Cancer patients' trust in their physician-a review

Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis

BACKGROUND

Underrepresented minority patients with surgical malignancies experience disparities in outcomes. The impact of provider-based factors, including communication, trust, and cultural competency, on outcomes is not well understood. This study examines modifiable provider-based barriers to care experienced by patients with surgical malignancies.

METHODS

A parallel, prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation. Surveys assessed patients' social needs and patient-physician relationship. Semi-structured interviews ascertained patient experiences and were iteratively analyzed, identifying key themes.

RESULTS

The cohort included 24 patients (age 62 years; 63% White and 38% Black/African American). The most common cancers were lung (n = 18, 75%) and gastroesophageal (n = 3, 13%). Survey results indicated that food insecurity (n = 5, 21%), lack of reliable transportation (n = 4, 17%), and housing instability (n = 2, 8%) were common. Lack of trust in their physician (n = 3, 13%) and their physician's treatment recommendation (n = 3, 13%) were identified. Patients reported a lack of empathy (n = 3, 13%), lack of cultural competence (n = 3, 13%), and inadequate communication (n = 2, 8%) from physicians. Qualitative analysis identified five major themes regarding the decision to undergo surgery: communication, trust, health literacy, patient fears, and decision-making strategies. Five patients (21%) declined the recommended surgery and were more likely Black (100% vs. 21%), lower income (100% vs. 16%), and reported poor patient-physician relationship (40% vs. 5%; all p < 0.05).

CONCLUSIONS

Factors associated with declining recommended cancer surgery were underrepresented minority race and poor patient-physician relationships. Interventions are needed to improve these barriers to care and racial disparities.

Philosophy leading the way: An interdisciplinary approach to study communication of severe diagnoses

This paper explores a brand-new interdisciplinary approach applied to an enduring problem: the communication of severe diagnoses. The moment when physicians explain the diagnosis to patients and their relatives is sensitive, particularly for a disease that is rarely diagnosed early. The first part of the article is dedicated to the context of this delicate doctor-patient interaction. With this framework in mind, the paper delves into the innovative interdisciplinary methodology developed in the pilot study Communi.CARE, conducted in a hospital in Northern Italy, which focuses on the diagnosis of pancreatic ductal adenocarcinoma (PDAC). SARS-CoV-2 impact on the study development is highlighted. The study aims to explore the topic by combining different areas of expertise, including medicine, philosophy, sociology, and psychology. The contribution of philosophy is here presented as essential: it has a leading role in the conception of the study, its development, and the elaboration of results. It is shown throughout the study, from methodology to the analysis of results. Strengths and weaknesses of the methodology are discussed. In conclusion, further philosophical considerations on effective and ethical communication in this delicate context are recommended.

Breast Cancer Survivors' Experiences of Acceptance Following Recurrence: A Qualitative Content Analysis

BACKGROUND

Breast cancer recurrence is a traumatic event for patients, and its treatment depends on the patient's ability to accept the circumstances.

OBJECTIVE

The aim of this study was to explore how patients experience breast cancer recurrence and go through a process of negotiating acceptance.

METHODS

This study explored the experiences of 16 patients with breast cancer recurrence regarding the acceptance of recurrence in a hospital in Tehran, Iran. Purposive sampling with maximum diversity was used. Data were collected through semistructured telephone interviews from November 2020 to November 2021 and analyzed using the qualitative content analysis.

RESULTS

Four themes emerged that described the process of accepting cancer recurrence: (1) response to recurrence (emotional reactions and loss of trust); (2) psychological preparedness (confirmation of medical diagnosis and acceptance of fate); (3) mobilizing supports (using spiritual capacities, utilizing supportive resources, and seeking relationships to promote knowledge); and (4) return to the path of treatment (rebuilding trust and continuation of treatment).

CONCLUSIONS

The acceptance of breast cancer recurrence is a process that begins with emotional reactions and ends with returning to the treatment path. The patient's psychological preparation, support systems, behavior of healthcare providers, and rebuilding trust are the determining factors in acceptance of recurrence.

IMPLICATIONS FOR PRACTICE

Nurses can compensate for the failures created in the primary treatment of breast cancer by spending time with patients and paying attention to their concerns, providing effective education, strengthening communication between patients with similar conditions and using the spiritual capacities of patients, and mobilizing the support of family and relatives.

Patients' and Clinicians' Perceptions of the Clinical Utility of Predictive Risk Models for Chemotherapy-Related Symptom Management: Qualitative Exploration Using Focus Groups and Interviews

BACKGROUND

Interest in the application of predictive risk models (PRMs) in health care to identify people most likely to experience disease and treatment-related complications is increasing. In cancer care, these techniques are focused primarily on the prediction of survival or life-threatening toxicities (eg, febrile neutropenia). Fewer studies focus on the use of PRMs for symptoms or supportive care needs. The application of PRMs to chemotherapy-related symptoms (CRS) would enable earlier identification and initiation of prompt, personalized, and tailored interventions. While some PRMs exist for CRS, few were translated into clinical practice, and human factors associated with their use were not reported.

OBJECTIVE

We aim to explore patients' and clinicians' perspectives of the utility and real-world application of PRMs to improve the management of CRS.

METHODS

Focus groups (N=10) and interviews (N=5) were conducted with patients (N=28) and clinicians (N=26) across 5 European countries. Interactions were audio-recorded, transcribed verbatim, and analyzed thematically.

RESULTS

Both clinicians and patients recognized the value of having individualized risk predictions for CRS and appreciated how this type of information would facilitate the provision of tailored preventative treatments or supportive care interactions. However, cautious and skeptical attitudes toward the use of PRMs in clinical care were noted by both groups, particularly in relationship to the uncertainty regarding how the information would be generated. Visualization and presentation of PRM information in a usable and useful format for both patients and clinicians was identified as a challenge to their successful implementation in clinical care.

CONCLUSIONS

Findings from this study provide information on clinicians' and patients' perspectives on the clinical use of PRMs for the management of CRS. These international perspectives are important because they provide insight into the risks and benefits of using PRMs to evaluate CRS. In addition, they highlight the need to find ways to more effectively present and use this information in clinical practice. Further research that explores the best ways to incorporate this type of information while maintaining the human side of care is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081.

Patient Knowledge and Trust in Health Care. A Theoretical Discussion on the Relationship Between Patients' Knowledge and Their Trust in Health Care Personnel in High Modernity

In this paper we aim to discuss a theoretical explanation for the positive relationship between patients' knowledge and their trust in healthcare personnel. Our approach is based on John Dewey's notion of continuity. This notion entails that the individual's experiences are interpreted as interrelated to each other, and that knowledge is related to future experience, not merely a record of the past. Furthermore, we apply Niklas Luhmann's theory on trust as a way of reducing complexity and enabling action. Anthony Giddens' description and analysis of the high modern society provides a frame for discussing the preconditions for patient-healthcare personnel interaction. High modernity is dominated by expert systems and demands trust in these. We conclude that patient knowledge and trust in healthcare personnel is related because both knowledge and trust are future- and action-oriented concepts. The traits of high modernity provides opportunities and challenges as the personnel can and must perform discretion. This discretion must be made in a context where knowledge is considered uncertain and preliminary.

When Bad News Comes Through the Portal: Strengthening Trust and Guiding Patients When They Receive Bad Results Before Their Clinicians

Communication in oncology was challenging long before the emergence of the US 21st Century Cures Act. Before 2021, a growing body of evidence had demonstrated the benefits of patients' access to and review of the clinical notes in their charts (open notes); however, studies examining the benefits of immediate access to test results were scarce until the implementation of the Cures Act's Information Blocking Rule. Individuals grappling with cancer today now possess immediate access to their laboratory results, imaging scans, diagnostic tests, and progress notes as mandated by law. To many clinicians, the implementation of the Cures Act felt sudden and presented new challenges and concerns for oncologists surrounding patients' potential emotional reactions to medical notes or lack of control over the careful delivery of potentially life-changing information. Despite data that show most patients want immediate access to information in their records before it is communicated directly by a health care professional, surveys of oncologists showed trepidation. In this chapter, perspectives from a patient with cancer, an oncologist, and a cancer psychiatrist (in that order) are shared to illuminate the adjustments made in clinician-patient communication amid the era of nearly instantaneous results within the electronic health record.

