Research on Patients’ Trust Risk Points and Promotion Path from the Perspective of Online Health Community / 中国医学伦理学

Online health community is a new medical treatment mode combining the Internet and medical treatment. Patients can get medical services through the network. However, it cannot be ignored that patients’ trust will be affected by the uncertainty of online medical information, the unsafe factors of patients’ private information, the insufficient standardization of the diagnosis and treatment process, and other issue in the process of using this new medical treatment mode. By taking measures such as improving the information quality in online health community, enhancing patients’ cognitive ability of health information, perfecting privacy protection measures in online health community, advancing patients’ participation in online health community and ensuring the standardization of diagnosis and treatment process, patients’ trust can be improved.

Analysis of Ethical Dilemmas in the Practice of Informed Consent of Critical Care Physicians in a Region of Beijing / 中国医学伦理学

【Objective:】 To explore the ethical dilemmas faced by the critical care physicians in the process of practicing the right to informed consent in a region of Beijing. 【Methods:】 14 doctors in the critical care unit from 5 medical institutions in a certain region of Beijing were interviewed in depth face-to-face by qualitative research method. The data obtained were analyzed through coding, classification, and extraction of subjects. 【Results:】 The lack of trust in doctor-patient communication leads to the instrumentalization of the right to know. When the decision of family members is inconsistent with the patient’s right to life and health, doctors are faced with the dilemma of choice and its impact. 【Conclusions:】 Faced with such ethical dilemmas, it is suggested to rebuild doctor-patient trust through multiple measures, and make appropriate restrictions on the agent-executing of the right of informed consent.

Evaluation and analysis on the degree of patients′ trust in community TCM physicians under the TCM service capability promotion program / 中华医院管理杂志

Objective@#To evaluate the degree of trust of patients in community traditional Chinese medicine(TCM)physicians, based on the TCM service capability promotion program, and to analyze the impacts by TCM prevention and health care service.@*Methods@#1 391 patients at 22 primary health service centers in 3 cities from Zhejiang province were investigated using the Chinese version of Wake Forest Physician Trust Scale(WFPTS)in September, 2017. Quantitative and qualitative variables were described by mean±SD, and ratio respectively. Differences were compared by t test, ANOVA and Kruskal-Wallis test.@*Results@#Chinese version of WFPTS had good reliability and validity in measuring community TCM physicians. The average scoring of patients′ trust in community TCM physicians was 38.00±6.42, while their benevolence and competence were 19.14±3.41, 18.82±3.50 respectively.For patients with different demographic characteristics, their quantity and the way to acquire and utilize TCM prevention and health care service had different degrees of trust in community TCM physicians. Patients′ gender, age, awareness and utilization of TCM prevention and health care service, etc. affect the degree of trust in community TCM physicians.@*Conclusions@#Patients have higher degree of trust in community TCM physicians, and improving the rate of awareness and utilization of TCM prevention has positive impacts on the degree of trust in these physicians. It is proposed that health knowledge education be strengthened and skills of community TCM physicians′ capacity be enhanced through various ways.

Qualitative Study on Doctor-patient Trust Mode in Beijing Public Hospitals: From the Prospective of Bureaucracy / 中国医学伦理学

Taking 6 one class A tertiary public hospitals at the top of the national medical service system in Beijing as the research site, and from the perspective of bureaucracy and system construction of public hospitals, this paper conducted a qualitative study on the doctor-patient trust mode, and analyzed that the institutional trust mode formed by the factors of universalism communication type and reputation trust mechanism among doctors and patients based on the framework of bureaucracy organization was the dominant mode of public hospitals. However, the traditional interpersonal trust mode still existed in the doctor-patient relationship in a recessive way. Systematic, rigorous hospital bureaucracy organization and system made public hospitals not only had a harmonious, orderly and efficient operation of the diagnosis and treatment environment, but also had well-known experts and professional standards at home and abroad, enjoying irreplaceable reputation and trust. Meanwhile, the principle of bureaucratic matter-based principle made an ineffective corporation between different clinic departments and the lack of interpersonal communication and humanistic care between doctors and patients, affecting the trust between doctors and patients. On this basis, it is proposed to strengthen the construction of humanistic environment in public hospitals, incorporate humanistic care and good doctor-patient communication into the performance appraisal of departments and medical staff. At the same time, by integrating the application and practice of medical model in diagnosis and treatment, it is advocated to rebuild more patient-friendly medical management based on organ system, and constantly improve the system trust between doctors and patients.

