How patients’ trust relates to their involvement in medical care

The Journal of Family Practice. 2005 April;54(4):344-352

April 1, 2005|The Journal of Family Practice

Trust in the medical profession is associated with greater willingness to seek care and follow recommendations

Methods

How the sample was collected

A random national sample of 2637 households was selected in 1999 from a proprietary database of working residential telephone exchanges in the continental United States. A minimum of 15 attempts was made to reach those numbers that were not answered. Respondent selection within eligible households was done using the next birthday method.¹⁹

FAST TRACK

Attitudes toward and preferred roles in medical care were measured by the 5 questions listed in Table 1

Inclusion criteria for the study included being at least 21 years of age and the ability to speak and understand English. Because this survey was part of a larger study of recent experiences with physicians and health insurers,^20-22 respondents were further screened to select only those with some type of public or private health care coverage and those who had been to a physician or other health professional at least twice during the past 2 years. Health care coverage broadly includes any type of public or private insurance, or access to other type of government or indigent care program or facility.

Contacts with 2172 potentially eligible individuals resulted in the following dispositions: 1117 (51.4%) were interviewed; 571 (26.3%) refused; 484 (22.3%) were unable to participate (not home, ill, non-English-speaking). To reduce respondent burden, the sample was randomly divided and only half (N=553) were asked the battery of questions about trust in the medical profession and following physicians’ recommendations. (The other half were asked other questions unrelated to this analysis. There were no statistically significant differences between the 2 halves on age, race, gender, health status, education, or income.)

Due to the particular selection criteria and survey method, this random sample is not fully representative of national norms. There is a somewhat greater representation of whites (84.3%) and females (68.9%) because they are more likely to have insurance and have gone to a physician recently. Otherwise, the majority of our sample was between 30 to 60 years old (58%) and college educated (58%), with a median income of about $40,000. Thus, the sample composition is sufficient to analyze most major demographic and socioeconomic groups.

Telephone interviews lasted approximately 25 minutes and were conducted by trained interviewers at the Survey Research Center of the University of South Carolina using computer assisted telephone interviewing. Verbal informed consent was obtained at the start of the telephone interviews and the study protocols were reviewed and approved by Wake Forest University Medical Center’s Institutional Review Board.

Measures

Attitudes toward and preferred roles in medical care were measured by the 5 questions listed in TABLE 1 . Data were also collected on a range of topics, including demographic characteristics, trust in the subject’s regular physician and the medical profession, satisfaction with care, and physical and mental health. Trust in the specific physician and in the medical profession were measured by 5-item scales, whose validation and properties are reported elsewhere (Cronbach’s alpha ≥0.77 for all).²³ Satisfaction with medical care was measured with a previously validated 12-item scale asking about health care received from all sources over the past few years.²⁴

TABLE 1
Items assessing patients’ roles in medical relationships

You always follow physicians’ recommendations about treatment. (5-point scale: strongly agree-strongly disagree) It is better to rely on the expert judgment of physicians than to rely on common sense in taking care of your own body. (agree/disagree)³⁸ It is almost always better to seek professional help than to try to treat yourself. (agree/disagree)³⁸ Which one statement best describes your attitude towards medical care? ³⁵ The patient should take complete control The patient should have more control than the physician The patient and the physician should share control equally The physician should have more control than the patient The physician should take complete control. What role do you prefer to play in your visits to the physician? ³⁹ You make all of the final decisions The physician and you make the final decisions together The physician considers some of your ideas but still makes most, if not all, of the final decisions The physician takes the initiative and decides what is best for you.

You always follow physicians’ recommendations about treatment. (5-point scale: strongly agree-strongly disagree)
It is better to rely on the expert judgment of physicians than to rely on common sense in taking care of your own body. (agree/disagree)³⁸
It is almost always better to seek professional help than to try to treat yourself. (agree/disagree)³⁸
Which one statement best describes your attitude towards medical care? ³⁵
1. The patient should take complete control
2. The patient should have more control than the physician
3. The patient and the physician should share control equally
4. The physician should have more control than the patient
5. The physician should take complete control.
What role do you prefer to play in your visits to the physician? ³⁹
1. You make all of the final decisions
2. The physician and you make the final decisions together
3. The physician considers some of your ideas but still makes most, if not all, of the final decisions
4. The physician takes the initiative and decides what is best for you.

FAST TRACK

Both patient trust and active patient involvement are associated with improved health outcomes

Statistical analysis

To assess patients’ involvement in medical care, frequencies of response categories were calculated for the general study population, as well as key subgroups— men, African Americans, and the elderly (age ≥65 years). Chi-square tests were used to determine whether views varied by sex, race, and the elderly. Spearman correlation was used to assess the relationship of the 5 views to each other, as well as to test whether views varied by trust in the physician and the medical profession, satisfaction with care, age, education, income, physical and mental health, number of visits and years with physician, and past dispute with a physician. Finally, multivariate regressions were performed to determine the most significant predictors of involvement in medical care. In all analyses, a P-value of .05 was considered statistically significant. However, in recognition of the multiple testing environment, consistency over the 5 items was considered as well.

References

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