A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy

BACKGROUND

The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model.

METHODS

A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable.

RESULTS

Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services.

DISCUSSION

Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Communication, understanding and engagement of patients with pancreatic cancer at time of diagnosis

BACKGROUND

Objectives: To investigate communication clarity and understanding at the time of pancreatic adenocarcinoma (PDAC) diagnosis and whether they can influence patient engagement and compliance.

METHODS

Consecutive PDAC patients were enrolled at the time of diagnosis after obtaining informed consent in a single-center study. The patients completed a validated scale (PHE-s®), and the understanding rate was assessed using standardized tools. Patient compliance was evaluated, and the correlation between the PHE-s®, understanding, and compliance was calculated.

RESULTS

Thirty patients were enrolled (15 female) with a mean age 64.4, 13 were metastatic. The mean visit time was 31 min, being longer if visiting doctor was an oncologist (p = 0.002). The engagement level was high in 70% of the patients, and all but one were compliant. The analysis of doctor-patient interactions showed a median of 121 conversational turns for doctors, 75 for patients, and 20 for caregivers (p < 0.0001), and the median percentage of speaking time was 77% for doctors, 13% for patients, and 2% for caregivers (p < 0.0001). Female caregivers spent more time speaking than did male caregivers (median 11.6% vs. 1.3%; p = 0.06). There were 290 instances of problematic understanding, most of which occurred during the taking of patients' personal medical history for doctors, while for patients and caregivers, these occurred mainly during the discussion of diagnosis/treatment (p < 0.0001). In a multivariable analysis, only origin from central or southern Italy was associated with high engagement (p = 0.0087).

CONCLUSION

In this first attempt to measure clarity of communication and engagement in patients with PDAC, typical features of conversation and problematic understanding emerged, which deserves further investigation.

Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness

Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.

Treatment confidence and patient participation in multidisciplinary tumor conferences: A structural equation modeling approach

OBJECTIVE

Multidisciplinary tumor conference (MTC) is a key instrument in multidisciplinary cancer care. In recent years, if and how patient participation in MTC can contribute to a more patient-centered care have been scientifically discussed. This study aimed to identify determinants of treatment confidence in the context of patient participation in MTC. Therefore, the association among health literacy-sensitive communication, trust in health-care providers (HCP), and treatment confidence is examined.

METHODS

This study used data from the multicenter, observational study "PINTU" on patient participation in MTC. Data were collected from November 2018 to February 2020. Validated scales for treatment confidence, health literacy-sensitive communication, and trust in providers were included in the structural equation modeling (SEM) analysis.

RESULTS

A total of 95 patients participated in MTC. The sample compromised n = 80 completed datasets. The SEM fit measures indicated good fit of the proposed model. The analysis showed a positive association between health literacy-sensitive communication and treatment confidence when adding the mediating effect of trust in providers.

CONCLUSION

Patient-centered communication during MTC in combination with a trustful relationship between participating patients and health-care providers is positively associated with treatment confidence. The results indicated the relevance of a trustful doctor-patient communication and relationship. Trainings for physicians targeting patient-centered communication could be a promising approach to strengthen patient participation.

Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients

BACKGROUND

Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided.

OBJECTIVE

This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology.

METHODS

This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors.

RESULTS

We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use).

CONCLUSIONS

Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.

Unveiling Patient Trust in Physicians Across China: Insights from a Nationwide Cross-Sectional Study

Background

Trust is a major factor affecting patient-physician relationship and healthcare quality. However, there has been a lack of comprehensive study on the extent of and major factors affecting patient trust in healthcare providers of China, the world's largest developing country. The objective of this study is to elucidate the current status of outpatient trust in physicians in China and its influencing factors, providing empirical evidence to enhance doctor-patient trust and improve doctor-patient relationships.

Methods

Between December 2017 and January 2018, 28,760 patients seeking care at the outpatient departments of 136 tertiary hospitals were interviewed, where they were asked to rate their trust in physicians. We applied a multilevel logistic regression model to explore the association between patients trust and characteristics of hospitals, physicians and patient characteristics. We conducted a series of sensitivity analysis to check the robustness of our findings.

Results

Among 28,760 participants included in this study, 91.54% expressed trust in their physicians, while 7.52% showed moderate trust. Only 0.94% expressly distrusted or strongly distrusted their physicians. Outpatients of hospitals with convenient payment, volunteer guidance and enough seats available in the rest and waiting area showed higher levels of trust. Physicians who had a senior title, showed patience and protection of the patient's privacy were more likely to be trusted by their patients in the outpatient setting. Compared to their female counterparts, male outpatients showed a higher degree of trust.

Conclusion

While this study highlights an overall high level of Trust in physicians (TIP) among patients in China's tertiary hospitals, it is found to vary with patient demographic factors as well as provider's attributes. Hospitals with a more keen sense of protecting patients privacy and better meeting patients' need for efficient and caring service provision process appeared to yield a higher level of trust.

Associations of Health Care Utilization and Therapeutic Alliance in Patients with Advanced Cancer

Introduction: Therapeutic alliance (TA), or the extent to which patients feel a sense of caring and trust with their physician, may have an impact on health care utilization. We sought to determine if TA is associated with: (1) emergency department (ED) visits within 30 days of death and (2) hospice enrollment. Methods and Materials: This is a secondary analysis of data from a randomized clinical trial. We used restricted cubic splines to assess the relationship between TA scores and health care utilization. Results: Six hundred seventy-two patients were enrolled in the study, with 331 (49.3%) dying within 12 months. Patients with higher TA were less likely to have an ED visit in the last 30 days of life, but there was no evidence of a relationship between TA and enrollment in hospice. Conclusions: Higher TA was associated with decreased ED visits within 30 days of death. There was no association between TA and rates of hospice enrollment. Clinical Registration Number: NCT02712229.

Trust in the Transplant Team Associated With the Level of Chronic Illness Management-A Secondary Data Analysis of the International BRIGHT Study

A trustful relationship between transplant patients and their transplant team (interpersonal trust) is essential in order to achieve positive health outcomes and behaviors. We aimed to 1) explore variability of trust in transplant teams; 2) explore the association between the level of chronic illness management and trust; 3) investigate the relationship of trust on behavioral outcomes. A secondary data analysis of the BRIGHT study (ID: NCT01608477; https://clinicaltrials.gov/ct2/show/NCT01608477?id=NCT01608477&rank=1) was conducted, including multicenter data from 36 heart transplant centers from 11 countries across four different continents. A total of 1,397 heart transplant recipients and 100 clinicians were enrolled. Trust significantly varied among the transplant centers. Higher levels of chronic illness management were significantly associated with greater trust in the transplant team (patients: AOR= 1.85, 95% CI = 1.47-2.33, p < 0.001; clinicians: AOR = 1.35, 95% CI = 1.07-1.71, p = 0.012). Consultation time significantly moderated the relationship between chronic illness management levels and trust only when clinicians spent ≥30 min with patients. Trust was significantly associated with better diet adherence (OR = 1.34, 95%CI = 1.01-1.77, p = 0.040). Findings indicate the relevance of trust and chronic illness management in the transplant ecosystem to achieve improved transplant outcomes. Thus, further investment in re-engineering of transplant follow-up toward chronic illness management, and sufficient time for consultations is required.

