabrina T. Wong, David Guzman, Amery Wu, Joanne Penko, Christine Miaskowski and Margot Kushel
The Annals of Family Medicine March 2011, 9 (2) 148-154; DOI: https://doi.org/10.1370/afm.1224
David H. Thom
MD, PhD
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  • For correspondence: dthom@fcm.ucsf.edu
Sabrina T. Wong
RN(c), PhD
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David Guzman
MSPH
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Amery Wu
PhD
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Joanne Penko
MS, MPH
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Christine Miaskowski
RN, PhD, FAAN
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Margot Kushel
MD
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Tables

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    Table 1

    Candidate Items for Trust in the Patient Scale

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

    • View popup
    Table 2

    Physician Trust in the Patient, Pratt Matrix D

    ItemDescription (Root: “How confident are you that this patient will…”)PSCD
    F1F2F1F2–F1F2
    1Provide all the medical information you need?.85.12.92.57.850.920.08
    4Let you know when there has been a major change in his or her condition?.91−.10.86.38.741.06−0.05
    5Tell you about all medications and treatments he or she is using?.83.10.89.54.800.930.07
    6Understand what you tell him/her?.73.09.78.47.610.930.07
    9Follow the treatment plan you recommend?.86.08.90.53.820.940.05
    11Be actively involved in managing his/her condition/problem?.94−.09.89.41.801.05−0.05
    12Tell you if he/she is not following the treatment plan?.86.00.85.45.731.000.00
    14Respect your time?.01.89.48.89.800.010.99
    15Respect personal boundaries?.00.95.50.96.910.001.00
    16Not make unreasonable demands?−.02.99.50.98.96−0.011.01
    17Not manipulate the office visit for secondary gain (eg, for inappropriate disability certification or prescription of controlled substances)?.12.82.55.88.790.080.92
    18Keep his or her appointments?.69.19.79.56.650.840.16
    • 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.

    • View popup
    Table 3

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

    Full ScalebFactor 1: Patient RolecFactor 2: Respect for Boundariesd
    VariableNo.aMean±SDP ValueeMean±SDP ValueeMean±SDP Valuee
    Clinician-reported behaviorsf
    Ordered toxicology screen<.001.001<.001
     Yes3237.4±10.623.7±8.013.8±4.4
     No12745.1±10.328.8±7.616.3±4.0
    Discontinued opioid because violated agreement.14.13.77
     Yes834.4±9.222.5±7.512.4±4.7
     No6040.5±10.527.0±8.014.4±4.2
    Did not prescribe opioid because concerned about misuse<.001<.001<.001
     Yes2634.3±10.622.3±7.712.0±4.7
     No13745.1±9.928.6±7.716.4±3.7
    Patient reported opioid lost or stolen.008.057.003
     Sometimes/often/very often2136.5±10.524.2±7.412.3±5.0
     Never/rarely8743.7±10.627.9±8.115.8±4.1
    Patient has used opioid to get high<.001<.001<.001
     Definitely/probably/maybe3736.5±10.023.4±11.013.2±4.0
     Probably not/definitely not7344.8±10.428.8±7.816.0±4.1
    Patient has sold, traded, stolen, given away opioid<.001<.001<.001
     Definitely/probably/maybe4636.3±9.523.0±7.113.2±4.8
     Probably not/definitely not6446.2±10.129.8±7.616.4±3.7
    Patient diagnoses
    Diabetes.53.33.78
     Yes1944.9±13.829.4±10.115.6±4.4
     No14643.2±10.127.4±7.615.8±4.0
    Peripheral neuropathy.87.78.26
     Yes7743.4±11.327.9±8.315.5±4.5
     No7943.2±10.427.3±7.915.9±4.0
    History of cancer.89.95.98
     Yes1342.6±12.227.4±8.915.2±4.3
     No15243.5±10.527.2±7.915.8±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.

Additional Files

  • Tables
  • The Article in Brief

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

    David H. Thom , and colleagues

    Background Although there are several measures of patient trust in the physician, this study describes the development and validation of the first measure of physician trust in the patient.

    What This Study Found Developed as part of a community-based study of prescription opioid use for chronic pain in HIV-infected patients, the final 12-item scale demonstrated high internal consistency, a distinct 2-factor pattern, and both convergent and discriminant validity. The final measure, which is consistent with the limited published qualitative work on physician trust of patients, includes items asking about expectations that patients will behave in ways that fulfill their roles in providing accurate and complete histories, asking questions, following a treatment plan, and following up. It also includes respecting the physician�s boundaries and not manipulating the relationship for personal gain.

    Implications

    • The authors suggest that the new measure will provide a better understanding of the relationship between mutual trust and processes and outcomes of care leading to improvements in the quality of care and both patient and physician satisfaction.
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The Annals of Family Medicine: 9 (2)
The Annals of Family Medicine: 9 (2)
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Physician Trust in the Patient: Development and Validation of a New Measure
David H. Thom, Sabrina T. Wong, David Guzman, Amery Wu, Joanne Penko, Christine Miaskowski, Margot Kushel
The Annals of Family Medicine Mar 2011, 9 (2) 148-154; DOI: 10.1370/afm.1224

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Physician Trust in the Patient: Development and Validation of a New Measure
David H. Thom, Sabrina T. Wong, David Guzman, Amery Wu, Joanne Penko, Christine Miaskowski, Margot Kushel
The Annals of Family Medicine Mar 2011, 9 (2) 148-154; DOI: 10.1370/afm.1224
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