Riva Silvia, Monti Marco, Iannello Paola, Pravettoni Gabriella, Schulz Peter J, Antonietti Alessandro
Department of Health Sciences, Università degli Studi di Milano, Milan, Italy; Institute of Communication and Health, Università della Svizzera Italiana, Lugano, Switzerland.
IBM Italia, Milan, Italy; Università Vita e Salute San Raffaele, Milan, Italy; Department for Adaptive Behaviour and Cognition, Max Planck Institute for Human Development, Berlin, Germany.
PLoS One. 2014 Mar 11;9(3):e90941. doi: 10.1371/journal.pone.0090941. eCollection 2014.
Several factors influence patients' trust, and trust influences the doctor-patient relationship. Recent literature has investigated the quality of the personal relationship and its dynamics by considering the role of communication and the elements that influence trust giving in the frame of general practitioner (GP) consultations.
We analysed certain aspects of the interaction between patients and GPs to understand trust formation and maintenance by focusing on communication channels. The impact of socio-demographic variables in trust relationships was also evaluated.
A cross-sectional design using concurrent mixed qualitative and quantitative research methods was employed. One hundred adults were involved in a semi-structured interview composed of both qualitative and quantitative items for descriptive and exploratory purposes. The study was conducted in six community-based departments adjacent to primary care clinics in Trento, Italy.
The findings revealed that patients trusted their GP to a high extent by relying on simple signals that were based on the quality of the one-to-one communication and on behavioural and relational patterns. Patients inferred the ability of their GP by adopting simple heuristics based mainly on the so-called social "honest signals" rather than on content-dependent features. Furthermore, socio-demographic variables affected trust: less literate and elderly people tended to trust more.
This study is unique in attempting to explore the role of simple signals in trust relationships within medical consultation: people shape trust and give meaning to their relationships through a powerful channel of communication that orbits not around words but around social relations. The findings have implications for both clinicians and researchers. For doctors, these results suggest a way of thinking about encounters with patients. For researchers, the findings underline the importance of analysing some new key factors around trust for future investigations in medical practice and education.
多种因素影响患者的信任，而信任又影响医患关系。近期文献通过考虑沟通的作用以及在全科医生（GP）诊疗框架中影响信任给予的因素，研究了人际关系的质量及其动态变化。
我们分析了患者与全科医生互动的某些方面，通过关注沟通渠道来理解信任的形成和维持。还评估了社会人口统计学变量在信任关系中的影响。
采用横断面设计，同时运用混合定性和定量研究方法。一百名成年人参与了一项半结构化访谈，访谈包含定性和定量项目，用于描述性和探索性目的。该研究在意大利特伦托市与基层医疗诊所相邻的六个社区部门进行。
研究结果显示，患者通过依赖基于一对一沟通质量以及行为和关系模式的简单信号，高度信任他们的全科医生。患者通过采用主要基于所谓社会“诚实信号”而非内容相关特征的简单启发式方法来推断全科医生的能力。此外，社会人口统计学变量影响信任：文化程度较低的人和老年人往往更信任他人。
本研究在试图探索简单信号在医疗咨询中信任关系中的作用方面独具特色：人们通过一个强大的沟通渠道塑造信任并赋予他们的关系意义，这个渠道围绕社会关系而非言语运转。研究结果对临床医生和研究人员都有启示。对医生而言，这些结果为思考与患者的接触提供了一种方式。对研究人员而言，研究结果强调了分析一些围绕信任的新关键因素对未来医疗实践和教育研究的重要性。
