title: Health-care system distrust in the intensive care unit.
abstract: OBJECTIVE
  To examine the performance and properties of the Revised Health Care System Distrust Scale among surrogates in the intensive care unit (ICU).
  
  
  METHODS
  Pilot, prospective cohort study of 50 surrogates of adult, mechanically ventilated patients surveyed on days 1, 3, and 7 of ICU admission.
  
  
  RESULTS
  Responses on the Health Care System Distrust Scale on day 1 ranged from 9 to 34 (possible range 9-45, with higher scores indicating more distrust), with a mean and SD of 20.3 ± 6.9. Factor analysis demonstrated a 2-factor structure, corresponding to the domains of values and competence. Cronbach α for the overall scale was .83, for the competence subscale, .76, and for the values subscale, .74. Health-care system distrust was inversely correlated with trust in ICU physicians (Pearson coefficient -.63). When evaluated over the course of each patient's ICU stay, health-care system distrust ratings decreased by 0.31 per patient-day (95% CI 0.55-0.06, P = .015). Correlation between health-care system distrust and trust in ICU physicians decreased slightly over time.
  
  
  CONCLUSIONS
  Among surrogates in the ICU, the Health Care System Distrust Scale has high internal consistency and convergent validity. There was substantial variability in surrogates' trust in the health-care system.
authors.affiliation: Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, USA. schenkery@upmc.edu
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003695:Delivery of Health Care; D005260:Female; D006302:Health Services Research; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D010865:Pilot Projects; D011368:Professional-Family Relations; D011446:Prospective Studies; D019727:Proxy / Q000523:psychology*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors; D035502:Trust