Trust in One's Physician: The Role of Ethnic Match, Autonomy, Acculturation, and Religiosity Among Japanese and Japanese Americans

Abstract

PURPOSE Trust is a cornerstone of the physician-patient relationship. We investigated the relation of patient characteristics, religiosity, acculturation, physician ethnicity, and insurance-mandated physician change to levels of trust in Japanese American and Japanese patients.METHODS A self-administered, cross-sectional questionnaire in English and Japanese (completed in the language of their choice) was given to community-based samples of 539 English-speaking Japanese Americans, 340 Japanese-speaking Japanese Americans, and 304 Japanese living in Japan.RESULTS Eighty-seven percent of English-speaking Japanese Americans, 93% of Japanese-speaking Japanese Americans, and 58% of Japanese living in Japan responded to trust items and reported mean trust scores of 83, 80, and 68, respectively, on a scale ranging from 0 to 100. In multivariate analyses, Englishspeaking and Japanese-speaking Japanese American respondents reported more trust than Japanese respondents living in Japan (P values <.001). Greater religiosity (P <.001), less desire for autonomy (P <.001), and physician-patient relationships of longer duration (P <.001) were related to increased trust. Among Japanese Americans, more acculturated respondents reported more trust (P <.001), and Japanese physicians were trusted more than physicians of another ethnicity. Among respondents prompted to change physicians because of insurance coverage, the 48% who did not want to switch reported less trust in their current physician than in their former physician (mean score of 82 vs 89, P <.001).CONCLUSIONS Religiosity, autonomy preference, and acculturation were strongly related to trust in one's physician among the Japanese American and Japanese samples studied and may provide avenues to enhance the physician-patient relationship. The strong relationship of trust with patient-physician ethnic match and the loss of trust when patients, in retrospect, report leaving a preferred physician suggest unintended consequences to patients not able to continue with their preferred physicians. INTRODUCTIONT rust between a patient and physician is a cornerstone of the patientphysician relationship.1,2 Trust can facilitate health information exchange, 3 as well as determine a patient' s willingness to seek care, 3,4 receptivity to health promotion counseling, 5-7 openness to examination and treatment, 4,5,[7][8][9][10][11] and likelihood of return for follow-up care. 5,10 Patients with more trust in their physician are likely to be more satisfi ed with care 5,[11][12][13][14] and to have positive clinical outcomes. 5,9,11 In recent years, patient trust has been challenged by perceived confl icts of interest inherent in managed Derjung M. Tarn, MD, MS 1 Lisa S. Meredith, PhD 2 Marjorie Kagawa-Singer, RN, PhD 3 Shinji Matsumura, MD, MSHS 4 Seiji Bito, MD, MSHS 5 Robert K. Oye, MD 6 Honghu Liu, PhD 6 Katherine L. Kahn, MD 6 Shunichi Fukuhara, MD 7 Neil S. Wenger, MD, MPH 8,[15][16][17][18][19][20] and by societal changes lea...

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