Race differences in patient trust and distrust from audio-recorded cardiology encounters

OBJECTIVE

Many have reported racial disparities in self-reported trust in clinicians but have not directly assessed expressions of trust and distrust in physician-patient encounters. We created a codebook to examine racial differences in patient trust and distrust through audio-recorded cardiologist-patient interactions.

METHODS

We analyzed data from a randomized controlled trial of audio-recorded outpatient cardiology encounters (50 White and 51 Black patients). We created a codebook for trust and distrust that was applied to recordings between White cardiologists and White and Black patients. We assessed differences in trust, distrust, and guardedness while adjusting for patient age, sex, and first appointment with the cardiologist.

RESULTS

Compared to White patients, Black patients had significantly lower expressions of trust ([IRR] [95 % CI]: 0.59 [0.41, 0.84]) and a significantly lower mean guarded/open score ([β] [95 % CI] -0.38 [-0.71, -0.04]). There was no statistically significant association between race and odds of at least one distrustful expression (OR [95 % CI] 1.36 [0.37, 4.94]).

CONCLUSION AND PRACTICE IMPLICATIONS

We found that coders can reliably identify patient expressions of trust and distrust rather than relying on problematic self-reported measures. Results suggest that White clinicians can improve their communication with Black patients to increase expressions of trust.

Information needs during cancer care: Qualitative research with locally advanced cervical cancer patients in Brazil, China, Germany, & the US

Objective

This study aimed to identify the information needs and factors for making informed treatment decisions among a diverse group of locally advanced cervical cancer (LACC) patients.

Methods

Semi-structured interviews were conducted with LACC patients of diverse demographic and socioeconomic backgrounds within two years of their cancer diagnosis. Trained moderators asked open-ended questions about patients' cancer journeys. Transcripts were analyzed using NVivo software to identify emergent themes.

Results

In 2022, 92 LACC patients in the United States (n = 26), Brazil (n = 25), China (n = 25), and Germany (n = 16) participated in the study. Physicians were valued sources of information, providing patients with details on prognosis, treatment options, and side effects. While most patients trusted their physicians, one-third sought a second opinion to validate their diagnosis or find a more trusted physician.Most patients conducted their own research on treatment options, side effects, causes of LACC, symptoms, and others' experiences. Challenges to information searches included understanding medical terms, finding relevant information, and evaluating source credibility.Overall, patients felt knowledgeable enough to participate in treatment decisions, either by accepting the recommended treatment or collaborating with their physicians. Nearly one-third of patients desired a more significant role in the decision-making process.

Conclusion

This study highlights the importance of physicians providing LACC patients comprehensive and understandable information, while involving them in the decision-making process. Understanding LACC patients' motivations to seek information and their willingness to actively engage in treatment decisions can lead to improved patient satisfaction in their cancer care.

Disentangling trust of patients with rare cancer in their healthcare professionals and the healthcare system: a qualitative interview study

PURPOSE

Patients with a rare cancer face challenges, e.g., delayed diagnosis, that may affect trust in the healthcare system and the healthcare professionals (HCPs) involved. This study aimed to explore trust of patients with a rare cancer in their HCPs and the healthcare system.

METHODS

Semi-structured interviews were conducted with 20 purposively sampled patients with a rare cancer. The interview guide included topics related to trust, including level, development, barriers and facilitators, importance, and trust dimensions. Thematic analysis was conducted with use of Atlas.ti.

RESULTS

The mean age of patients was 50 years, 60% were female, and 70% were highly educated. Three themes were constructed: (1) "Confirmed expertise is a prerequisite of trust." Patients need confirmation of their HCPs' expertise, as it could not be assumed due to the rarity of their cancer; (2) "Trust depends on the adequacy of information and how it is provided." Limited information about rare cancer reduced patients' trust in health care, whereas interpersonal trust was mainly affected by how HCPs provided information; and (3) "Trust is built on properly coordinated and supportive care." Proper organization and cooperation within and between hospitals, and integration of supportive care, enhanced trust.

CONCLUSION

Patients with a rare cancer experience challenges that influence trust in HCPs and the healthcare system. Further research should examine trust among subgroups of patients with a rare cancer, to enable development of tailored interventions.

IMPLICATIONS FOR CANCER SURVIVORS

HCPs may improve trust by focusing on expertise, effective information provision, proper coordination of care, and provision of adequate supportive care.

Bereaved Family Caregivers Perception of Trust in Palliative Care Doctors by Patients with Terminal Cancer

Trust is a key factor in achieving a good death. However, few studies have focused on factors that help patients with terminal cancer establish trusting relationships with their palliative care doctors. This exploratory qualitative study, conducted in Japan, was designed to identify factors related to terminal cancer patients' trust in their doctors. Semi-structured interviews were conducted with 18 caregivers and grounded theory was the research approach chosen to guide this study. The data revealed seven factors related to the trust to palliative care doctors, including caring attitude, symptom management, courteous and specific explanations, long-term involvement in the patient's care, being faced with inevitable death, good impression of the institution, and referral by a trusted doctor. These factors were categorized into three main themes: [1] palliative care doctors, [2] patients with terminal cancer, and [3] professional reputation. There is potential for improving end-of-life experiences through understanding and implementing interventions to ensure trust identified by these caregivers.

Building Authentic Connection in the Patient-Physician Relationship

INTRODUCTION/OBJECTIVES

Delivering optimal patient care is impacted by a physician's ability to build trusting relationships with patients. Identifying techniques for rapport building is important for promoting patient-physician collaboration and improved patient outcomes. This study sought to characterize the approaches highly skilled primary care physicians (PCPs) use to effectively connect with diverse patients.

METHODS

Using an inductive thematic analysis approach, we analyzed semi-structured interview transcripts with 10 PCPs identified by leadership and/or colleagues for having exceptional patient communication skills. PCPs practiced in 3 diverse clinic settings: (1) academic medical center, (2) Veterans Affairs clinic, and (3) safety-net community clinic.

RESULTS AND CONCLUSIONS

The thematic analysis yielded 5 themes that enable physicians to establish connections with patients: Respect for the Patient, Engaged Curiosity, Focused Listening, Mutual Participation, and Self-Awareness. Underlying all of these themes was a quality of authenticity, or a state of symmetry between one's internal experience and external words and actions. Adopting these communication techniques while allowing for adaptability in order to remain authentic in one's interactions with patients may facilitate improved connection and trust with patients. Encouraging physician authenticity in the patient-physician relationship supports a shift toward relationship-centered care. Additional medical education training is needed to facilitate authentic connection between physicians and patients.

The Impact of Procedural Justice and Trust on Customers' Continuity Intention Toward Healthcare Providers

As life has become noticeably more comfortable compared to the past, there is a mounting interest in various service sectors, such as healthcare, where growing demand has led to an increase in the number facilities that supply products essential to service provision. Enhancing the service quality is critical to gaining an advantage in the fiercely competitive healthcare environment and is especially important as the outcomes encompass not only the treatment of disease but also patients' emotional and experiential satisfaction. This study presents procedural justice and two dimensions of trust as factors related to physician and patient relationship, investigating their effects on patients' intention to continue the relationship with their healthcare providers. We found that procedural justice had a positive effect on the two dimensions of trust, and the latter had a significant positive effect on the continuity intention. As this study verifies the necessity of procedural justice and trust for patients to continuously experience medical services, it is imperative for the healthcare industry to understand and incorporate these factors into their practices.

A qualitative study on the healthcare experiences of adolescents and young adults (AYA) with an uncertain or poor cancer prognosis

PURPOSE

Treatment advancements have improved life expectancy for adolescents and young adults (AYAs) with an uncertain and/or poor cancer prognosis (UPCP) and change clinical practice. This improved survival requires a different approach and specific expertise to meet the needs of this group. The aim of this study is to explore the health care experiences of AYAs with a UPCP.

METHODS

We conducted a multicenter qualitative study using semi-structured interviews and elements of the grounded theory by Corbin and Strauss.