Qualitative study on doctor-patient trust at public hospitals based on bureaucracy theory / 中华医院管理杂志

Objective To analyze the impacts of bureaucracy management at tertiary public hospitals in Beijing on exchange modes and trust between doctors and patients, using both the bureaucracy theory and trust theory. To study the role of such management as an organizational structure for hospital operation and service, in the transition of doctor-patient trust from traditional special trust to a universal trust based on bureaucracy structure and specialized job division. Methods The purpose sampling method was used to select 94 hospital administrators, medical staff, and patients from six tertiary hospitals for a field survey. Results Bureaucracy at public tertiary hospitals keeps improving, and its systematic and refined organizational structure is changing the exchanges between doctors and patients, earmarking universal trust of the fundamental type of doctor-patient trust, aided by special trust. Rules and regulations of bureaucracy normalize medical services, and specialization enables medical workers in their clinical work against difficult and severe diseases, winning both reputation and patient trust as well. However, the specialized, professional and dehumanized characteristic of bureaucracy tend to encourage doctors to attend to diseases than patients, and separate links in medical services to decrease doctor-patient trust in the meantime. Conclusions Bureaucracy is a necessary organizational form of urban public hospitals, but it should strengthen their humanity feature and improve their communication with patients with rules and regulations. At the same time, with the use of integrated medical mode in clinical practice, bureaucracy could be improved to benefit patients and enhance trust of patients.

Reconstruction of Doctor-patient Trust in China from the Perspective of " Double Movement"? / 中国医学伦理学

The expansion movement of the market and the reverse movement that it has encountered to control its expansion constituted the " double movement" written by the British scholar Karl Polan.In traditional China,because the market was strictly embedded in the social,political,economic and ethical structure,there was no so-called " double movement",and the trust between doctors and patients was naturally established and historical-ly continued.Since the reform and opening up,with the gradual introduction of market mechanism in the reform of medical system,the market was increasingly " un-embedded" and expanded rapidly.At the same time,the socie-ty represented by the patients and their families gradually began to wake up and took action against market expan-sion,forming a more typical trend of " double movement" and triggering a more obvious crisis of doctor-patient trust.From the perspective of "double movement",to rebuild doctor-patient trust in the new period must re-em-bed the market into the society and strictly regulate some spontaneous social reverse movements.

Analysis of the Current Situation and Influencing Factors of Doctor - patient Trust from Different Perspectives of Doctors and Patients:Based on the Investigation of Six Medical Institutions in Beijing / 中国医学伦理学

From two perspectives of doctors and patients, we selected two microscopic angles of the hospital level and communication mode to carry out a parallel research and analyzed the effect of different levels of hospitals and doctor - patient communication mode on the trust between doctor and patient. The study found that both doctors and patients tended to trust each other, and in the process of medical treatment, the trust degree of patients that medical staffs believed was lower than that of the doctors that patients believed; both doctors and patients tended to consider that the hospital levels had great influence on doctor - patient trust, and their evaluation to doctor - patient trust in different levels of hospitals was discrepant; and both the doctors and patients tended to consider that the communication mode had great influence on the doctor - patient trust, in which the patients thought that doctors' appearance, detailed asking about disease and communication channels existed differences of effect in different lev-els of hospital.

