How patients’ trust relates to their involvement in medical care
Trust in the medical profession is associated with greater willingness to seek care and follow recommendations
Results
TABLE 2 summarizes the response frequencies for the 5 questions and TABLE 3 shows the correlations of the 5 items with each other. All items are significantly correlated at level 0.005 or below. As one might expect, the questions on relying on physicians’ judgment and seeking professional help are most correlated, as are physician/patient control and roles.
TABLE 2
Views of the general population and subgroups about involvement in medical care
| OVERALL (N=553) | MEN (N=172) | AFRICAN AMERICANS (N=45) | ELDERLY (N=127) | |
|---|---|---|---|---|
| You always follow physicians’ recommendations about treatment (N=506) | ||||
| Strongly agree | 5.5% | 6.2% | 4.4% | 11.1% |
| Agree | 56.3% | 57.1% | 55.6% | 65.9% |
| Neutral | 15.4% | 16.8% | 15.6% | 7.9% |
| Disagree | 22.1% | 19.9% | 24.4% | 14.3% |
| Strongly disagree | 0.6% | 0.0% | 0.0% | 0.8% |
| P-value | .654 | .701 | <.001 | |
| It is better to rely on the expert judgment of physicians (N=474) | ||||
| Agree | 62.2% | 71.7% | 71.4% | 75.6% |
| Disagree | 37.8% | 28.3% | 28.6% | 24.4% |
| P-value | .003 | .355 | .001 | |
| It is almost always better to seek professional help (N=493) | ||||
| Agree | 83.0% | 83.4% | 84.31% | 87.9% |
| Disagree | 17.0% | 16.6% | 15.9% | 12.1% |
| P-value | .847 | .743 | .090 | |
| Attitude towards control of medical care (N=496) | ||||
| Patient complete control | 3.6% | 5.0% | 0.0% | 2.4% |
| Patient more control | 5.4% | 6.3% | 4.7% | 0.8% |
| Share control equally | 77.4% | 67.9% | 83.7% | 72.4% |
| Physician more control | 9.7% | 15.1% | 7.0% | 12.2% |
| Physician complete control | 3.8% | 5.7% | 4.7% | 12.2% |
| P-value | .009 | .586 | <.001 | |
| What role do you prefer to play in your visits to the physician (N=499) | ||||
| You make decisions | 9.2% | 14.4% | 20.9% | 2.4% |
| You and physician make decisions | 67.5% | 60.6% | 44.2% | 65.0% |
| Physician considers your ideas | 13.6% | 13.8% | 20.9% | 11.4% |
| Physician makes decisions | 9.6% | 11.3% | 14.0% | 21.1% |
| P-value | .028 | .169 | <.001 | |
TABLE 3
Correlation between views on involvement in medical care
| RELY ON PHYSICIAN’S JUDGMENT | SEEK PROFESSIONAL HELP | MORE PHYSICIAN CONTROL | MORE PASSIVE PATIENT ROLE | |
|---|---|---|---|---|
| Follow physician recommendations | 0.256 | 0.125 | 0.244 | 0.171 |
| Rely on physician’s judgment | 0.316 | 0.240 | 0.167 | |
| Seek professional help | 0.140 | 0.192 | ||
| More physician control | 0.316 | |||
| P≥.005 for all | ||||
Trust and satisfaction
As shown in TABLE 4 , trust in a specific physician is associated only with always following recommendations. Trust in the medical profession and satisfaction with care are both highly associated with all 5 views towards involvement in medical care. More trust in the medical profession, and greater satisfaction with care, are associated with following recommendations, relying on the judgment of physicians, seeking professional medical help, and granting increased control and decision making to the physician.
TABLE 4
Correlation between trust and satisfaction and medical views
| FOLLOW PHYSICIAN’S RECOMMENDATION | RELY ON PHYSICIAN | SEEK HELP | PHYSICIAN CONTROL | PASSIVE ROLE | |
|---|---|---|---|---|---|
| Trust in | 0.170 | 0.017 | 0.031 | 0.002 | 0.060 |
| physician | (P<.001) | (P=.712) | (P=.495) | (P=.960) | (P=.180) |
| Trust in medical | 0.440 | 0.302 | 0.195 | 0.245 | 0.206 |
| profession | (P<.001) | (P<.001) | (P<.001) | (P<.001) | (P<.001) |
| Satisfaction | 0.309 | 0.131 | 0.107 | 0.103 | 0.166 |
| with care | (P<.001) | (P=.005) | (P=.018) | (P=.023) | (P<.001) |
Patient demographics
A number of patient demographic characteristics are significantly associated with patients’ involvement in medical care. Women are less likely to want to rely on the judgment of physicians and are more likely to want to share control and make joint decisions. There is also an extremely strong effect of age. The elderly (age ≥65 years) are more compliant, deferential, and passive under each of our measures. Interestingly, race has no significant effects on these measures of involvement.
Patients with less education are more likely to want to follow physicians’ recommendations, rely on their physician’s judgment, and seek professional medical help (P=.0015, <0.001, 0.027, respectively). They are also more likely to give the physician more control and authority to make decisions for them (P<.001 for both). People with less income (on a 9-point scale) are also more likely to want to follow physicians’ recommendations, rely on their judgment, and give the physician more control and authority (P<.007 for all). Patients in worse physical health (on a 5-point scale) are more likely to want to rely on the judgment of physicians and to seek professional medical help (correlation=0.11; P=.014, .017). There is no significant association between mental health and any of these views.
Patients’ relationship with physicians
Several aspects of the patient/physician relationship were significantly associated with patients’ involvement in medical care. Not surprisingly, willingness to seek professional medical help increases with number of visits to the physician (P=.039), and granting increased control and decision making to the physician increases with continuity of care, as measured by number of years with the physician (P=.001, .037). Additionally, having had a past dispute with a physician was significantly related to patients’ involvement in medical care. Patients with a past dispute were less likely to always follow physicians’ recommendations, rely on the judgment of physicians, or seek professional medical help. They were also more likely to take control and make medical decisions themselves.
Multivariate regression models
Multivariate regression models were used to determine the most significant predictors of patients’ involvement in medical care. Multivariate linear regression was used for the outcomes of following physicians’ recommendations and physician/patient control and roles. Logistic regression was used for the binary outcome variables— rely on physician’s judgment and seek professional help.
The predictor variables used in the model were sex, age, education, physical health, number of physician visits, number of years with physician, past dispute, trust, and satisfaction with care. Income and elderly were not used as they are correlated with education and age, respectively, which were more predictive of patient involvement. Significant predictors are shown in TABLE 5 . Notably, the patient’s trust in their specific physician did not predict any of these views, and satisfaction with care predicted only following physicians’ recommendations. Demographic, health status, and other variables were also nonsignificant in many or most regressions. Only trust in the medical profession predicted all 5 views.