RESULTS

Interviews were conducted with 46 AYAs with a UPCP. They were on average 33.4 years old (age range 23-44), and most of them were woman (63%). Additionally, five AYAs with a UPCP participated as AYA research partners in two focus groups. They were on average 31.8 years old and four of them were woman. AYAs with a UPCP reported four pillars for a satisfied healthcare experience: (1) trust, (2) tailored communication, (3) holistic empathic open attitude, and (4) care being offered (pro-)actively. They reported both optimal and suboptimal experiences about distrust based on a delay in diagnostic trajectory, lack of tailored communication and discussion of sensitive topics, preference for a holistic approach, and struggles with finding the way to get additional healthcare support.

CONCLUSION

For AYAs with a UPCP, it is important that both age-specific issues and issues related to the UPCP are understood and addressed; however, this seems not yet optimally implemented in clinical practice. This emphasizes the importance of providing this patient group with tailored care incorporating both aspects. Healthcare professionals need to be supported with training and tools to understand the healthcare needs of AYAs with a UPCP. AYAs can be empowered to take more control over their own healthcare needs.

Multi-Institutional Analysis of Cancer Patient Exposure, Perceptions, and Trust in Information Sources Regarding Complementary and Alternative Medicine

PURPOSE

Complementary and alternative medicine (CAM) use during cancer treatment is controversial. We aim to evaluate contemporary CAM use, patient perceptions and attitudes, and trust in various sources of information regarding CAM.

METHODS

A multi-institutional questionnaire was distributed to patients receiving cancer treatment. Collected information included respondents' clinical and demographic characteristics, rates of CAM exposure/use, information sources regarding CAM, and trust in each information source. Comparisons between CAM users and nonusers were performed with chi-squared tests and one-way analysis of variance. Multivariable logistic regression models for trust in physician and nonphysician sources of information regarding CAM were evaluated.

RESULTS

Among 749 respondents, the most common goals of CAM use were management of symptoms (42.2%) and treatment of cancer (30.4%). Most CAM users learned of CAM from nonphysician sources. Of CAM users, 27% reported not discussing CAM with their treating oncologists. Overall trust in physicians was high in both CAM users and nonusers. The only predictor of trust in physician sources of information was income >$100,000 in US dollars per year. Likelihood of trust in nonphysician sources of information was higher in females and lower in those with graduate degrees.

CONCLUSION

A large proportion of patients with cancer are using CAM, some with the goal of treating their cancer. Although patients are primarily exposed to CAM through nonphysician sources of information, trust in physicians remains high. More research is needed to improve patient-clinician communication regarding CAM use.

Stem Cell Transplant Experiences Among Hispanic/Latinx Patients: A Qualitative Analysis

BACKGROUND

Hispanic/Latinx (H/L) patients with cancer treated with stem cell transplant are vulnerable to adverse outcomes, including higher mortality. This study explored their unmet transplant needs, barriers, and facilitators.

METHODS

Eighteen English- or Spanish-speaking H/L patients (M age = 59.2) who had a transplant in the past year were interviewed about their transplant experience and rated their interest in receiving information about transplant topics (0 = not at all to 10 = extremely).

RESULTS

Content analysis revealed five main themes: (1) pre-transplant barriers and concerns; (2) complex relationships with medical teams; (3) informational mismatch; (4) impacts on daily life after transplant; and (5) methods of coping. Participants were most interested in information about ways of coping with transplant (M = 9.11, SD = 1.45) and words of hope and encouragement (M = 9.05, SD = 1.80). At just above the scale's midpoint, they were least interested in information about side effects and unintended consequences of transplant (M = 5.61, SD = 3.85).

CONCLUSIONS

Cultural factors, social determinants, and structural inequalities give rise to unique needs in this growing patient population. Healthcare team members and researchers can better meet the needs of H/L transplant recipients through attention to described considerations, such as financial barriers, communication difficulties, family dynamics, and coping styles.

Cancer patients' trust as a motivator to seek a second opinion and its effects on trust

OBJECTIVE

Cancer patients may seek a second opinion (SO) driven by reduced trust in their own providers. Their trust may be diminished or reinforced through the SO. This study aimed to assess (1) what proportion of patients seek SOs motivated by lacking trust and how trust changes over time; (2) whether patients' trust differs by the outcome of the SO (i.e. similar/different opinion); and (3) how communication during the SO affects trust.

DESIGN

A longitudinal mixed methods study including self-report assessments before (T0), immediately following (T1), and two months after the SO (T2). SO consultations (N = 62) were audio recorded, and patient-oncologist communication about the referring oncologist was coded.

MAIN OUTCOME MEASURES

Patient-reported motives and their trust in referring oncologists.

RESULTS

Reduced trust motivated 21% of patients to seek a SO. Most patients criticised their referring oncologist. Consulting oncologists generally defended their colleagues, but such affirmation was unrelated to patients' subsequent trust. Over time, trust did not change substantially. Yet, it was restored in patients motivated by impaired trust, and remained low for patients receiving a different medical outcome.

CONCLUSION

Patients need support to more constructively discuss their treatment relationship. Oncologists need support in providing independent SOs without harming trust relations.

[Ethical stakes of information in radiation oncology: Thinking the risk and building the therapeutic alliance]

Informing patients before receiving radiation therapy is a fundamental ethical imperative. As a condition of the possibility of autonomy, information allows people to make health decisions concerning themselves, which is required by French law. This information includes in particular the potential risks due to radiation therapy. It is therefore necessary to think about what risk is, and how to define and assess it, in order to finally communicate it. The practice of informing people involves many ethical issues relating to the very content of the information, the form in which it is transmitted or even the intention that leads the health professional to say (or not to say) the risk. The transmission of information also questions the way to build a relationship of trust with the patients and how to integrate their own representations about these treatments. Between the risks of paternalism or even defensive medicine, this practice is at the heart of our professional practice.

Trustworthy management in hospital settings: a systematic review

BACKGROUND

Trustful relationships play a vital role in successful organisations and well-functioning hospitals. While the trust relationship between patients and providers has been widely studied, trust relations between healthcare professionals and their supervisors have not been emphasised. A systematic literature review was conducted to map and provide an overview of the characteristics of trustworthy management in a hospital setting.

METHODS

We searched Web of Science, Embase, MEDLINE, APA PsycInfo, CINAHL, Scopus, EconLit, Taylor & Francis Online, SAGE Journals and Springer Link from database inception up until Aug 9, 2021. Empirical studies written in English undertaken in a hospital or similar setting and addressed trust relationships between healthcare professionals and their supervisors were included, without date restrictions. Records were independently screened for eligibility by two researchers. One researcher extracted the data and another one checked the correctness. A narrative approach, which involves textual and tabular summaries of findings, was undertaken in synthesising and analysing the data. Risk of bias was assessed independently by two researchers using two critical appraisal tools. Most of the included studies were assessed as acceptable, with some associated risk of bias.

RESULTS

Of 7414 records identified, 18 were included. 12 were quantitative papers and 6 were qualitative. The findings were conceptualised in two categories that were associated with trust in management, namely leadership behaviours and organisational factors. Most studies (n = 15) explored the former, while the rest (n = 3) additionally explored the latter. Leadership behaviours most commonly associated with employee's trust in their supervisors include (a) different facets of ethical leadership, such as integrity, moral leadership and fairness; (b) caring for employee's well-being conceptualised as benevolence, supportiveness and showing concern and (c) the manager's availability measured as being accessible and approachable. Additionally, four studies found that leaders' competence were related to perceptions of trust. Empowering work environments were most commonly associated with trust in management.

CONCLUSIONS

Ethical leadership, caring for employees' well-being, manager's availability, competence and an empowering work environment are characteristics associated with trustworthy management. Future research could explore the interplay between leadership behaviours and organisational factors in eliciting trust in management.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives

Objective

The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians.