A systematic review of effectiveness of interventions on patient trust / 中国心理卫生杂志

Objective: To assess the effectiveness of interventions on patient trust Methods: A system review was conducted through searching 11 relevant databases, such as Cochrane Library, EMBASE, PsycINFO, CINAHL, PubMed, Web of Science, SinoMed, CNKI, WANFANG. The randomized controlled trials (RCTs) were screened from 1539 original studies according to inclusion and exclusion criteria Meta-analysis was used to evaluate and interpret the interventions. Results: Ten RCTs were included in the review. It was concluded from meta-analysis that no significant difference could be found between controlled and intervention groups by increasing doctors'abilities(SMD = -0.05, 95％ CI: -0.22 -0.12); while the other two interventions, doctor's information disclosure as well as patient education and nursing intervention, significantly enhanced patient trust (SMD = 0.13, 95％ CI: 0.06 - 0.21; SMD = 0.60, 95％ CI: 0.29 - 0.90). Conclusion: Doctor's information disclosure, patient education and nursing intervention are effective in increasing patients'trust, while intervention of doctor's ability promotion seems not so remarkable.

Research on transfer of patient trust in online health websites / 中华医院管理杂志

Objective To explore the determinants and mechanism of trust transfer among patients for online health websites using the equation model. Methods A trust transfer model was built based on the theory of group convergence and doctor-patient interaction. 225 doctor records of online consultations were collected from Haodf, an online health website by data crawling from May 1 to Nov.30, 2017. Multiple regression was used for an empirical analysis. Results The patients' online trust has a positive impact on the physicians'trust offline, with a regression coefficient of 0.94, being significant at the level 0.01. Patient incentives, group size, and frequency of group interaction are important for online patient trust. Meanwhile, patient motivation, group size, and patient online efforts all have significant effect on patient offline trust. Conclusions Online patients' trust affects their offline trust significantly. Developers of online health websites can increase the online trust of patients by motivation and interaction, which help create a desirable medical environment and encourage their trust to offline doctors, contributing to higher medical satisfaction.

Analysis of the doctor-patient trust strategies in family physicians contracted service from residents′perspectives / 中华医院管理杂志

Objective To learn the current doctor-patient trust in contracted service of family physicians in suburban Beijing, and analyze its influencing factors from residents′ perspectives to propose countermeasures. Methods A total of 197 contracted residents were sampled from 12 community health service centers in 4 out of 10 suburb districts of Beijing, for a questionnaire survey using stratified random sampling method. Items of the questionnaire cover residents′knowledge of the family physicians′ contracted service, their trust of family physicians′ competence, and their trust level of the ethics and the influencing factors. Measurement data were calculated form the mean value, while the count data were subject to proportion analysis, frequency description and rank ordering. Results 175(88.8% )and 156(79.2% )of the contracted residents trust the ethics and competence of their family physicians. Whether the ethics trust exists between doctors and patients was decided by if residents′respect, care, and interests considerations taken into account by the physicians; the factors influencing the competence trust of the residents were the age, education of the residents, and whether the physicians display respect, care. Conclusions Upgrading the medical competence and ethical conduct is conducive to the establishment of doctor-patient trust. In the establishment of the family physicians contracted service, it is necessary to improve acceptance of the contracted residents. At the same time, medical ethics issues such as respect for care, privacy protection, and maximum interests of the residents in the process of medical treatment deserve further attention.

Study on the Influencing Factors of Doctor-patient Relationship and the Multi-Angle Countermeasure:Taking Ningxia Region for Example / 中国医学伦理学

Objective:To analyze the causes and influencing factors of the strained relationship between doctors and patients and explore the corresponding countermeasures.Methods:Five public hospitals in Ningxia were selected to conduct a questionnaire survey.The influencing factors of doctor-patient relationship were analyzed using SPSS17.0,combined with the results of field case interviews.Results:The society was not satisfied with the medical staff,the rate of dissatisfaction was 87.9％.The causes of tense doctor-patient relationship were mainly focused on the following aspects:imperfect medical insurance system,unreasonable medical system,negative media reports,inflated expectations of patients,lack of necessary communication between doctors and patients,and lack of medical ethics.Conclusion:According to the influencing factors of doctor-patient relationship,this paper puts forward some countermeasures from the perspective of governments,the society and media.

