Predictors of trust in the medical profession among cancer patients receiving palliative care: A preliminary study.

Abstract

Background: Trust influences healthcare through the willingness to seek care, disclose sensitive information, adhere to treatment, and satisfaction with care. Understanding factors that influence trust may help in physician-patient relationship particularly at end of life. Objectives: We explored the association between trust and other demographic and psychosocial factors. We also explored the performance of the single-item Degree of Trust scale (0 best to 10 worst) compared with the validated five-item Trust in Medical Profession scale (5 best to 25 worst). Design: A secondary analysis of prospectively collected data was performed. Trust scores completed by 100 patients were correlated with age, gender, ethnicity, educational level, anxiety, depression, and hopefulness (Herth Hope Index [12 best to 48 worst]). Setting/Subjects: The study was conducted on 100 patients in an outpatient Supportive Care Center in a cancer center in Houston, Texas. Results: Median age was 57 years (49-65), depression was 6 (3-9), and hopefulness was 22 (20-25). Trust in Medical Profession score was 13, 11-14 (median, IQR) and Degree of Trust score was 2, 1-4 (median, IQR) with moderate correlation (r = 0.587, p < 0.001). On evaluating performance of Degree of Trust scale to the validated Trust in Medical Profession scale, a moderately high performance was found (Youden's J = 0.73; Topleft = 0.21). Older age ( p = 0.02) lower depression scores ( p < 0.01) and more hopefulness ( p = 0.01) were associated with higher levels of trust. Conclusions: Trust was associated with older age, less depressed, and more hopeful patients. A single 0-10 item trust scale was found to perform adequately compared with a multiple-item questionnaire.

Patient Perceptions of Care as Influenced by a Large Institutional Pharmacogenomic Implementation Program

“…Changes at a similar scale have previously been associated with significant changes to clinical outcomes. [20][21][22][23][24][25] To better understand this improvement in scores across several dimensions, we measured whether these visits were associated with longer clinical encounters, noting that the mean estimated provider minutes available was 5.6 minutes higher for GPS Log In visits than No Log In visits (29.2 [9.1] vs. 23.6 [7.1]; P < 0.001). This suggests that physicians were more likely to use the GPS when more time was available for the encounter.…”

“…Previous work has demonstrated that small changes to patient perceptions measured with similar survey tools can be associated with significant changes in clinical outcomes. [20][21][22][23][24][25] Trust and privacy findings were also intriguing. Trust scores, which measured a patient's belief that the provider had his or her best interest in mind when making clinical decisions, were not affected for the genotyped patients in this study by their providers' use of pharmacogenomics.…”

“…36 Previous work using similar measurement tools has shown that small differences in Likert-type scores can be associated with significant changes in clinical outcomes and patient adherence. [20][21][22][23][24][25] Each dimension consisted of one to four questions, and responses were based on a five-point Likert scale (agree strongly 5 5; agree somewhat 5 4; not sure 5 3; disagree somewhat 5 2; disagree strongly 5 1). Each dimension score was a mean of the sum of the questions in the dimension scale.…”

Trust in physicians among patients with head and neck cancer before and after treatment

“…Age and sex have been shown to play a role in patient–physician trust in other studies which showed that older patients and patients who are sex congruent with his or her physician have higher trust 10,19 . In this cohort of 50 patients with head and neck cancer, age was not associated with differences in trust.…”

“…Existing data demonstrate that various factors can affect patients' trust in providers, including both intrinsic patient characteristics and various aspects of their interactions with providers. In one study of patients with a broad range of cancers, older, less depressed, and more hopeful patients were more likely to have trust in their physician 10 . These results have been corroborated by similar large‐scale studies in primary care 11,12 .…”