Berrios-Rivera Javier P, Street Richard L, Garcia Popa-Lisseanu Maria G, Kallen Michael A, Richardson Marsha N, Janssen Namieta M, Marcus Donald M, Reveille John D, Warner Noranna B, Suarez-Almazor Maria E
Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
Arthritis Rheum. 2006 Jun 15;55(3):385-93. doi: 10.1002/art.21988.
To identify components of the patient-doctor relationship associated with trust in physicians.
We assessed 102 patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) seen at publicly funded hospitals in Houston, Texas. Patients completed a self-response survey examining patient perceptions of the medical encounter and trust in their physicians. Evaluated components of physicians' behaviors included: informativeness, sensitivity to concerns, reassurance and support, patient-centeredness, and participatory decision-making style. Scales were scored 0 to 10, with higher numbers indicating more positive perceptions of communication.
Seventy patients had RA and 32 SLE; 25% were white, 43% Latino, 31% African American, and 75% were female. Mean scores for the medical interaction and trust scales ranged from 6.2-7.1, indicating moderate degrees of positive perceptions. All components were highly and positively correlated with each other, and with trust, suggesting that these traits are all elements of a positive style of doctor-patient communication. In multivariate analysis, ethnicity, physicians' informativeness, physicians' sensitivity to concerns, patient-centeredness, disease activity, and patient trust in the US health care system were independent predictors of trust in physicians. A separate model examined the predictors of patient disclosure of information. Patient perceptions of physicians' patient-centeredness and severity of disease activity were independently predictive of patient disclosure of information.
In patients with SLE and RA, trust in physicians is significantly associated with patients' ethnicity and their perceptions about specific components of physicians' communication style. Trust in physicians can be improved by using a patient-centered approach, being sensitive to patient concerns, and providing adequate clinical information. Furthermore, patients appear to be more willing to disclose concerns when physicians use a patient-centered communication style.
确定与患者对医生信任相关的医患关系组成部分。
我们评估了在得克萨斯州休斯敦的公立医院就诊的102例系统性红斑狼疮（SLE）或类风湿关节炎（RA）患者。患者完成了一项自我应答调查，该调查考察了患者对医疗接触的看法以及对其医生的信任。评估的医生行为组成部分包括：信息提供、对患者担忧的敏感性、安慰与支持、以患者为中心以及参与式决策风格。量表评分从0到10，分数越高表明对沟通的积极看法越多。
70例患者患有RA，32例患有SLE；25%为白人，43%为拉丁裔，31%为非裔美国人，75%为女性。医疗互动和信任量表的平均分数在6.2至7.1之间，表明有中等程度的积极看法。所有组成部分彼此之间以及与信任都高度正相关，这表明这些特质都是积极的医患沟通风格的要素。在多变量分析中，种族、医生的信息提供、医生对患者担忧的敏感性、以患者为中心、疾病活动度以及患者对美国医疗保健系统的信任是患者对医生信任的独立预测因素。一个单独的模型考察了患者信息披露的预测因素。患者对医生以患者为中心的看法以及疾病活动度的严重程度是患者信息披露的独立预测因素。
在SLE和RA患者中，对医生的信任与患者的种族以及他们对医生沟通风格特定组成部分的看法显著相关。采用以患者为中心的方法、对患者担忧保持敏感并提供充分的临床信息，可以提高患者对医生的信任。此外，当医生采用以患者为中心的沟通风格时，患者似乎更愿意披露担忧。