Methods

The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child).

Results

IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (β = -0.419, p < 0.01) and mothers' (β = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (β = -0.353, p < 0.01) and fathers' (β = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores.

Conclusion

The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

A scoping review to explore patient trust in dentistry: the definition, assessment and dental professionals' perception

Background A trusting dentist-patient relationship is pivotal in providing person-centred care. This scoping review aims to identify how trust is defined, measured and perceived by dental professionals.Methods The Joanna Briggs Institute framework was adopted. A search strategy was developed using MeSH (Medical Subject Headings) terms and key words. Medline/PubMed, Embase, PsycINFO and CINAHL were searched. Data were synthesised using thematic analysis.Findings In total, 16 studies were included that frequently used quantitative research methodology. Only four studies provided definition of trust. Many studies employed either Dental Trust Scale or Dental Beliefs Survey to measure dentist-patient trust, although others developed their own items. Limited research suggested that the dental professionals appreciated communication was paramount to building a trusting relationship with patients.Conclusion No consensus was found on the definition of trust, nor on a preferred assessment tool to measure dentist-patient trust. The limited evidence intimated that dental professionals acknowledged the importance of effective communication in building a trusting alliance with patients. The scarcity of relevant research highlights the need for more robust investigations of trust in dental care.

Effects of connection-based physician-patient relationships on perceptions of outcome: A vignette experiment

OBJECTIVES

To investigate the effects of media reports of medical outcomes and connection-based medicine on trust in physicians. In "connection-based medicine," people use personal connections to obtain better medical resources.

METHODS

Vignette experiments were used to investigate attitudes toward physicians among 230 cancer patients and their families (Sample 1) and a cross-validated sample of 280 employees from various industries (Sample 2).

RESULTS

For both samples, negative media reports were associated with lower trust in physicians; when the reports were positive, the participants generally perceived physicians as more competent and trustworthy. However, with negative reports, patients and families perceived connection-based physicians as less right and professional than non-connection-based physicians; the public (represented by the employee sample) perceived connection-based physicians as less right than non-connection-based physicians and negative outcomes to be caused more by connection-based physicians than non-connection-based physicians.

CONCLUSIONS

Medical reports can influence the perception of a physician's traits, which are important for trust. Positive reports promote evaluation of Rightness, Attribution, and Professionalism, whereas negative results may elicit the opposite effect, especially for connection-based physicians.

PRACTICAL IMPLICATIONS

Positive media images of physicians can help facilitate trust. Connection-based medical treatment should be reduced to improve access to medical resources in China.

Trust in healthcare before and during the COVID-19 pandemic

BACKGROUND

Public trust is often advantageous for health authorities during crises such as the COVID-19 pandemic. Norwegian health authorities used the public´s high trust to control the pandemic, resulting in relatively few casualties.

METHODS

We wanted to describe and compare the Norwegian public trust in GPs, public healthcare, information and treatment in hospitals before and during the early phases of the COVID-19 pandemic. Further, we wanted to investigate the relationship between somatic or mental illness, and trust in GPs and public health information, and to develop a theoretical understanding of the relationship between trust in healthcare institutions, generalised trust and the societal situation caused by the COVID-19 pandemic. We performed two surveys, the first in December 2019; the second in May 2020, thus providing two snapshots of the Norwegian public's trust in healthcare and healthcare actors before and during the COVID-19 pandemic.

RESULTS

There was statistically significant increased trust in public healthcare, in treatment at hospital and in information at hospital after the outbreak of the COVID-19 pandemic. There was a non-significant rise in trust in GPs. We found that trust in public health information was not related to mental health nor having a chronic, somatic disease.

CONCLUSION

The findings confirm that the Norwegian public's trust in healthcare and healthcare actors is high. The trust levels are also relatively stable, and even show an increase during the early phases of the pandemic. We suggest that there is a dynamic relationship between trust in public health information, healthcare institutions, generalised trust and a societal crisis situation such as the COVID-19 pandemic. However, the GP-patient trust seems less affected by a crisis situation, than the public´s trust in healthcare institutions. This difference may be explained by the relative stability caused by mandates of trust obtained from the patient.

Communication matters when it comes to adverse events: Associations of adverse events during implant treatment with patients' communication quality and trust assessments

OBJECTIVES

Because patients' trust in their physicians is a critical factor in improving health outcomes and patient response to adverse events, it is important to analyze the determinants of trust. One of these determinants is patient-centered communication. Because the occurrence of adverse events must be communicated to the patient, we asked whether the perceived quality of patient-physician communication acts as an isolating factor between adverse events and patient trust.

METHODS

We proposed and tested a structural equation model linking the occurrence of adverse events to the mediator patient-provider communication quality and to the outcome patient trust. The model was controlled for sociodemographic and health-related factors. We used online survey data from German implant patients (n = 1312), as implant treatment is associated with frequent adverse events such as infections.

RESULTS

Our results show that adverse events during implant treatment are associated with small but significantly lower trust levels. Patient-provider communication quality partially mediates this association.

CONCLUSIONS

Patient trust does not appear to be immune to deterioration from adverse events. Patient-provider communication plays a role in mitigating this association.

PRACTICE IMPLICATIONS

To improve the quality of care, attention should be paid to how adverse events are communicated in a patient-centered manner.

What Affects Treatment Underuse in Multiple Myeloma in the United States: A Qualitative Study

BACKGROUND

Multiple myeloma (MM) is the second most common hematologic malignancy. African Americans are more likely than Whites to be diagnosed with and die of MM, but they experience the same survival times in clinical trials, suggesting that differences in survival may be attributed to differences in receipt of treatment or differences in access to new treatments. We undertook this study to identify the reasons and needs underlying disparities in treatment among patients diagnosed with MM.

METHODS

We conducted in-depth interviews in 2019-2020 with patients diagnosed with MM between 2010 and 2014 who were identified as eligible for transplant and maintenance therapy and having experienced delays in or underuse of treatment for MM. Underuse was defined as the lack of a particular treatment that the patient was eligible to receive, not being transplanted if eligible, and/or not receiving maintenance therapy. Underuse included patients' decision to delay harvest or autologous stem cell transplant (ASCT) for the time being and return to the decision in the future. All interviews were audio-recorded and transcribed verbatim. Four investigators independently coded transcripts through inductive analysis to assess reasons for treatment decisions.

RESULTS

Of the 29 patients interviewed, 68% experienced treatment underuse: 21% self-identified as African American, 5% as Hispanic, 10% as mixed race, 57% as White, and 16% as Asian. There were no racial differences in reasons for underuse or delay. Themes relating to treatment underuse included: perceived pros and cons of treatment, including potential harm or lack thereof in delaying treatment; physician recommendations; and personal agency.

CONCLUSION

Patients' decision making, delays, and underuse of MM treatment are influenced by social, personal, medical, and contextual factors. Patients consider their relationship with their physician to be one of the most significant driving forces in their decisions and treatment plans.

Patient and Family Mistreatment of Residents in the Surgical Learning Environment

OBJECTIVE

Identify the frequency and types of mistreatment experienced by residents from patients and their families (P&F) and determine whether the types and frequency varied based on resident gender.

DESIGN

An anonymous survey was distributed to residents to assess the types of P&F mistreatment toward residents and the association with resident gender.

SETTING

The survey was distributed to the general surgery and urology programs at a large academic medical center in the mid-Atlantic. Participants: 23 of 53 residents (43% response rate) participated in the anonymous survey. Residents: 15 male residents (65%), 8 female residents (35%). Results: 12 of 23 responding residents (52%) indicated they experienced at least one form of mistreatment from P&F. Women were more likely to experience mistreatment (88% vs. 33%), with verbal assault was the most frequent (50% for female residents, 33% for male residents). Patients were more often the source than families (52% vs. 41%); verbal assault or threats of physical harm were the most common (50% for female residents, 33% for male residents).

