DOES PATIENT-CENTERED COMMUNICATION AND TRUST IN PHYSICIAN INFORMATION VARY BY CANCER SURVIVORSHIP STATUS? AN ANALYSIS OF THE HEALTH INFORMATION NATIONAL TRENDS SURVEY (HINTS) 2017

Abstract

Trust is the foundation of the patient-physician relationship. Patients’ trust in a physician has been associated with patient satisfaction, adherence to treatment, continuity of care, and improved health outcomes. Trust in a physician is especially important for health-vulnerable populations, such as cancer survivors, as they tend to endure complex emotional needs related to re-acclimating to the new normal post cancer diagnosis. The patient-physician relationship also relies heavily on effective patient-centered communication (PCC), however, associations between PCC and trust in physician information overall and by cancer survivorship status is not well understood. Using nationally representative data (N = 2604) ascertained from Cycle 1 of the fifth iteration of the 2017 Health Information National Trends Survey (HINTS), a cross-sectional analysis was conducted to examine PCC in relation to trust in physician information. PCC was assessed on a 4-point Likert scale using responses from seven sub-questions that address the main functions of PCC: 1) fostering healing relationships, 2) exchanging clinical information, 3) responding to emotional needs, 4) managing uncertainty, 5) facilitating shared decision-making, and 6) enabling patient self-management. Trust in physician information was analyzed dichotomously (high versus low) based on responses from a single item question. PCC was analyzed as individual components (optimal versus sub-optimal) and as an overall score. Confounders included age, sex, race/ethnicity, education, and household annual income. Odds ratios (OR) and 95% confidence intervals (CI) for the relationship between PCC and trust in physician information were estimated using multivariable logistic regression. Analyses of cancer survivorship status (cancer survivor versus never had cancer) as an effect modifier of the relationship between PCC and trust in physician information was also conducted using an interaction term. Results from the weighted multivariable models revealed that for every one-unit increase in the overall PCC score (range 1 to 100), the odds of having high trust in physician information increased by 4% (adj OR = 1.04, 95% CI = 1.03–1.05). The odds of reporting high level of trust in physician information were significantly associated with each individual component of PCC when comparing those who felt their communication component was optimal versus sub-optimal (PCC components: exchanging clinical information (adj OR = 2.57, 95% CI = 1.82–3.62), responding to emotional needs (adj OR = 2.34, 95% CI = 1.65–3.30), facilitating in shared decision-making (adj OR = 2.35, 95% CI = 1.70–3.26), enabling patient self-management (adj OR = 2.88, 95% CI = 2.11–3.92), managing uncertainty (adj OR = 2.45, 95% CI = 1.74–3.44), fostering healing relationships (adj OR = 2.79, 95% CI = 2.18–3.57), and spending enough time with you (adj OR = 2.09, 95% CI = 1.49–2.93)). When examining relationships by cancer survivorship status, estimates among cancer survivors were of greater magnitude compared to persons who reported never having cancer, however, no significant interactions were observed in the weighted multivariable models (all p-interaction>0.05). These findings provide insight on how optimal experiences of PCC influence trust in physician information and can help inform the development of PCC strategies to ultimately improve health outcomes and reduce consequences related to poor patient-physician trust overall and among cancer survivors.