The impact of trust on roles patients wish to play in making medical decisions

grantor: University of TorontoBackground. Current medical and bioethical literature calls for active patient participation in making decisions about their own treatment. However, the literature also suggests that many patients do not want to participate. This study examines the following questions: To what extent do patients want to participate in problem solving (where preferences are irrelevant, e.g. diagnosis) and decision making (e.g. what is to be done) about their own treatment? To what extent do they want to be informed? What is the impact of respondents' trust in their physician, personal characteristics (age, level of education) and disease characteristics (diagnosis of cancer, chronicity, availability of support groups) on their desire for participation? What is the impact of respondents' desire for participation and trust in the physician on use of alternative therapies and preference of label ('patients', 'clients', 'partners', 'consumers', 'survivors', or 'customers')? Methods. In this cross-sectional survey, questionnaires including the PSDM scale and the Trust in Physician scale were completed by 202 respondents from each of 3 teaching hospital clinics (breast cancer, prostate cancer, fractures). Results. We found that most respondents (52%) wanted a shared participation role, where problem solving (PS) is handed over to the physician but not decision making (DM); 43.7% of respondents desired a passive role, where both PS and DM are handed over; and only 4.3% desired an autonomous role. Trust in the physician was inversely related to desire for participation: as trust levels rose, the respondent was more likely to be passive. Age, education, and support group use were found to be predictive of desire for participation, although other disease characteristics were not. Low trust levels were associated with alternative therapy use. Preference of label was influenced by both trust and desire for participation: respondents with high trust levels and desire for a passive role were more likely to indicate they strongly liked being referred to as a patient. Conclusions. The impact of trust on the desire for participation is our most important finding. The links between trust, use of alternative therapies, and preference of a consumerist label suggest that trust in physicians is an integral element of satisfying patient-physician relationships.Ph.D