Interventions for improving patients' trust in doctors and groups of doctors

Trust is a fundamental part of a patient-doctor relationship. Trust can increase patient satisfaction, adherence to treatment, and continuity of care. This raises the question whether there are effective ways of enhancing patient trust in doctors, by involving doctors (such as training) or patients (such as by providing information). The review authors searched a wide variety of databases and found only three randomised controlled trials all based in North American primary care. The trials did not provide sufficient evidence to conclude that a specific intervention may increase or decrease trust in doctors. One trial was of a training intervention for family doctors to improve behaviours known to be associated with trust: expressing empathy, good communication and sharing information. The 20 doctors in the trial were assessed by 414 patients showing no effect of training; however, the training was not intensive and given to doctors known to be interested in communication. Another trial explored disclosing to patients (1918 participants) the sorts of incentives doctors are given for practising medicine in a cost-effective way. Two types of insurance plans were investigated. One led to no reduction and possibly an increase in trust in the insurance plan. However, the information about this plan was presented in a way that emphasised reducing unnecessary tests, rather than cost-cutting. The third trial looked at three different types of educational introductory visits and 564 new patients' trust in the doctors working for their health organisation. Trust in the doctors rose with one type of visit, which was a group visit. This was the least well taken up compared with individual visits with a physician, or a physician and health educator. The review authors have highlighted the types of further trials that are now required to explore the impact of policy changes, guidelines and specific doctors' training on patients' trust.