CONCLUSIONS

Residents experience mistreatment from multiple sources. This paper provides insight into the experiences of surgical residents with mistreatment from their P&F, with differences in frequency of behaviors dependent upon the perpetrator group and resident gender. Patients and their family mistreatments are likely underreported and may be more difficult to prevent. It is important to identify mitigation strategies and ensure resources are available for those residents experiencing mistreatment. A strong culture against mistreatment and providing specific resources may minimize the experience and negative effects of mistreatment.

Fifty Years of Trust Research in Health Care: A Synthetic Review

Policy Points First, policymakers can create conditions that will facilitate public trust in health care organizations by making creating and enforcing health policies that make exploitative behavior costly. Second, policymakers can bolster the trustworthiness of health care markets and organizations by using their regulatory authority to address and mitigate harm from conflicts-of-interest and regulatory capture. Third, policymakers and government agencies can further safeguard the public's trust by being transparent and effective about their role in the provision of health services to the public.

CONTEXT

Trust plays a critical role in facilitating health care delivery and calls for rebuilding trust in health care are increasingly commonplace. This article serves as a primer on the trust literature for health policymakers, organizational leaders, clinicians, and researchers based on the long history of engagement with the topic among health policy and services researchers.

METHODS

We conducted a synthetic review of the health services and health policy literatures on trust since 1970. We organize our findings by trustor-trustee dyads, highlighting areas of convergence, tensions and contradictions, and methodological considerations. We close by commenting on the challenges facing the study of trust in health care, the potential value in borrowing from other disciplines, and imperatives for the future.

FINDINGS

We identified 725 articles for review. Most focused on patients' trust in clinicians (n = 499), but others explored clinicians' trust in patients (n = 11), clinicians' trust in clinicians (n = 69), and clinician/patient trust in organizations (n = 19) and systems (n = 127).  Across these five subliteratures, there was lack of consensus about definitions, dimensions, and key attributes of trust. Researchers leaned heavily on cross-sectional survey designs, with limited methodological attention to the relational or contextual realities of trust. Trust has most commonly been treated as an independent variable related to attitudinal and behavioral outcomes. We suggest two challenges have limited progress for the field: (1) conceptual murkiness in terms and theories, and (2) limited observability of the phenomena. Insights from philosophy, sociology, economics, and psychology offer insights for how to advance both the theoretical and empirical study of health-related trust.

CONCLUSION

Conceptual clarity and methodological creativity are critical to advancing health-related trust research. Although rigorous research in this area is challenging, the essential role of trust in population health necessitates continued grappling with the topic.

Exploring trust development in families of children towards surgical and emergency care providers: A scoping review of the literature

BACKGROUND

Trust is central to the therapeutic relationship between patients and their providers, yet little is known about how it is developed in the unique context of children facing surgical emergencies. We sought to identify factors fostering trust development, gaps, and areas for improvement.

METHODS

We searched eight databases from inception to June 2021 to identify studies focusing on trust in pediatric surgical and urgent care settings. PRISMA-ScR protocols were followed, and screening carried out by two independent reviewers. Data collection included study characteristics, outcomes, and results.

RESULTS

Out of 5578 articles screened, 12 fulfilled the inclusion criteria. Four major trust constructs were identified: competence, communication, dependability, and caring. Despite various instruments used, all studies reported a high level of parental trust. Nearly all studies (11/12) noted trust depending on parents' sociodemographic background, with ethnicity (3/12) and level of education and language barriers (2/12) limiting parents' confidence in physicians. High trust levels significantly correlated with effective communication and perceived quality of care. Most effective interventions enhancing trust included communication and caring trust constructs (10/12) rather than competence and dependability (5/12). Parents' individual experiences, development of compassionate interactions, and practice of family-centered care appeared important in developing trust.

CONCLUSIONS

Improving communication and providing compassionate care, as well as encouraging a patient-centered approach, appear to be most effective in promoting trust in pediatric surgical and urgent settings. Our findings can guide future educational interventions towards strengthening parental trust and promoting child- and family-centered care in pediatric surgical settings.

The Impact of Patient-Centered Care on Cancer Patients' QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey

Patient-centered approaches impact cancer patients' perceptions and outcomes in different ways. This study explores the impact of patient-centered care practices on cancer patients' quality-of-care (QOC), self-efficacy, and trust in their doctors. We utilized cross-sectional national survey data from the National Cancer Institute collected between 2017 and 2020. All estimates were weighted using the jackknife method. We used multivariable logistic regression to test our hypotheses adjusted for the demographics of the 1932 cancer patients that responded to the survey. Findings indicate that patient-centered communication resulted in better QOC, self-efficacy, and trust in doctors. In addition, engagement in their care improved patients' trust in cancer-related information received from doctors. QOC and patients' trust in doctors were significantly improved with the patients' understanding of the next steps, addressing feelings, clear explanation of the problems, spending enough time with the clinicians, addressing uncertainty, and involvement in decisions. Patients who were given a chance to ask questions were significantly more likely to trust their doctors. Technology use did not impact any of these interactions. Patient-centered strategies should consider the needs of the patients in the cancer settings to improve overall outcomes. Organizations should also build strategies that are goal-oriented and centered around the patients' needs, as standard strategies cannot induce the wanted results.

Patient's perceptions of oral and oropharyngeal cancer diagnosis disclosure: communication aspects based on SPIKES protocol

OBJECTIVE

Breaking bad medical news is a complex task of clinical practice. The manner in which this is done has a significant impact on patients. This study aimed to assess patient's perceptions regarding oral and oropharyngeal cancer diagnosis disclosure according to the "SPIKES" protocol.

STUDY DESIGN

This cross-sectional study used a questionnaire with 21 SPIKES-based items. The questionnaire was administered to 100 patients with recently diagnosed oral and oropharyngeal squamous cell carcinoma who evaluated each item according to their preference and experience.

RESULTS

Nineteen items showed a significant difference between patient's preference and recalled experience. Eighteen of these items showed lower experience scores primarily related to the amount of information desired by patients, presence of a companion, time to express feelings, and summary of information. Most patients preferred receiving as much information as possible about the diagnosis. However, only 35% reported that they had obtained sufficient information. Patients who were aware of cancer diagnostic suspicion had better communication experiences.

CONCLUSIONS

Protocols may be useful to guide health professionals to support patient-centered strategies to disclose oral cancer diagnoses.

The role of trust in the acceptance of adjuvant endocrine therapy in breast cancer patients

OBJECTIVE

Despite adjuvant endocrine therapy (AET) considerably reducing mortality and recurrence in hormonal receptor-positive (HR+) breast cancer (BC) patients, acceptance of AET remains an issue. The reasoning behind the lack of acceptance is complex and multifactorial, and some associated risk factors have been previously analyzed. Our study aims to assess women's beliefs and concerns toward AET and women's trust in the treating physician, focusing on determining the importance of these factors in the acceptance of AET.

METHODS

Out of n = 539, n = 269 women with HR + BC participated in a cross-sectional online survey. The main study variables were AET necessity beliefs and concerns (Beliefs about Medicines Questionnaire) and the trust in treating physicians. A binary hierarchical logistic regression was applied to predict AET acceptance.

RESULTS

We did not observe a meaningful mean difference in the necessity beliefs between women who accepted versus refused AET by the time of study conduct. Women with ongoing AET intake indicated significantly higher trust in their treating physician (d = 0.57) and have lower concerns (d = -1.65) regarding AET than women who had declined or discontinued AET prematurely. Results of the logistic regression demonstrated that after adjusting for clinical factors (e.g., prognosis, age), higher trust and lower concerns significantly increased the likelihood of accepting AET treatment.

CONCLUSIONS

Our results demonstrate the importance of discussing potential concerns regarding AET and establishing a trustful patient-physician relationship, which outweighs non-modifiable factors such as cancer prognosis.

