Trust in physicians and elements of the medical interaction in patients with rheumatoid arthritis and systemic lupus erythematosus
Article first published online: 31 MAY 2006
Copyright © 2006 by the American College of Rheumatology
Arthritis Care & Research
Volume 55, Issue 3, pages 385–393, 15 June 2006
How to Cite
Berrios-rivera, J. P., Street, R. L., Garcia Popa-lisseanu, M. G., Kallen, M. A., Richardson, M. N., Janssen, N. M., Marcus, D. M., Reveille, J. D., Warner, N. B. and Suarez-almazor, M. E. (2006), Trust in physicians and elements of the medical interaction in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis & Rheumatism, 55: 385–393. doi: 10.1002/art.21988
- Issue published online: 31 MAY 2006
- Article first published online: 31 MAY 2006
- Manuscript Accepted: 3 NOV 2005
- Manuscript Received: 11 MAY 2005
- National Institute for Arthritis and Musculoskeletal and Skin Diseases. Grant Number: R01-AR-47858
- Houston Center for Quality of Care & Utilization Studies
- Health Services Research and Development Service
- Office of Research & Development
- Department of Veterans Affairs
- Physician trust;
- Rheumatoid arthritis;
- Systemic lupus erythematosus
To identify components of the patient-doctor relationship associated with trust in physicians.
We assessed 102 patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) seen at publicly funded hospitals in Houston, Texas. Patients completed a self-response survey examining patient perceptions of the medical encounter and trust in their physicians. Evaluated components of physicians' behaviors included: informativeness, sensitivity to concerns, reassurance and support, patient-centeredness, and participatory decision-making style. Scales were scored 0 to 10, with higher numbers indicating more positive perceptions of communication.
Seventy patients had RA and 32 SLE; 25% were white, 43% Latino, 31% African American, and 75% were female. Mean scores for the medical interaction and trust scales ranged from 6.2–7.1, indicating moderate degrees of positive perceptions. All components were highly and positively correlated with each other, and with trust, suggesting that these traits are all elements of a positive style of doctor-patient communication. In multivariate analysis, ethnicity, physicians' informativeness, physicians' sensitivity to concerns, patient-centeredness, disease activity, and patient trust in the US health care system were independent predictors of trust in physicians. A separate model examined the predictors of patient disclosure of information. Patient perceptions of physicians' patient-centeredness and severity of disease activity were independently predictive of patient disclosure of information.
In patients with SLE and RA, trust in physicians is significantly associated with patients' ethnicity and their perceptions about specific components of physicians' communication style. Trust in physicians can be improved by using a patient-centered approach, being sensitive to patient concerns, and providing adequate clinical information. Furthermore, patients appear to be more willing to disclose concerns when physicians use a patient-centered communication style.