Article Figures & Data
Tables
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).
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↵a Items retained in final scale.
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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).
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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.
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- Table 3
Construct Validity: Mean Physician Trust Scores by Clinician-Reported Behaviors and Patient Diagnoses
Full Scaleb Factor 1: Patient Rolec Factor 2: Respect for Boundariesd Variable No.a Mean±SD P Valuee Mean±SD P Valuee Mean±SD P Valuee Clinician-reported behaviorsf 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.
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↵b Possible scores range from 0 to 60; higher scores indicate greater trust.
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↵c Possible scores range from 0 to 40; higher scores indicate greater trust.
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↵d Possible scores range from 0 to 20; higher scores indicate greater trust.
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↵e P values were calculated by a generalized linear mixed model to account for clustering by clinician.
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↵f In the past 12 months.
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Additional Files
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.