Trust in physicians and elements of the medical interaction in patients with rheumatoid arthritis and systemic lupus erythematosus

• Published in: Arthritis and rheumatism 2006-06, Vol.55 (3), p.385-393
• Main Authors: Berrios‐rivera, Javier P., Street, Richard L., Garcia Popa‐lisseanu, Maria G., Kallen, Michael A., Richardson, Marsha N., Janssen, Namieta M., Marcus, Donald M., Reveille, John D., Warner, Noranna B., Suarez‐almazor, Maria E.
• Format: Article
• Language: English
• Subjects: Adult; African Americans - ethnology; Arthritis, Rheumatoid - ethnology; Arthritis, Rheumatoid - psychology; Biological and medical sciences; Communication; Cross-Sectional Studies; Decision Making; Diseases of the osteoarticular system; European Continental Ancestry Group - ethnology; Female; Hispanic Americans - ethnology; Humans; Inflammatory joint diseases; Lupus Erythematosus, Systemic - ethnology; Lupus Erythematosus, Systemic - psychology; Male; Medical sciences; Middle Aged; Patient Satisfaction - ethnology; Physician trust; Physician-Patient Relations; Physicians - psychology; Rheumatoid arthritis; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Surveys and Questionnaires; Systemic lupus erythematosus; Texas; Trust - psychology; Truth Disclosure
• ISSN: 0004-3591; 0893-7524; 1529-0131; 1529-0123
• DOI: 10.1002/art.21988

Objective To identify components of the patient‐doctor relationship associated with trust in physicians. Methods 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. Results 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. Conclusion 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.