title: Trust in physicians and elements of the medical interaction in patients with rheumatoid arthritis and systemic lupus erythematosus.
abstract: OBJECTIVE
  To identify components of the patient-doctor relationship associated with trust in physicians.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: Javier P
authors.initials: JP
authors.lastname: Berrios-Rivera
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.forename: Maria G
authors.initials: MG
authors.lastname: Garcia Popa-Lisseanu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kallen
authors.forename: Marsha N
authors.initials: MN
authors.lastname: Richardson
authors.forename: Namieta M
authors.initials: NM
authors.lastname: Janssen
authors.forename: Donald M
authors.initials: DM
authors.lastname: Marcus
authors.forename: John D
authors.initials: JD
authors.lastname: Reveille
authors.forename: Noranna B
authors.initials: NB
authors.lastname: Warner
authors.forename: Maria E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology; D001172:Arthritis, Rheumatoid / Q000208:ethnology / Q000523:psychology*; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000208:ethnology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000208:ethnology; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires; D013781:Texas; D035502:Trust / Q000523:psychology*; D014342:Truth Disclosure; D044465:White People / Q000208:ethnology