Establishing trust between physicians and patients with rheumatic diseases

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Public release date: 26-May-2006

Establishing trust between physicians and patients with rheumatic

diseases

Study finds relationships can be improved by using patient-centered

approach

Trust between a patient and doctor is a key factor in promoting

improved quality of life, compliance with treatment, and better

health outcomes. Without trust, the patient-doctor relationship may

not become firmly established, thus potentially hindering physicians'

ability to help patients. This is of special concern in the setting

of rheumatic diseases, which are chronic and involve patient-doctor

relationships that need to be established over a lifetime of disease;

yet few studies have been conducted to identify the components of

establishing trust in these patients. A new study published in the

June 2006 issue of Arthritis Care & Research (http://

www.interscience.wiley.com/journal/arthritiscare) examined ethnically

diverse patients with rheumatoid arthritis (RA) or systemic lupus

erythematosus (SLE) to determine the elements of the patient-doctor

relationship associated with trust in physicians.

Led by P. Berrios- of the Baylor College of Medicine in

Houston, Texas, researchers assessed 102 patients with SLE or RA who

were being treated at outpatient rheumatology clinics at publicly

funded hospitals in Houston between September and November 2003.

Patients responded to a questionnaire that assessed various aspects

of the medical encounter, including doctors' informativeness,

sensitivity to concerns, reassurance and support, and patient-

centered behavior (e.g. " My doctors always ask me what I need " ).

Patients were also evaluated in terms of their willingness to

disclose information to their physicians and their trust in the U.S.

heath care system. Thirty-one percent of the patients were African-

American, 43% were Latino and 25% were White.

The results showed that patients' trust of their doctors was

independently associated with ethnicity, quality of the patient-

doctor relationship, disease activity, and trust in the U.S. health

care system. There was a lower level in trust observed in Latino and

African-American patients, that the authors hypothesized could be due

to subconscious biases or misconceptions on the part of physicians

and/or patients that could interfere with open communication,

empathy, and the development of trust. Physicians' patient-centered

communication was the only variable that was significantly associated

with patients' willingness to disclose information; the researchers

did not find an association between trust or ethnicity and patient

disclosure of information. " This finding suggests that physician

interaction styles that are centered on patients' concerns result in

more effective communication on the part of the patient, clearly

reinforcing the importance of the doctor-patient dynamic, " the

authors state, adding that emphasizing these components of the

patient-doctor relationship can lead to increased information sharing

by patients.

Although the study may have been limited by its size, and by the fact

that patients may have recalled only their most recent experiences

(recall bias) or may have responded with answers they thought were

socially acceptable, it has several strengths. It evaluated specific

components of the patient-doctor encounter in an ethnically diverse

group of patients, and it had nearly complete data for most of the

questions. The authors suggest that additional studies in other

patient populations are needed, but the current study indicates that

improving doctor-patient communication would result in increased

trust in physicians, which would positively affect health outcomes.

The authors conclude by stating that the, " data suggest that trust in

physicians is significantly and independently associated with

patient's ethnicity and specific components of physicians'

communicative style, including informativeness, sensitivity to

concerns, and patient-centeredness. " Moreover, they add that trust

can also be improved by being sensitive to patients' concerns and

providing adequate medical information.

http://www.eurekalert.org/pub_releases/2006-05/jws-etb052406.php