Geriatrics communication skills training program for oncology healthcare providers to improve the management of care for older adults with cancer

Objective

We evaluated the feasibility, acceptability, and preliminary efficacy of a novel intervention, the Geriatric Communication Skills Training Program (Geriatric Comskil Training) for multidisciplinary healthcare providers (HCPs).

Methods

Three 2-h modules comprised the training: Geriatrics 101, Cognitive Syndromes, and Shared Decision-Making. Modules consisted of didactic knowledge, exemplary videos, and experiential learning role plays with standardized patients. We collected pre- and post-training data from 11 HCPs (module evaluations, self-efficacy, communication skills uptake in interaction with standardized patients, perceived ageism) and 44 patients (perceived HCP empathy, satisfaction with HCP communication).

Results

HCPs rated all modules high, with over 90% agreement on all course evaluation items assessing involvement, critical thinking, and reflectiveness, and significant improvements in self-efficacy. HCPs demonstrated an uptake in communication skills from pre- to post-training in agenda setting and overall skill use and reported promising trends towards lower ageism scores (d = 0.58). Promising trends in patient-reported HCP empathy (d = 0.39) and satisfaction with communication (d = 0.29) emerged from pre- to post-training.

Conclusion

Continued efforts are needed to strengthen HCP education related to geriatric communication across the cancer continuum.

Innovation

The Geriatric Comskil Training demonstrated feasibility, acceptability, and increases in self-efficacy and communication skills uptake for HCPs.

The Association between Survivorship Care Plans and Patient-Reported Satisfaction and Confidence with Follow-Up Cancer Care Provided by Primary Care Providers

Survivorship care plans aim to facilitate a smooth transition from tertiary to primary care settings after primary cancer treatment is completed. This study sought to identify the sociodemographic factors associated with receiving a survivorship care plan and examine the relationship between receiving a plan and confidence in follow-up care delivered by primary care providers. A cross-sectional analysis of the Canadian Partnership Against Cancer's Experiences of Cancer Patients in Transition Study was conducted (n = 9970). Separate adjusted multinomial logistic regression models assessed the relationship between survivorship care plans and follow-up care outcomes. Proportion of survivors more likely to receive a survivorship care plan varied by numerous sociodemographic and medical factors, such as cancer type (colorectal and prostate), gender (male), and education (high school or less). In unadjusted and adjusted models, individuals who received a Survivorship Care Plan had significantly higher odds of: having felt their primary care providers were involved; agreeing that their primary care providers understood their needs, knew where to find supports and services, and were able to refer them directly to services; and were confident that their primary care provider could meet their follow-up care needs.

Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis

OBJECTIVE

Lack of clarity regarding effective communication behaviors in chronic pain management is a barrier for implementing psychologically informed physical therapy approaches that rely on competent communication by physical therapist providers. This study aimed to conduct a systematic review and meta-synthesis to inform the development of a conceptual framework for preferred communication behaviors in pain rehabilitation.

METHODS

Ten databases in the health and communication sciences were systematically searched for qualitative and mixed-method studies of interpersonal communication between physical therapists and adults with chronic pain. Two independent investigators extracted quotations with implicit and explicit references to communication and study characteristics following Standards for Reporting Qualitative Research and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality for individual studies was assessed with Critical Appraisal Skills Programme, and quality of evidence was evaluated with GRADE-CERQual. An inductive thematic synthesis was conducted by coding each quotation, developing descriptive themes, and then generating behaviorally distinct analytical themes.

RESULTS

Eleven studies involving 346 participants were included. The specificity of operationalizing communication terms varied widely. Meta-synthesis identified 8 communication themes: (1) disclosure-facilitating, (2) rapport-building, (3) empathic, (4) collaborative, (5) professional accountability, (6) informative, (7) agenda-setting, and (8) meta-communication. Based on the quality of available evidence, confidence was moderate for 4 themes and low for 4 themes.

CONCLUSION

This study revealed limited operationalization of communication behaviors preferred by physical therapists in chronic pain rehabilitation. A conceptual framework based on 8 communication themes identified from the literature is proposed as a preliminary paradigm to guide future research.

IMPACT

This proposed evidence-based conceptual framework for preferred communication behaviors in pain rehabilitation provides a framework for clinicians to reflect on their own communication practices and will allow researchers to identify if and how specific communication behaviors impact clinical outcomes.

Patient participation in multidisciplinary tumor conferences in breast and gynecological cancer care: How patient-centered is the communication?

OBJECTIVE

Patients' participation is part of patient-centeredness, but it is so far unclear whether providers in multidisciplinary tumor conferences (MTCs) with patient participation communicate in a patient-centered way. Our aim is to explore (a) to what extent providers ask questions to breast and gynecological cancer patients during case discussion in MTCs, (b) how providers respond to patients' expressions of emotions during case discussions, and (c) which patient- and context-related characteristics and responses are associated with patients' trust in the treatment team after the case discussion.

METHODS

This observational study included survey data and audio recordings of MTCs with patient participation at three breast and gynecological cancer centers. Providers' questions to patients and responses to patients' emotional expressions were coded using the Verona Coding Definitions of Emotional Sequences. The response can be explicitly or non-explicitly related to the emotion and space-reducing or space-providing. Multiple linear regression analysis was used to determine associations between providers' responses, patient- and context-related characteristics, and patients' trust in the treatment team after the case discussion.

RESULTS

We analyzed 82 case discussions (77 breast, 5 breast and gynecological cancer patients). Providers asked a total of 646 questions, of which 86% were polar (yes/no). Providers gave 303 responses to a total of 230 emotional expressions by patients. Non-explicit responses were associated with more trust when they were space-providing, but with less trust when space-reducing.

CONCLUSIONS

The frequency of providers' closed questions and space-reducing responses to emotions shows that patient-centered communication rarely takes place in MTCs with patient participation.

The fragility of trust between patients and oncologists: A multiple case study

OBJECTIVES

This study aimed to explore in a naturalistic, real-life setting the dynamics of trust in oncological consultations.

METHODS

Cases to study were purposively selected from a data set of audio-recorded and transcribed consultations between oncology physicians and patients with advanced cancer, and analyzed qualitatively. The analytical approach was deductive, relying on a thematic framework of dimensions of trust, and inductive, not restricted by this framework.

RESULTS

The multiple case study approach allowed to identify factors, which play a role in the dynamics of trust. These factors are the number of treating physicians and how they communicate, continuity of care and the capital of trust, the hierarchical position of the physician and the physician's self-trust, and the patient's personality.

SIGNIFICANCE OF RESULTS

The findings illustrate the importance to contextualize trust in the flow of oncological consultations and to conceive it comprehensively for each singular encounter between patients and clinicians.

Cancer and COVID-19: ethical issues concerning the use of telemedicine during the pandemic

The lockdown imposed in France during the first wave of the COVID-19 pandemic wreaked havoc with access to healthcare. From March 2020 onwards, the oncologists of Foch Hospital, like many others at hospitals throughout the world, were obliged to adapt to the new conditions, including, in particular, the impossibility of seeing patients in classic consultations for the diagnosis and treatment of cancer. Patients with cancer are particularly susceptible to this new virus, due to their immune status, and this made it difficult to carry out standard hospital visits for these patients. Some patients refused to come to the hospital, whereas the doctors decided, for others, that consultation conditions at the hospital were not sufficiently safe, with sanitary measures that had yet to be precisely defined. Telemedicine was one of the adaptations adopted during this period. This mode of consultation was little used before the pandemic, for various reasons, and reimbursement was not automatic. This new approach proved to have limitations as well as advantages, as demonstrated by our empirical ethics research study, a retrospective qualitative survey of the doctors of the oncology and supportive care departments of Foch Hospital, performed during July 2021. The interview grid was based on the studies on telemedicine, oncology, COVID-19 and empirical ethics available at the time. Based on the experience gained in this domain during the first wave of the epidemic, which hit France between March and June 2020, we identified three eligibility criteria for consultations in telemedicine: the consultation concerned should not be the first consultation, the patient should be a known patient that the doctor trusts not to minimize the description of symptoms, and the results of the patient's evaluations and examinations must be good. It may be appropriate to continue the use of teleconsultation in the future, provided that these criteria are respected.

