Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study

被引:175
作者
Dang, Bich N. [1 ,2 ,3 ]
Westbrook, Robert A. [3 ,4 ]
Njue, Sarah M. [1 ,2 ]
Giordano, Thomas P. [1 ,2 ,3 ]
机构
[1] VA Ctr, Innovat Qual Effectiveness & Safety IQuESt, Houston, TX USA
[2] Michael E DeBakey Vet Affairs Med Ctr 152, 2002 Holcombe Blvd, Houston, TX 77030 USA
[3] Baylor Coll Med, Dept Med, Houston, TX USA
[4] Rice Univ, Jesse H Jones Grad Sch Business, Houston, TX USA
基金
美国国家卫生研究院;
关键词
Patient satisfaction; Patient-centered care; Patient preference; Physician-patient relations; Patient engagement; Health communication; HIV infection; Retention in care; Qualitative studies; Longitudinal studies; PRIMARY-CARE; COMMUNICATION-SKILLS; REASSURANCE; PHYSICIANS; CANCER; STIGMA; AGENDA; SCHIZOPHRENIA; TRAJECTORIES; ONCOLOGISTS;
D O I
10.1186/s12909-017-0868-5
中图分类号
G40 [教育学];
学科分类号
040101 ; 120403 ;
摘要
Background: New patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Persons with HIV infection may be an ideal population to study the drivers of a positive initial patient-provider relationship, as it is a chronic and serious condition that requires a reliable, ongoing relationship with a provider. Informed by patients' real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset. Methods: We conducted longitudinal, in-person interviews with 21 patients new to the HIV clinic at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, from August 2013 to March 2015. Patients were interviewed across three time points: once before their first provider visit, a second time within two weeks after the first visit, and a third time at 6 to 12 months after the first provider visit. Results: We conducted 61 h of patient interviews. The mean age was 53 years; 52% were non-Hispanic white, 23% were non-Hispanic black and 19% were Hispanic. Patients described significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider. Our analysis of these experiences revealed five actions providers can take to reduce their patients' anxiety and build trust early in the first visit: 1) provide reassurance to patients, 2) tell patients it's okay to ask questions, 3) show patients their lab results and explain what they mean, 4) avoid language and behaviors that are judgmental of patients, and 5) ask patients what they want [i.e., treatment goals and preferences]. Conclusions: Our study incorporates direct input from patients and highlights the unique psychological challenges that patients face in seeking care from a new provider. The actionable opportunities cited by patients have the potential to mitigate patients' feelings of anxiety and vulnerability, and thereby improve their overall health care experience.
引用
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页码:1 / 10
页数:10
相关论文
共 55 条
[1]  
[Anonymous], 1999, PERM J, DOI DOI 10.7812/TPP/99-020
[2]   THE EFFECT OF PHYSICIAN BEHAVIOR ON THE COLLECTION OF DATA [J].
BECKMAN, HB ;
FRANKEL, RM .
ANNALS OF INTERNAL MEDICINE, 1984, 101 (05) :692-696
[3]   Effective training strategies for teaching communication skills to physicians: An overview of systematic reviews [J].
Berkhof, Marianne ;
van Rijssen, H. Jolanda ;
Schellart, Antonius J. M. ;
Anema, Johannes R. ;
van der Beek, Allard J. .
PATIENT EDUCATION AND COUNSELING, 2011, 84 (02) :152-162
[4]   Effectiveness of Intensive Physician Training in Upfront Agenda Setting [J].
Brock, Douglas M. ;
Mauksch, Larry B. ;
Witteborn, Saskia ;
Hummel, Jeffery ;
Nagasawa, Pamela ;
Robins, Lynne S. .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2011, 26 (11) :1317-1323
[5]   Developing longitudinal qualitative designs: lessons learned and recommendations for health services research [J].
Calman, Lynn ;
Brunton, Lisa ;
Molassiotis, Alex .
BMC MEDICAL RESEARCH METHODOLOGY, 2013, 13
[6]  
Coia P, 1998, J PSYCHOSOM RES, V45, P377
[7]   Patterns of primary care and mortality among patients with schizophrenia or diabetes: a cluster analysis approach to the retrospective study of healthcare utilization [J].
Copeland, Laurel A. ;
Zeber, John E. ;
Wang, Chen-Pin ;
Parchman, Michael L. ;
Lawrence, Valerie A. ;
Valenstein, Marcia ;
Miller, Alexander L. .
BMC HEALTH SERVICES RESEARCH, 2009, 9
[8]   Mental health stigma and primary health care decisions [J].
Corrigan, Patrick W. ;
Mittal, Dinesh ;
Reaves, Christina M. ;
Haynes, Tiffany F. ;
Han, Xiaotong ;
Morris, Scott ;
Sullivan, Greer .
PSYCHIATRY RESEARCH, 2014, 218 (1-2) :35-38
[9]   Retaining HIV Patients in Care: The Role of Initial Patient Care Experiences [J].
Dang, Bich N. ;
Westbrook, Robert A. ;
Hartman, Christine M. ;
Giordano, Thomas P. .
AIDS AND BEHAVIOR, 2016, 20 (10) :2477-2487
[10]   A 3-stage model of patient-centered communication for addressing cancer patients' emotional distress [J].
Dean, Marleah ;
Street, Richard L., Jr. .
PATIENT EDUCATION AND COUNSELING, 2014, 94 (02) :143-148