Tarn Derjung M, Meredith Lisa S, Kagawa-Singer Marjorie, Matsumura Shinji, Bito Seiji, Oye Robert K, Liu Honghu, Kahn Katherine L, Fukuhara Shunichi, Wenger Neil S
Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA.
Ann Fam Med. 2005 Jul-Aug;3(4):339-47. doi: 10.1370/afm.289.
Trust is a cornerstone of the physician-patient relationship. We investigated the relation of patient characteristics, religiosity, acculturation, physician ethnicity, and insurance-mandated physician change to levels of trust in Japanese American and Japanese patients.
A self-administered, cross-sectional questionnaire in English and Japanese (completed in the language of their choice) was given to community-based samples of 539 English-speaking Japanese Americans, 340 Japanese-speaking Japanese Americans, and 304 Japanese living in Japan.
Eighty-seven percent of English-speaking Japanese Americans, 93% of Japanese-speaking Japanese Americans, and 58% of Japanese living in Japan responded to trust items and reported mean trust scores of 83, 80, and 68, respectively, on a scale ranging from 0 to 100. In multivariate analyses, English-speaking and Japanese-speaking Japanese American respondents reported more trust than Japanese respondents living in Japan (P values <.001). Greater religiosity (P <.001), less desire for autonomy (P <.001), and physician-patient relationships of longer duration (P <.001) were related to increased trust. Among Japanese Americans, more acculturated respondents reported more trust (P <.001), and Japanese physicians were trusted more than physicians of another ethnicity. Among respondents prompted to change physicians because of insurance coverage, the 48% who did not want to switch reported less trust in their current physician than in their former physician (mean score of 82 vs 89, P <.001).
Religiosity, autonomy preference, and acculturation were strongly related to trust in one's physician among the Japanese American and Japanese samples studied and may provide avenues to enhance the physician-patient relationship. The strong relationship of trust with patient-physician ethnic match and the loss of trust when patients, in retrospect, report leaving a preferred physician suggest unintended consequences to patients not able to continue with their preferred physicians.
信任是医患关系的基石。我们调查了患者特征、宗教信仰、文化适应、医生种族以及保险规定的医生更换与日裔美国人和日本患者信任水平之间的关系。
对539名说英语的日裔美国人、340名说日语的日裔美国人和304名居住在日本的日本人进行社区抽样调查，采用英语和日语的自填式横断面问卷（由他们选择的语言完成）。
87%的说英语的日裔美国人、93%的说日语的日裔美国人和58%居住在日本的日本人回答了信任相关问题，在0至100的量表上，他们报告的平均信任得分分别为83、80和68。在多变量分析中，说英语和说日语的日裔美国受访者比居住在日本的日本受访者报告了更多的信任（P值<.001）。更高的宗教信仰（P<.001）、对自主权的较低渴望（P<.001）以及更长时间的医患关系（P<.001）与信任增加有关。在日裔美国人中，文化适应程度更高的受访者报告了更多的信任（P<.001），并且日本医生比其他种族的医生更受信任。在因保险覆盖范围而被提示更换医生的受访者中，48%不想更换的人对现任医生的信任低于对前任医生的信任（平均得分82对89，P<.001）。
在研究的日裔美国人和日本样本中，宗教信仰、自主权偏好和文化适应与对医生的信任密切相关，可能为加强医患关系提供途径。信任与医患种族匹配的紧密关系以及当患者回顾性报告离开首选医生时信任的丧失，表明对无法继续选择首选医生的患者会产生意想不到的后果。