Cancer patients' perspectives on remote monitoring at home during the COVID-19 pandemic- a qualitative study in Norway

BACKGROUND

The COVID-19 pandemic triggered an unprecedented demand for digital health technology solutions, such as remote monitoring. Previous research has focused on patients with chronic diseases, and their experiences with remote monitoring during the pandemic. Several recommendations have been presented to reduce the frequency of cancer patients' visits to oncology centers and minimizing the risk of exposure to COVID-19, such as remote monitoring. However, few studies have explored how this has influenced the healthcare services to cancer patients.

AIM

To explore cancer patients' perspectives on remote monitoring at home during the COVID-19 pandemic.

DESIGN

The study had a qualitative design, using in-depth, individual interviews.

METHODS

A total of eleven interviews were conducted with patients who received remote monitoring during the COVID-19 outbreak. Three of the interviews were conducted by telephone, and eight on a digital platform, audio recorded, and transcribed verbatime. Data were analyzed using reflexive thematic analysis as recommended by Braun & Clarke.

RESULTS

All participants were conscious about being vulnerable to infections due to having cancer and receiving cancer treatment, and the pandemic to them represented an extra burden. Most of the participants experienced that their healthcare services had changed due to the pandemic, but there was no consensus on how the services had changed. All of the participants presented remote monitoring as something «new». Whether they received remote monitoring by telephone, video consultations or more advanced solutions with the possibility to complete a questionnaire or fill in measurements, did not seem to impact their views. However, all agreed that remote monitoring could never totally replace physical consultations in hospital. Participants' views seemed to grow more positive over time, but still they emphasized both positive and negative aspects of remote monitoring solutions in cancer care.

CONCLUSION

Remote monitoring was introduced as a necessity in cancer care during the COVID-19 outbreak. This may seem as an efficient solution, allowing for patients to stay at home and avoid infection. Our results indicate that, in the case of cancer patients, it is important that healthcare personnel balance the remote monitoring solution with person-to-person contact.

Development and Validation of the Trust in My Doctor, Trust in Doctors in General, and Trust in the Health Care Team Scales

RATIONALE

Historic and present-day racism and inequity in the United States (U.S.) have resulted in diminished trust in health care among many populations. A key barrier to improving trust in health care is a dearth of well-validated measures appropriate for diverse populations. Indeed, systematic reviews indicate a need to develop and test updated trust measures that are multidimensional and inclusive of relevant domains (e.g., fairness).

OBJECTIVE

We developed three trust measures: the Trust in My Doctor (T-MD), Trust in Doctors in General (T-DiG), and Trust in the Health Care Team (T-HCT) scales.

METHODS

After developing an initial item pool, expert reviewers (n = 6) provided feedback on the face validity of each scale. We conducted cognitive interviews (n = 21) with a convenience sample of adults to ensure items were interpreted as intended. In 2020, we administered an online survey to a convenience sample of U.S. adults recruited through the Qualtrics Panel (n = 801) to assess scale reliability and validity.

RESULTS

Exploratory and confirmatory factor analyses indicated acceptable model fit for second order latent factor models for each scale (root mean square error of approximation: <0.07, comparative fit index: ≥0.98, and standardized root mean square residual: ≤0.03). The T-MD contained 25 items and six subscales: communication competency, fidelity, systems trust, confidentiality, fairness, and global trust. The T-DiG and T-HCT each contained 29 items and seven subscales (the same subscales in the T-MD plus an additional subscale related to stigma-based discrimination). Each scale was strongly correlated with existing trust measures and perceived racism in health care and was significantly associated with delayed health care seeking and receipt of a routine health exam.

CONCLUSIONS

The multidimensional T-MD, T-DiG, and T-HCT scales have sound psychometric properties and may be useful for researchers evaluating trust-related interventions or conducting studies where trust is an important construct or main outcome.

The effects of the COVID-19 pandemic, risk perception, and perceived social support on public trust in physicians in China: A latent transition analysis

A population-based, longitudinal study was conducted among 29 provinces in mainland China to investigate how public trust in physicians (PTP) changed since the outbreak of COVID-19 and how the resulting lockdown and social support contributed to its restoration. The baseline sample (n = 3,233) was obtained during the period of the most rapid progression of COVID-19 (February 1 to 9, 2020, T1). Follow-up (n = 1,380) took place during the recovery period (March 17 to 24, T2). Latent profile models and a latent transition model were estimated. Participants were classified into either a moderate trust (21% at T1; 45% transition into high at T2) or a high trust (79% at T1; 88% remained in the high group) group in the latent profile. A latent transition from moderate to high trust was observed in locked-down regions and among those with higher social support. Social support moderated the transition from low to high trust. The current study showed that the epidemic outbreak and lockdown experience in China were associated with increased PTP; furthermore, public trust can be restored during a public health emergency. Attention should be paid to assure that social support and risk management strategies maintain PTP.

Does Internet Use Aggravate Public Distrust of Doctors? Evidence from China

The internet has exacerbated the spillover of medical information, and changes in the quantity, quality, and scope of information supply also affect public trust in doctors, which is of great significance to the construction of a harmonious physician–patient relationship. The objective of this study is to explore the relationship between internet use and residents’ trust in doctors using data from the China Family Panel Studies for 2018. The empirical investigation utilizes an endogenous switching regression model (ESR) to overcome the endogeneity bias. Our results indicate that internet use is negatively associated with residents’ trust in doctors (β = 0.07, p < 0.05). Specifically, the patient trust of internet users is nearly 7 percent less than that of non-internet users. Nevertheless, residents with higher dependence on traditional media such as television, newspapers, magazines and radio as an information channel show stronger patient trust. Finally, the results of the subsample analysis indicate a need to focus on older and less-educated residents, who are more vulnerable and more likely to be affected.

Documenting patients’ and providers’ preferences when proposing a randomized controlled trial: a qualitative exploration

Background

With advances in cancer diagnosis and treatment, women with early-stage breast cancer (ESBC) are living longer, increasing the number of patients receiving post-treatment follow-up care. Best-practice survivorship models recommend transitioning ESBC patients from oncology-provider (OP) care to community-based care. While developing materials for a future randomized controlled trial (RCT) to test the feasibility of a nurse-led Telephone Survivorship Clinic (TSC) for a smooth transition of ESBC survivors to follow-up care, we explored patients’ and OPs’ reactions to several of our proposed methods.

Methods

We used a qualitative study design with thematic analysis and a two-pronged approach. We interviewed OPs, seeking feedback on ways to recruit their ESBC patients for the trial, and ESBC patients, seeking input on a questionnaire package assessing outcomes and processes in the trial.

Results

OPs identified facilitators and barriers and offered suggestions for study design and recruitment process improvement. Facilitators included the novelty and utility of the study and simplicity of methods; barriers included lack of coordination between treating and discharging clinicians, time constraints, language barriers, motivation, and using a paper-based referral letter. OPs suggested using a combination of electronic and paper referral letters and supporting clinicians to help with recruitment. Patient advisors reported satisfaction with the content and length of the assessment package. However, they questioned the relevance of some questions (childhood trauma) while adding questions about trust in physicians and proximity to primary-care providers.

Conclusions

OPs and patient advisors rated our methods for the proposed trial highly for their simplicity and relevance then suggested changes. These findings document processes that could be effective for cancer-patient recruitment in survivorship clinical trials.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01549-1.