Review of Social Trust Mechanism and Doctor-patient Trust Evaluation / 中国医学伦理学

Objective:Through literature search,this paper aims to understand the current situation of social trust mechanism and the research progress of trust evaluation methods,and thus to provide theoretical reference for further researches.Methods:Using the literature search method,this paper sorted out,analyzed and concluded the domestic and foreign literatures and information about social trust mechanism and trust evaluation.Results:The domestic research on social trust mechanism could be mainly divided into two parts,while the foreign research path was different and mainly related to the field of electronic commerce,government departments,medical behavior,and so on.Evaluation methods in doctor-patient trust mainly included trust scale evaluation and trust model.Conclusion:There is a certain development of the domestic researches on social trust mechanism and evaluation,but still need further improvement.The limitation of doctor-patient trust evaluation is prominent and efforts should be made to research on the improvement measures of medical social trust mechanism.

Analysis of the Cognitive Factors of Medical Professionalism Affecting Doctor-patient Trust:Based on Investigations of Six Medical Institutions in Beijing / 中国医学伦理学

This paper analyzed the three basic principles of medical professionalism established in the Medical Professionalism in the New Millennium:Physician Declaration and influencing factors of a series of clear professional responsibilities from the medical technology , medical ethics , medical professional responsibility and medical equity four levels .The study found that the proportions of doctors and patients ' identification with the elements of medical professionalism were relatively high , of which the proportion of doctors was higher than patients .It indicated that the basic principles and professional responsibility advocated by medical professionalism had been recognized and accepted by medical staff and the public .

The effect of the third party evaluation of patient trust on improving medical quality / 复旦学报（医学版）

Objective To investigate the effect of the third party evaluation on improving the quality of medical service as well as the degree of patient trust in hospital.Methods Discharge patients from a two-level hospital in Minhang District was enrolled to evaluate their trust for medical service.Telephone follow-up were implemented in group A by the third party evaluation team.Group B was evaluated by the in-patient department when they left the hospital.These two evaluation methods were compared for the effects.Results During the first evaluation,1 073 people in group A,the equipartition satisfaction was 3.83 ± 0.57,the satisfaction rate was 54.99％.While in group B of 1 480 people,the equalization satisfaction was 3.83 ± 0.49,the satisfaction rate was 57.03％ (P＞0.05).At the fourth evaluation,1 233 people in group A and 1 512 people in group B were evaluated.Regarding group A,the patient satisfaction scores was 4.18 ± 0.33,patients satisfaction rate was 84.43％,the equipartition of patients referral was 3.44 ± 0.83,the equipartition of patients recommends the physician was 3.52 ±0.88,the equipartition of the doctor and patient had a quarrel was 4.33 ± 0.60,the equipartition of patients will find another doctor for diagnosis was 3.31 ± 0.72,the equipartition of patients expressed fully in accordance with the doctor's order of medication was 3.45 ± 0.72,group A were better than groupB (P＜0.05).Of the28 entries in the level of trust related to medical services,15 entries of group A were higher than group B (P＜0.05).In group A,the equipartition of moderate intensity activity was 3.62 ± 0.81,the equipartition of emotional coordination refers to 3.71 ± 0.76,the equipartition of family coordination was 3.69 ± 0.58,the equipartition of friends coordination was 3.73 ± 0.74,the equipartition of overall health was 3.31 ± 0.77,all were superior to group B (P＜0.05).Conclusions The third party evaluation is a supplementation for hospital management,which has positive effects on improving medical service quality of medical institutions,the hospital performance appraisal system,patients' experiences and trust degree.

