title: Role of patient treatment beliefs and provider characteristics in establishing patient-provider relationships.
abstract: BACKGROUND
  Positive patient-provider relationships have been associated with improved depression treatment outcomes. Little is known about how patient treatment beliefs influence patient-provider relationships, specifically treatment alliance and shared decision making in primary care (PC).
  
  
  OBJECTIVE
  We evaluated the relationship between patient treatment beliefs and patient-provider relationships by gender, race and current depression.
  
  
  METHODS
  We used a deductive parallel convergent mixed method design with cross-sectional data. Participants were 227 Black and White patients presenting with depression symptoms in PC settings. Individuals were randomized into either a quantitative survey (n = 198) or qualitative interview (n = 29) group. We used multiple ordinary least squares regression to evaluate the association between patient beliefs, as measured by the Treatment Beliefs Scale and the Medication Beliefs Scale, and treatment alliance or shared decision making. We concurrently conducted thematic analyses of qualitative semistructured interview data to explicate the nature of patient-provider relationships.
  
  
  RESULTS
  We found that patients who believed their provider would respectfully facilitate depression treatment reported greater bond, openness and shared decision making with their provider. We also identified qualitative themes of physicians listening to, caring about and respecting patients. Empathy and emotive expression increased patient trust in PC providers as facilitators of depression treatment.
  
  
  CONCLUSIONS
  This work systematically demonstrated what many providers anecdotally believe: PC environments in which individuals feel safe sharing psychological distress are essential to early identification and treatment of depression. Interprofessional skills-based training in attentiveness and active listening may influence the effectiveness of depression intervention.
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL, patricia.king@northwestern.edu.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Lee King
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA and.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Cederbaum
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA and.
authors.forename: Seth
authors.initials: S
authors.lastname: Kurzban
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, CA and.
authors.forename: Timothy
authors.initials: T
authors.lastname: Norton
authors.affiliation: School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Palmer
authors.affiliation: School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D003863:Depression / Q000628:therapy*; D004645:Empathy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011897:Random Allocation; D011795:Surveys and Questionnaires; D035502:Trust; D055815:Young Adult
keywords: Depression/mood disorders; doctor–patient relationship; health disparities; primary care; quality of care.