Concepts of trust among patients with serious illness
Section snippets
Exploratory study design
In this study we interviewed 90 patients, 30 each from three illness groups: breast cancer, chronic Lyme disease, and mental illness. Each of these illnesses is characterized by its severity and the uncertainty of its prognosis, characteristics that we believe are likely to contribute to intense relationships with physicians and increase the saliency of trust in the relationship. The breast cancer subjects were all recruited from a treatment/research center that exclusively treats cancer
Socio-demographic characteristics of subjects
Due at least in part to the different contexts from which they were recruited, the three groups differed significantly in their demographic characteristics (see Table 1). These differences probably contributed to some of the variations in their views on trust. All breast cancer patients were female; in the Lyme disease group, twenty-five of the thirty respondents were female; and fourteen, a significantly lower number, of the patients with mental illness were female. In terms of age, subjects
Biases
There are several biases inherent in this study. First, the three samples were recruited from different clinics and patient self-help groups and are not representative of all such patients. For example, members of self-help groups are self-selected and tend to be more involved and vocal than patients generally. Since recruitment differed by group, comparisons across groups may reflect such differences. Second, the interview schedule followed a conceptual view of trust that helped frame the
Dimensions of trust
Our interview guide asked questions about the five dimensions of trust derived from our conceptual approach: competence (technical and interpersonal); fiduciary responsibility and agency; control; disclosure; and confidentiality (Mechanic, 1998a, Mechanic, 1998b). The interviews enhanced our understanding of how patients construed these varying areas and how interpretations may differ among different patient groups. In addition, other dimensions of trust became apparent as the interviews were
Major differences among illness groups
There were some noteworthy differences among the three patient groups in the emphasis placed on different aspects of trust, as can be seen in Table 2. As noted in the previous discussion of the study design, the different means by which each group was recruited could account for some of the differences found. Further, the groups’ demographic characteristics are dissimilar which could also contribute to appreciable differences, as discussed below. Despite these potential biases, it appears that
Differences by patient characteristics
Clearly, the differences among groups are likely to have contributed to the variation in the type of comments and the relative frequency with which different aspects of trust were mentioned by each group, as was illustrated in Table 2, and this should be considered when viewing the study results. That the thirty patients with mental illness had substantially less to say overall (5642 total phrases for their interviews as opposed to 6371 and 6962 total phrases for the breast cancer and Lyme
Discussion and conclusions
There are tangible clinical, economic, and ethical consequences when trust is undermined. A major way of countering this and building patient trust is to provide opportunities for patients to select their health plans and physicians (Kao et al., 1998a, Kao et al., 1998b). The market transformations brought about by more restricted choices and the growth of more rigorous managed care affect patient trust. In respect to the former, almost half of employees in large firms and four-fifths of
Acknowledgements
This article was supported, in part, by an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation.
References (27)
- et al.
Understanding the quality challenge for health consumers: The Kaiser/AHCPR study
Journal of Quality Improvement
(1997) - et al.
Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships
Psychological Reports
(1990) The logic and limits of trust
(1983)- et al.
Understanding the managed care backlash
Health Affairs
(1998) - et al.
Bridging the gap between expert and public views on health care reform
Journal of the American Medical Association
(1993) Chronic fatigue syndrome
(1993)- et al.
Sharing decisions with patients: is the information good enough?
British Medical Journal
(1999) - et al.
The four habits of highly effective clinicians: A practical guide
(1996) - et al.
Small employers and their health benefits, 1988–1996: An awkward adolescence
Health Affairs
(1997) - et al.
Informing consumer decisions in health care: implications from decision-making research
Milbank Quarterly
(1997)
Patients’ trust in their physicians: Effects of choice, continuity, and payment method
Journal of General Internal Medicine
The relationship between method of payment and patient trust
Journal of The American Medical Association
Trust and power
Cited by (420)
Will the reforms of medical studies really produce better doctors?
2023, Revue du Rhumatisme (Edition Francaise)Is patients' trust in clinicians related to patient-clinician racial/ethnic or gender concordance?
2023, Patient Education and CounselingUnderstanding Health Attitudes and Behavior
2023, American Journal of MedicineDiscrimination, trust, and withholding information from providers: Implications for missing data and inequity
2022, SSM - Population HealthInformal payments and patients’ perceptions of the physician agency problem: Evidence from rural China
2022, Social Science and Medicine