Analysis of the Cognitive Factors of Medical Professionalism Affecting Doctor-patient Trust:Based on Investigations of Six Medical Institutions in Beijing / 中国医学伦理学

This paper analyzed the three basic principles of medical professionalism established in the Medical Professionalism in the New Millennium:Physician Declaration and influencing factors of a series of clear professional responsibilities from the medical technology , medical ethics , medical professional responsibility and medical equity four levels .The study found that the proportions of doctors and patients ' identification with the elements of medical professionalism were relatively high , of which the proportion of doctors was higher than patients .It indicated that the basic principles and professional responsibility advocated by medical professionalism had been recognized and accepted by medical staff and the public .

The effect of the third party evaluation of patient trust on improving medical quality / 复旦学报（医学版）

Objective To investigate the effect of the third party evaluation on improving the quality of medical service as well as the degree of patient trust in hospital.Methods Discharge patients from a two-level hospital in Minhang District was enrolled to evaluate their trust for medical service.Telephone follow-up were implemented in group A by the third party evaluation team.Group B was evaluated by the in-patient department when they left the hospital.These two evaluation methods were compared for the effects.Results During the first evaluation,1 073 people in group A,the equipartition satisfaction was 3.83 ± 0.57,the satisfaction rate was 54.99％.While in group B of 1 480 people,the equalization satisfaction was 3.83 ± 0.49,the satisfaction rate was 57.03％ (P＞0.05).At the fourth evaluation,1 233 people in group A and 1 512 people in group B were evaluated.Regarding group A,the patient satisfaction scores was 4.18 ± 0.33,patients satisfaction rate was 84.43％,the equipartition of patients referral was 3.44 ± 0.83,the equipartition of patients recommends the physician was 3.52 ±0.88,the equipartition of the doctor and patient had a quarrel was 4.33 ± 0.60,the equipartition of patients will find another doctor for diagnosis was 3.31 ± 0.72,the equipartition of patients expressed fully in accordance with the doctor's order of medication was 3.45 ± 0.72,group A were better than groupB (P＜0.05).Of the28 entries in the level of trust related to medical services,15 entries of group A were higher than group B (P＜0.05).In group A,the equipartition of moderate intensity activity was 3.62 ± 0.81,the equipartition of emotional coordination refers to 3.71 ± 0.76,the equipartition of family coordination was 3.69 ± 0.58,the equipartition of friends coordination was 3.73 ± 0.74,the equipartition of overall health was 3.31 ± 0.77,all were superior to group B (P＜0.05).Conclusions The third party evaluation is a supplementation for hospital management,which has positive effects on improving medical service quality of medical institutions,the hospital performance appraisal system,patients' experiences and trust degree.

Mediation effect of perceived social support between aggression of patients and doctor-patients trust / 中华行为医学与脑科学杂志

Objective To explore the relationship among aggression of patients,doctor-patient trust and perceived social support,and to provide a new prospective of improving doctor-patient relationship.Methods Data of Chinese buss-perry aggression scale,wake forest physician trust scale and perceived social support were collected from a sample of 338 patients in Guangzhou and analyzed with structural equation modeling.Results ①Median (interquartile range) of aggression,doctor-patient trust and perceived social support were 54(18),32(8) and 62(15) respectively.②Total score of aggression(Z=-2.37,P=0.02) and the dimension score of physical-aggression(Z=-4.07,P＜0.01) between different gender were statistically significant,and the scores of male were higher than female.③According to relevant result,aggression of patients was significantly negatively correlated with both doctor-patient trust (r=-0.13,P＜0.05)and perceived social support(r=-0.14,P＜0.01).Doctor-patient trust was significantly positively correlated with perceived social support(r=0.36,P＜0.01) ④Perceived social support fully mediate the relationship between aggression of patients and doctor-patient trust(GFI =0.989,NFI =0.989,IFI =0.998,CFI =0.998,RMSEA =0.026,x2/df=1.229).Conclusion Perceived social support is a protective factor of aggression of patients.Improving the perceived social support of patients can promote the doctor-patient trust.

