How does trust affect patient preferences for participation in decision-making?

Area of Science:

• Medical Sociology
• Health Psychology
• Patient-Physician Communication

Background:

• Patient autonomy and shared decision-making (DM) are central to modern healthcare.
• Understanding the patient's perspective on trust in physicians is crucial for effective communication and treatment adherence.

Purpose of the Study:

• To investigate the relationship between patient trust in physicians and their preferred role in medical treatment decisions.
• To determine if trust influences patient autonomy or participation in decision-making.

Main Methods:

• A cross-sectional survey was conducted with 606 patients across three clinics (breast cancer, prostate cancer, fracture) at a Canadian teaching hospital.
• The study utilized the Problem Solving Decision Making (PSDM) Scale and the Trust-in-Physician Scale to assess preferred roles and trust levels.
• Demographic factors including sex, age, and education were controlled for in the analysis.

Main Results:

• Most patients preferred shared decision-making (DM) (48.7%-67.3%) or a passive role (29.6%-50.1%), with few desiring an autonomous role (1.2%-2.9%).
• Patient trust levels varied, with most reporting moderate (48.6%) or high trust (36.1%).
• Lower trust was associated with autonomous preferences, while passive roles correlated with blind trust. Shared DM was linked to high, but not excessive, trust.

Conclusions:

• Very few patients seek an autonomous role; those who do tend to have lower trust in their physicians.
• Increased familiarity with a condition enhances the desire for shared decision-making (DM) over a passive role.
• Shared DM is often accompanied by, and may necessitate, a trusting patient-physician relationship.