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Interventions for improving patients' trust in doctors and groups of doctors

  • Review
  • Intervention

Authors


Abstract

Background

Trust is a fundamental component of the patient-doctor relationship and is associated with increased satisfaction, adherence to treatment, and continuity of care. It is not clear if there are interventions known to be effective in enhancing patient trust in doctors.

Objectives

To assess the effects of interventions intended to improve a patient's trust in the doctor or a group of doctors.

Search methods

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1 2003), MEDLINE (1966 to week 4 2003), EMBASE (1985 to July 2003), Health Star (1975 to July 2004), PsycINFO (1967 to July 2004), CINAHL (1982 to June 2003), LILACS (1982 to April 2003), African Trials Register (1948 to April 2003), African Health Anthology (1924 to April 2003), Dissertation Abstracts International (1861 to April 2003) and the bibliographies of studies assessed for inclusion. We also searched the bibliographies of studies assessed for inclusion, and contacted researchers active in the field.

Selection criteria

Randomised controlled trials (RCTs), controlled clinical trials, controlled before and after studies, and interrupted time series studies of interventions (informative, educational, behavioural, organisational) directed at doctors or patients (or carers) where trust was assessed as a primary or secondary outcome.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data.

Main results

Three RCTs, all published in English and set in North American primary care, and involving 2916 participants, were included. There was considerable heterogeneity in terms of aims, format and content of the interventions. One trial of a training intervention for family doctors to improve communication behaviours (20 doctors assessed by 414 patients) showed no effect on trust. The other two interventions were patient focussed. One explored the impact on trust of disclosing physician incentives to patients (n = 1918) in a Health Maintenance Organisation (HMO) and showed no diminution in trust. Another investigated the effect of induction visits on new HMO members' (n = 564) trust in their HMO doctors. Trust in doctors rose compared with control following the visit for one type of induction visit, the group visit (Trust out of 10 (standard deviation (SD)) was 8.8 (1.5) and 7.1 (2.2), difference 1.7, (95% confidence interval 1.22 to 2.18)). However there were many drop-outs and analysis was not on intention to treat.

Authors' conclusions

Overall there remains insufficient evidence to conclude that any intervention may increase or decrease trust in doctors. Further trials are required to explore the impact of policy changes, guidelines and specific doctors' training on patients' trust.

摘要

背景

增進病人對醫師和醫師群信任度的方式

信任是醫病關係的基礎,和增進滿意度,遵醫囑性和持續性照護相關。不知是否有已知有效的方式,可以增進病人對醫師的信任。

目標

評估不同介入方式,增進病人對醫師或醫師群信任度的效果

搜尋策略

搜尋Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1 2003) , MEDLINE (1966 to week 4 2003) ,EMBASE (1985 to July 2003) ,Health Star (1975 to July 2004) ,PsycINFO (1967 to July 2004) ,CINAHL (1982 to June 2003) ,LILACS (1982 to April 2003) ,African Trials Register (1948 to April 2003) ,African Health Anthology (1924 to April 2003) , Dissertation Abstracts International (1861 to April 2003) and the bibliographies of studies。連絡此領域的專家。

選擇標準

隨機對照試驗,對照臨床試驗,前後對照試驗和中斷時間序列研究 (interrupted) 。研究包含提供資訊、教育性的、行為上的或組織的介入方式,針對醫師或病人 (或照顧者) 以信任度為主要或次要的評估指標。

資料收集與分析

兩個檢閱作者獨立評估試驗品質和擷取資料

主要結論

本回顧納入三個英文發表,關於在北美的基層醫療單位進行研究的隨機對照試驗,共包含2916位受試者。介入方式的目標,形式和內容有很大差異。一個試驗用訓練家庭醫師改進溝通行為 (414位病人評估20位醫師) 。結果對信任沒有影響。另兩個試驗採用病人端的介入方法。一個試驗在健康維護機構 (HMO) ,探討公開醫師薪資對信任度的影響 (樣本數1918) ,結果沒有減少信任度。另試驗對健康維護機構新成員 (樣本數為564人) 進行引導式問診 (induction visit) ,樣本數564。與對照組相比,兩組群體診療信任度 (信任度得分總分10分) /標準差 (standard deviation) ,分別為8.8/1.5及 7.1/2.2,差異為1.7 (95% 信賴區間1.22 – 2.18)) 。 然而此研究有很多中途退出者,且並非使用意圖治療分析方式 (intention to treat) 來分析資料。

作者結論

總體而論,仍沒有足夠證據顯示有任何介入可增加或減少病人對醫師的信任度.需要更進一步的試驗,研究是否政策改變,臨床指引或特定醫師訓練可以增進病人信任度.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

增進病人對醫生和醫生群信任度的介入方式是醫病關係的基礎。信任度可增進滿意度,遵醫囑性和治療持續性。不知是否有已知有效的方式,可以增加病人對醫生的信任度。醫師端的介入方法包含訓練醫師,病人端則有提供資訊。作者搜尋很多資料庫,但只找到三篇在北美的基層醫療單位進行研究執行的隨機對照試驗,沒有足夠證據證明某介入可增加或降低對醫師的信任度。一個試驗對家庭醫師進行訓練介入來促進一些與信任有關的行為:包括表達同理心、良好溝通和分享資訊414位病人評估20位參與計畫的醫師。然而這些訓練並非很積極且是給一些已經是對醫病溝通有興趣的醫師。結果訓練對信任度沒有影響。另一個試驗是告知病患 ‘醫師收入與其執業是否符合成本效益的方式有關’ 對信任的影響 (樣本數1918) ,試驗包含兩個保險計畫,其中一個保險計畫的結果顯示信任度並沒有下降,甚至反而可能增加。然而這個保險計畫呈現的重點在強調減少不必要檢查,而不是降低成本。第三個試驗觀察3種教育性介紹訪視,對564位新病人,對自己醫師信任度的影響。群體訪視組和單獨訪視 (醫師,一位醫師和一位衛教師) 相比,信任度上升。作者認為需要研究改變政策、建立指引及特定的醫師訓練是否可改進病人信任度.

Plain language summary

Interventions for improving patients' trust in doctors and groups of doctors

Trust is a fundamental part of a patient-doctor relationship. Trust can increase patient satisfaction, adherence to treatment, and continuity of care. This raises the question whether there are effective ways of enhancing patient trust in doctors, by involving doctors (such as training) or patients (such as by providing information). The review authors searched a wide variety of databases and found only three randomised controlled trials all based in North American primary care. The trials did not provide sufficient evidence to conclude that a specific intervention may increase or decrease trust in doctors. One trial was of a training intervention for family doctors to improve behaviours known to be associated with trust: expressing empathy, good communication and sharing information. The 20 doctors in the trial were assessed by 414 patients showing no effect of training; however, the training was not intensive and given to doctors known to be interested in communication. Another trial explored disclosing to patients (1918 participants) the sorts of incentives doctors are given for practising medicine in a cost-effective way. Two types of insurance plans were investigated. One led to no reduction and possibly an increase in trust in the insurance plan. However, the information about this plan was presented in a way that emphasised reducing unnecessary tests, rather than cost-cutting. The third trial looked at three different types of educational introductory visits and 564 new patients' trust in the doctors working for their health organisation. Trust in the doctors rose with one type of visit, which was a group visit. This was the least well taken up compared with individual visits with a physician, or a physician and health educator. The review authors have highlighted the types of further trials that are now required to explore the impact of policy changes, guidelines and specific doctors' training on patients' trust.

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