Research on the Evaluation System of Doctor-patient Trust / 中国医学伦理学

Doctor-patient trust is the core and foundation of harmonious doctor-patient relationship, because our country is at the stage of social transformation and deepening medical reform, various problems make the doctor-patient relationship unoptimistic, and there appeared crisis of confidence between doctors and patients. This arti-cle analyzes the current situation of doctor -patient trust in our country, based on the clarification of doctor -patient trust. It also comb the researches focused on doctor-patient trust evaluation on the basis of domestic and foreign literature. It is expected to provide a reference to the future evaluation of doctor-patient trust, to improve the level of trust between doctors and patients, and to build a harmonious doctor-patient relationship.

Trust and expectation on psychiatrist and its correlation with satisfaction and adherence in patients with mental illness

Background: Trust and expectation are important aspect of doctor patient relationship and its role in patient’s satisfaction and medication adherence is unclear. Objective: To study the levels of trust and expectation on psychiatrist and its relationship with patient’s satisfaction and treatment adherence. Methods: One hundred and twenty three consecutive outpatients were recruited on follow-up if they satisfied the selection criteria. They were assessed with socio-demographic and clinical proforma designed for this study, Patient Trust Scale, Patient Satisfaction Survey, Patient Expectations Questionnaire and Medication Adherence Rating Scale. Results: There was a high mean score on trust scale (Mean 38.9, SD 8.5) and expectation questionnaire (Mean 13.5, SD 3.3). On Kruskal-Wallis H test significant group differences were observed in nuclear vs joint family type (c2 = 18.496, h2 = .151, df = 1, Sig. = .000) and knowledge of treatment option (medication only vs medication + psychotherapy) treatment option (c2 = 18.100, h2 = .148, df = 2, Sig. = .000) and occupational status (employed vs unemployed) (c2 = 3.165, h2 =.029, df = 1, Sig. = .056) on the score of PTS. Similar differences were also observed in method of treatment sought before (no treatment vs allopathic) (c2 = .065, h2 = .065, df = 3, Sig. = .005), knowledge about treatment option (medication only vs medication + psychotherapy) (c2 = .026, h2 = .161, df = 2, Sig. = .000) and occupation (employed vs unemployed) (c2 = .061, h2 = .061, df = 1, Sig. = .006) on the score of PEQ. On regression analysis (R2 = .723, F = 156.46, p = .000) value of the score on patient satisfaction was statistically significant as predicted by score on measure of expectation (beta = -0.095, t = -1.966, p = 0.052) and trust (beta = .842, t = 17.504, p = .000). Discussion: Levels of patients trust and expectation on physician varies with knowledge about treatment option & occupational status, and significantly...

Comparison of Doctor-patient Trust Mechanism between Doctors in Urban and Rural Areas from the Perspective of Rural Residents---Based on the Field Research in H County of Beijing / 中国医学伦理学

Objective:To compare the similarities and differences of doctor -patient trust building mechanism between doctors in urban and rural areas from the perspective of rural residents by the empirical study .Methods:Based on the field research and secondary in -depth interviews to the related personnel in H County of Beijing .Re-sults:There had obvious difference of doctor -patient trust building mechanism between doctors in urban and rural areas from the perspective of rural residents .Trust building mechanism between village doctors were mainly the trust of the similar social background , between the doctors in township health centers and city hospital were the trust based on reputation , institution-based trust , and relationship-based trust .Conclusion:The difference of re-gional and cultural between urban and rural areas ,the nature of medical institutions the relationship with doctors , reputation of medical institution and medical and health care system in urban and rural areas ,maybe the reasons that The difference of doctor -patient trust building mechanism between doctors in urban and rural areas .