McKinstry B, Ashcroft R E, Car J, Freeman G K, Sheikh A
University of Edinburgh, General Practice Section, Community Health Sciences, 20 West Richmond Street, Edinburgh, Scotland, UK EH10 5PF.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004134. doi: 10.1002/14651858.CD004134.pub2.
Trust is a fundamental component of the patient-doctor relationship and is associated with increased satisfaction, adherence to treatment, and continuity of care. It is not clear if there are interventions known to be effective in enhancing patient trust in doctors.
To assess the effects of interventions intended to improve a patient's trust in the doctor or a group of doctors.
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1 2003), MEDLINE(1966 to week 4 2003), EMBASE (1985 to July 2003), Health Star (1975 to July 2004), PsycINFO (1967 to July 2004), CINAHL (1982 to June 2003), LILACS (1982 to April 2003), African Trials Register (1948 to April 2003), African Health Anthology (1924 to April 2003), Dissertation Abstracts International (1861 to April 2003) and the bibliographies of studies assessed for inclusion. We also searched the bibliographies of studies assessed for inclusion, and contacted researchers active in the field.
Randomised controlled trials (RCTs), controlled clinical trials, controlled before and after studies, and interrupted time series studies of interventions (informative, educational, behavioural, organisational) directed at doctors or patients (or carers) where trust was assessed as a primary or secondary outcome.
Two review authors independently assessed trial quality and extracted data.
Three RCTs, all published in English and set in North American primary care, and involving 1916 participants, were included. There was considerable heterogeneity in terms of aims, format and content of the interventions. One trial of a training intervention for family doctors to improve communication behaviours (20 doctors assessed by 414 patients) showed no effect on trust. The other two interventions were patient focussed. One explored the impact on trust of disclosing physician incentives to patients (n= 918) in a Health Maintenance Organisation (HMO) and showed no diminution in trust. Another investigated the effect of induction visits on new HMO members' (n=564) trust in their HMO doctors. Trust in doctors rose compared with control following the visit for one type of induction visit, the group visit (Trust out of 10 (standard deviation (SD)) was 8.8 (1.5) and 7.1 (2.2), difference 1.7, (95% confidence interval 1.22 to 2.18)). However there were many drop-outs and analysis was not on intention to treat.
AUTHORS' CONCLUSIONS: Overall there remains insufficient evidence to conclude that any intervention may increase or decrease trust in doctors. Further trials are required to explore the impact of policy changes, guidelines and specific doctors' training on patients' trust.
信任是医患关系的一个基本要素，与更高的满意度、治疗依从性和持续护理相关。目前尚不清楚是否存在已知有效的干预措施来增强患者对医生的信任。
评估旨在提高患者对医生或一组医生信任的干预措施的效果。
我们检索了Cochrane对照试验中心注册库（2003年第1期《Cochrane图书馆》）、MEDLINE（1966年至2003年第4周）、EMBASE（1985年至2003年7月）、Health Star（1975年至2004年7月）、PsycINFO（1967年至2004年7月）、CINAHL（1982年至2003年6月）、LILACS（1982年至2003年4月）、非洲试验注册库（1948年至2003年4月）、非洲健康文选（1924年至2003年4月）、国际学位论文摘要（1861年至2003年4月）以及纳入研究评估的参考文献。我们还检索了纳入研究评估的参考文献，并联系了该领域的活跃研究人员。
随机对照试验（RCT）、对照临床试验、前后对照研究以及针对医生或患者（或护理人员）的干预措施（信息性、教育性、行为性、组织性）的中断时间序列研究，其中信任被评估为主要或次要结局。
两位综述作者独立评估试验质量并提取数据。
纳入了三项RCT，均以英文发表，在北美初级保健机构开展，涉及1916名参与者。干预措施在目的、形式和内容方面存在相当大的异质性。一项针对家庭医生的培训干预以改善沟通行为（414名患者评估20名医生）对信任没有影响。另外两项干预以患者为中心。一项探讨了在健康维护组织（HMO）中向患者披露医生激励措施对信任的影响（n = 918），结果显示信任没有降低。另一项研究了入职访视对新HMO成员（n = 564）对其HMO医生信任的影响。对于一种入职访视类型，即小组访视，访视后与对照组相比，对医生的信任有所提高（10分制信任度（标准差（SD））分别为8.8（1.5）和7.1（2.2），差值为1.7，（95%置信区间1.22至2.18））。然而，有许多失访情况，且分析并非基于意向性治疗。
总体而言，仍然没有足够的证据得出任何干预措施可能增加或降低对医生信任的结论。需要进一步的试验来探索政策变化、指南和特定医生培训对患者信任的影响。
