Earning trust and losing it: Adolescents’ views on trusting physicians
Specific physician behaviors—particularly those implying an assurance of confidentiality—encourage trust-building among adolescents
Objective: To explore how adolescents with and without chronic illness perceive patient-physician trust and to identify physician behaviors related to these perceptions that might be modified to promote adolescent health care.
Methods: Fifty-four adolescents recruited from the community (healthy subjects) and from hospital-based clinics (subjects with chronic illnesses) participated in 12 focus groups divided by age (11–14 or 15–19 years old), gender, and health status. Major themes related to preferred physician characteristics and trusting one’s doctor were derived through a multistep, team-based qualitative analytic process.
Results: Adolescents hold varied perspectives of trust in their physicians. They describe elements of patient-physician trust similarly to the comprehensive model developed with adults, including fidelity, confidentiality, competency, honesty, and a global perspective intersecting several of the more specific domains. However, adolescents differ in the relative importance of these dimensions. Younger adolescents express more concern about confidentiality of their health information, and adolescents with chronic illnesses are more interested in involving parents in their care than are adolescents without chronic illnesses. Examples of specific behaviors to improve trust include asking for adolescent’s opinion, keeping private information confidential, not withholding information, and engaging in small talk to show concern.
Conclusion: Understanding the importance of trust and listening to recommendations about behaviors to improve it, in the words of the adolescents, may help physicians build positive relationships with their adolescent patients.
- Keep in mind that adolescents are generally more concerned than adults about confidentiality when deciding on a physician’s trustworthiness.
- Approach adolescents who have chronic illnesses with the expectation that they will be more comfortable involving parents in their care than will healthy adolescents.
In the primary care setting, a patient’s trust of the physician is more strongly associated with self-reports of improved health than is any other characteristic of the patient-physician relationship.1 Trust has been shown to affect a patient’s satisfaction with health care services and willingness to disclose sensitive information, adhere to treatment, continue with a physician, and recommend that physician to others.1,2
Increasing age of a patient has a modestly positive correlation with trust, possibly due to greater contact with physicians; other demographic characteristics have not been consistently found to relate to trust.3,4
Studies examining health status and trust have shown a weak and inconsistent relationship.1,3 Persons with poor health, such as a chronic illness, may be more vulnerable and thus have a greater need to trust. Poor health may also cause negative feelings that may influence how patients trust their physicians.
Physician behavior and patient trust
The importance of patient trust to the process and outcome of health care has prompted the study of how specific physician behaviors may help to build trust. Among adults with and without chronic conditions, trust is associated with perceived physician caring, competence, and communication.1,5,6 Among adolescents, trust seems more strongly influenced by a physician’s confidentiality, competence, honesty, and respect, than by any other set of characteristics pertaining to health care professionals, health care sites, or incentives to use primary care services.7,8 Distrust that physicians will protect confidentiality has been cited as a barrier to health care use and compliance among adolescents.9
However, unlike the adult literature on patient-physician trust, no study of adolescents has defined trust from the patient’s perspective or identified physician behaviors that promote trust among adolescent patients. Directly asking adolescents about trust in their doctor may identify specific physician behaviors that encourage building trust. Understanding the importance of trust to adolescents and listening to their recommendations about behaviors to improve it, in the words of the adolescents, may help physicians build positive relationships with their adolescent patients.
This study addresses the call by Rosser and Kasperski for more research pertaining to the development of trust between doctors and patients.10 A model of trust between adult patients and their physicians, developed by Hall et al,3 was used as a framework to understand adolescents’ perceptions of patient-physician trust. The 5 specific domains of this model include patient perceptions of physician fidelity, protection of confidential information, competence, honesty, and a global perspective that intersects several of the more specific domains and captures the holistic aspect of trust. This study’s objective was to explore how adolescents with and without chronic illness perceive patient-physician trust and to identify physician behaviors related to these perceptions that might be modified to promote adolescent health care.
Methods
Participants
This study was part of a larger qualitative and quantitative research project examining health care preferences of adolescents with chronic health conditions.11 The protocol for the research project on adolescent health care preferences and the analyses performed for the current study on trust were approved by the Institutional Review Board of the Cincinnati Children’s Hospital Medical Center.
