RESUMO
BACKGROUND: The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model. METHODS: A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable. RESULTS: Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services. DISCUSSION: Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.
Assuntos
Relações Médico-Paciente , Confiança , Humanos , Letramento em Saúde , Relações Médico-Paciente/éticaRESUMO
BACKGROUND: Research concerning transitions from one rotation to another during medical specialist training is scarce. This study examined trainee doctors' perceived preparedness for core clinical activities, trainee doctors' preparedness levels, and general perceptions of medical specialist training in geriatric psychiatry. METHOD: Swiss trainee doctors in geriatric psychiatry were surveyed about their perceived preparedness for 18 preliminary entrustable professional activities (EPAs), curricular support, and general perceptions of their medical specialist training. Closed questions were analysed using descriptive statistics, while open questions were subjected to content analysis. RESULTS: The participants comprised 48 trainee doctors (30.4% response rate) who differed in their educational experience (years of residency and specialism) and clinical subspecialisation goals. Trainee doctors felt adequately prepared for most EPAs but less prepared for some, including electroconvulsive therapy, psychotherapy, and treating older adults in the home environment or residential facilities. Despite the trainee doctors' diversity, they did not differ significantly in perceived preparedness for most EPAs. The most often offered suggestions for improving geriatric psychiatry training were intensified clinical supervision and a structured induction programme. CONCLUSION: Trainee doctors reported that they felt sufficiently prepared for most EPAs, regardless of their backgrounds and professional goals. However, several professional activities in geriatric psychiatry warrant further training. Our findings indicate the need for a higher intensity of clinical supervision (e.g. more direct observation and specific feedback), the introduction of structured induction programmes (e.g. orientation week), and specific teachings (e.g. on neurocognitive assessment).
