Trust, social support and patient type--associations between patients perceived trust, supportive communication and patients preferences in regard to paternalism, clarification and participation of severely injured patients

Objective

Trust is an important aspect of physician–patient-interaction, both in terms of compliance and patient- and physician-reported outcomes. Trust-building communication is especially important in terms of severely injured patients because of severity of their injuries and frequently associated physical and psychological consequences. Patients preferences concerning medical treatment (patient type) is also regarded to be important in terms of trust. The objective of this study was to investigate the relationships between patients perceived trust, supportive communication of physicians and patient type of severely injured patients.

Methods

Seventy-one severely injured patients, who were predominantly injured in the workplace or in traffic accidents and were treated in one of four hospitals in Northrhine-Westfalia between 2001 and 2005, completed a self-administered questionnaire. “Trust in physicians_short form” (TRIP_sf) describes different aspects, such as general trust, competence of doctors and the feeling to be in good hands. “Informational support” and “emotional support” comprise verbal and non-verbal aspects, such as clear and understandable information or devotion and empathic manner. “Patient type” measures patients preferences in regard to paternalism of physician, clarification of medical facts and participation in treatment.

Results

Trust is strongly correlated with informational (.628**) and emotional support (.542**) and is less correlated with patients preferences of “paternalism” (.250*)“, “clarification” (.438**) and participation” (.378**). Informational and emotional support are in general not significantly correlated with type of patient, all correlations were adjusted for age, gender, marital and socioeconomic status, length of hospital stay, and severity of injury.

Conclusions

Trust is significantly related to patient type but more related to doctor support: the results confirm the importance of supportive communication in terms of emotional and informational support.

Practice implications

Medical education should integrate sound knowledge about the psychosocial aspects of physician patient interaction to enable doctors to provide effective social support and to identify and consider patients preferences.     

Trust and distrust among Appalachian women regarding cervical cancer screening: a qualitative study

Objective

To explore Appalachian women's perceptions of trust and distrust of healthcare providers and the medical care system as they relate to views about cervical cancer and screening.

Methods

Thirty-six Ohio Appalachia female residents participated in community focus groups conducted by trained facilitators. Discussion topics included factors related to cervical cancer, and the issues of trust and distrust in medical care. The tape-recorded focus groups were transcribed and analyzed to identify salient themes.

Results

Five themes emerged related to trust in healthcare. Patient-centered communication and encouragement from a healthcare provider led women to trust their physicians and the medical care system. In contrast, lack of patient-centered communication by providers and perceptions of poor quality of care led to distrust. Physician gender concordance also contributed to trust as women reported trust of female physicians and distrust of male physicians; trust in male physicians was reported to be increased by the presence of a female nurse.

Conclusions

Important factors associated with trust and distrust of providers and the medical care system may impact health-seeking behaviors among underserved women.

Practice implications

Opportunities to improve patient-centered communication around the issues of prevention and cervical cancer screening (such as providing patient-focused information about access to appropriate screening tests) could be used to improve patient care and build patients’ trust.     

Patient–practitioner relationships desired by overweight/obese adults

Objective

This study investigated the characteristics of the patient–practitioner relationship desired by overweight/obese individuals in weight management. The aim was to identify characteristics of the relationship which empower patients to make lifestyle changes.

Methods

Grounded theory was used inductively to build a model of the patient–practitioner relationship based on the perspectives of 21 overweight/obese adults.

Results

Emerging from the match between patient and practitioner characteristics, collaboration was the key process explicitly occurring in the patient–practitioner relationship, and was characterised by two subcategories; perceived power dimensions and openness. Trust emerged implicitly from the collaborative process, being fostered by relational, informational, and credible aspects of the interaction. Patient trust in their practitioner consequently led to empowering outcomes including goal ownership and perceiving the utility of changes.

