An integrative review of promoting trust in the patient-primary care provider relationship

Aim. An integrative review of empirical studies on factors promoting trust in the patient-primary care provider relationship. Background. Trust is essential to the patient-provider relationship. Patients with high trust in their healthcare providers have been found to have improved outcomes, including improved chronic disease management, increased use of preventative services and satisfaction with care. Breaches of trust in the healthcare system threaten trust. Exploring factors that promote trust in the patient-provider relationship is warranted. Design. Integrative literature review. Data sources. Electronic databases searched included CINAHL, MEDLINE and PsycARTICLES, using combinations of the key term 'trust' with: concept, practitioner, provider, physician, developing, creating, engendering, promoting and establishing. The results were limited to original publications in English, published between 1998-2013. Review methods. A review of the literature was conducted by two independent reviewers based on the criteria established by Cooper; Whittemore and Knafl; and Polit and Beck. Methodological assessment tools were used to organize, evaluate the quality of and synthesize the data. Results. A new conceptual definition of promoting trust is proposed that includes three core qualities: interpersonal and technical competence, moral comportment and vigilance. Gaps in the literature still exist related to rural, young adult, older adult and well patient populations. Conclusion. The core qualities could serve as target areas for the development of interventions aimed at modifying provider behaviours so that trust can be established, maintained or improved. Future prospective longitudinal research studies are needed that enhance understanding of trust with multiple primary care provider types.