Conclusion

An appropriate match between patient and practitioner characteristics facilitates collaboration which leads to trust, both of which appear to precede empowering outcomes for patients such as goal ownership and perceiving the utility of changes. Collaboration is an explicit process and precedes the patient trusting their practitioner.

Practice implications

Practitioners should be sensitive to patient preferences for collaboration and the opportunity to develop trust with patients relationally, through information provision, and modelling a healthy lifestyle.     

从患者视角看预设性信任／不信任及其根源

预设性信任是患者主动建立医患关系的先决条件：患者如果没有对医生的预设性信任,现实的医患关系则难以建立。预设性信任是患者应对复杂性和不确定性的简化机制,是减轻心理恐慌感和焦虑感的“求放心”策略,是道德主义的信任和心理契约,更是对医学科学的信仰和对专家系统信任的直接反应。而患者的预设性不信任则可能导致医患信任关系的崩溃。     

关于医院投诉性信访问题的伦理思考

实现医患关系和谐是医院管理工作的重要价值诉求。医院在处理群众投诉性信访问题的过程中,管理者在思想认识上高度重视,医患间相互信任,确立一套行之有效的应对投诉性信访问题的伦理机制,有利于投诉性信访问题的解决及和谐医患关系的建构。     

A sniff of trust: meta-analysis of the effects of intranasal oxytocin administration on face recognition, trust to in-group, and trust to out-group

The neuropeptide oxytocin has a popular reputation of being the 'love' hormone. Here we test meta-analytically whether experiments with intranasal administration of oxytocin provide support for the proposed effects of oxytocin. Three psychological effects were subjected to meta-analysis: facial emotion recognition (13 effect sizes, N=408), in-group trust (8 effect sizes, N=317), and out-group trust (10 effect sizes; N=505). We found that intranasal oxytocin administration enhances the recognition of facial expressions of emotions, and that it elevates the level of in-group trust. The hypothesis that out-group trust is significantly decreased in the oxytocin condition was not supported. It is concluded that a sniff of oxytocin can change emotion perception and behavior in trusting relationships.     

Temporality in chronic diseases and adherence to long-term therapies: From philosophy to science and back

This narrative review exhibits the construction and validation of a hypothesis to explain how treatment non-adherence in people with chronic disease, a major issue in contemporary medicine, occurs. I propose that non-adherence to long-term therapies is at least in part due to failure to prioritize the future, which is caused by a condition I dub disruption in time projection. This article gives the rationale for this hypothesis, which is largely grounded on philosophical arguments. Then, it demonstrates the plausibility of the hypothesis: on the one hand, it is consistent with certain epidemiological data found in the literature. On the other, it is possible to predict the underlying mechanisms of this lack of prioritization from recent achievements of neuro-economics and neuroscience. Next, it reviews empirical data that provide an experimental verification for this explanatory hypothesis. Finally, a general evolutionary and philosophical meaning for adherence is proposed, considering the advantages of its preconditions, namely, patience and foresight.     

Lay people's experiences with reading their medical record

An increasing number of patients now make use of their legal right to read their medical record. We report findings from a study in which we conducted qualitative interviews with 17 Norwegian adult patients about their experiences of requesting a copy of their medical record following a hospital stay. Interviews took place between May, 2008 and April 2009. The analytical process, guided by qualitative content analysis, identified two main themes; "keeping a sense of control" and "not feeling respected as a person". The informants' experiences with reading their own medical record were often connected to their experiences in direct communication with health care professionals during the hospital stay, revealing a delicate interaction between trust and power. The informants were hoping for a more mutual exchange of information and knowledge from which they could benefit in the management of their own health. We conclude that to meet patients' expectations of mutuality, health care professionals in hospitals need to be more conscious about their attitudes and communication skills as well as how they exercise their power to define the patient's situation. At the same time, there should be more focus on how structural changes in the organization of hospitals may have impaired the capacity of health care professionals to meet these expectations. In the future, greater attention should also be paid to information exchange to avoid placing unreasonable responsibility on the patient to compensate for deficits in the health care system.