Patient & Physician Trust Measurement Tools

“Trust is one of the central features of patient-physician relationships. Rapid changes in the health care system are feared by many to be threatening patients’ trust in their physicians. Yet, despite its acknowledged importance and potential fragility, rigorous efforts to conceptualize and measure patient trust have been relatively rare… For practicing clinicians and for those who teach medical students and residents, the elements of physician behavior that foster trust can continue to reflect the instincts of physician-theorists: competence, compassion, reliability, integrity, and open communication. A widely accepted empirical conceptualization and understanding of trust is yet to come… For patient-physician trust to be strengthened, our ability to measure the mediators and outcomes of trust must mature.” Pearson and Raeke, J. Gen. Int. Med. 15, 509 to 513, Jul 2000.

Public Trust in Health Care (PTHC)

• Authors: G.F.M. Straten,R.D. Friele, P.P. Groenewegen (2002)
• Administration: The 37 items are scored on a 5-point Likert scale.
• Constructs Measured: Six of the eight possible dimensions appear in factor analysis. These dimensions are trust in: the patient-focus of health care providers; macro policies level will have no consequences for patients; expertise of health care providers; quality of care; information supply and communication by care providers; and the quality of cooperation..
• Reliability and Validity: The reliability of most scales is higher than 0.8. The validity of the dimensions was assessed by determining the correlation between the scales with people’s experience and a general mark they would assign.
• Assessment in Minorities and Elderly: None
• Costs: None

Health Insurer Trust Scale (HITS)

• Authors: B. Zheng, M.A. Hall, E. Dugan, K.E. Kidd, D. Levine (2002)
• Administration: 11 item self-administered questionnaire. Takes less than 10 minutes to complete.
• Constructs Measured: The scale has four components reflecting overlapping aspects of insurance organizations: Fidelity, Competence, Honesty, and Confidentiality.
• Reliability and Validity: Internal reliability was excellent. Two-month test-retest reliability was good. As measures of external validity HITS score is significantly correlated with physician trust, general satisfaction with health care, insurer satisfaction, and intent to switch insurers.
• Assessment in Minorities and Elderly: None
• Costs: None

Interpersonal Physician Trust Scale (IPTS)

• Authors: M.A. Hall, B. Zheng, E. Dugan, F. Camacho, K.E. Kidd, A. Mishra, R. Balkrishnan (2002)
• Administration: 10 item self-administered questionnaire.
• Constructs Measured: Overall patient trust in their individual physician.
• Reliability and Validity: Excellent reliability. Significant correlations with physician satisfaction, willingness to recommend to friends, desire to switch physicians, and seeking a second opinion. Test-retest reliability is very good. The WFTS has good correlations with other physician trust scales.
• Assessment in Minorities and Elderly: None
• Costs: None

Primary Care Assessment Survey (PCAS)

• Authors: D.G. Safran, M. Kosinski, A.R. Tarlov, W.H. Rogers, D.A. Taira, N. Lieverman, J.E. Ware (1998)
• Administration: 51 self-administered questions taking 7 minutes to complete on average.
• Constructs Measured: The PCAS measures seven domains of care through 11 summary scales: accessibility (organizational, financial), continuity (longitudinal, visit-based), comprehensiveness (contextual knowledge of patient, preventive counseling), integration, clinical interaction (clinician-patient communication, thoroughness of physical examinations), interpersonal treatment, and trust.
• Reliability and Validity: Good to excellent reliability for each of the 11 summary scales.
• Assessment in Minorities and Elderly: None
• Costs: None

Patient Trust Scale (PTS)

• Authors: A.C. Kao, D.C. Green, A.M. Zaslavsky, J.P. Koplan, P.D. Cleary (1998)
• Administration: 10 item telephone survey.
• Constructs Measured: Overall patient trust in their physicians.
• Reliability and Validity: Excellent internal reliability. No information available regarding external validity.
• Assessment in Minorities and Elderly: None
• Costs: None

Patient Trust in Their Physician Scale (PTTPS)

• Authors: B. Leisen, M.R. Hyman (2001)
• Administration: 51-item self-administered questionnaire. Takes less than 15 minutes to complete.
• Constructs Measured: Two overarching dimensions encompass the ten dimensions of trust. The overarching dimension of technical competence includes the following dimensions: evaluating problems, providing appropriate and effective treatment, predisposing factors, and structural/staffing factors. The overarching dimension of benevolence includes the following dimensions: understanding the patient’s individual experiences, expressing caring, communicating clearly and completely, building partnership, demonstrating honesty, and keeping information confidential.
• Reliability and Validity: Reliability of the individual trust dimensions are good to excellent. Factor analysis confirms the overall significance of the scale and the significance of the two overarching dimensions. As measures of criterion-related validity, correlations of the scale with several objective measures is high.
• Assessment in Minorities and Elderly: None
• Costs: None

Trust in the Medical Profession (TMP)

• Authors: M.A. Hall, F. Camacho, E. Dugan, R. Balkrishnan (2002)
• Reference: Trust in the Medial Profession: Conceptual and measurement issues. Health Services Research 37(5), 1419 to 1439.
• Administration: 11-item self-administered questionnaire.
• Constructs Measured: Overall patient trust in physicians in general.
• Reliability and Validity: The TMP has good internal reliability. There are significant correlations with other measures of patient trust and satisfaction.
• Assessment in Minorities and Elderly: No associations were found with race/ethnicity.
• Costs: None

Trust in Medical Researchers (TMR1)

• Authors: AG Mainous, III, DW Smith, ME Geesey, BC Tilley (2006)
• Reference: Development of a measure to assess patient trust in medical researchers. Annals of Family Medicine 4(3), 247 to 252.
• Administration: 12-item self-administered questionnaire.
• Constructs Measured: Overall patient trust in medical researchers. Two subscales (Participant deception and Researcher honesty) were identified.
• Reliability and Validity: The TMR1 has good internal reliability. Individuals with high trust in medical researchers were more likely to express interest in future participation in medical research.
• Assessment in Minorities and Elderly: White respondents had greater trust than Black respondents.
• Costs: None

Trust in Medical Researchers (TMR2)

• Authors: M.A. Hall, F. Camacho, JS Lawlor, V DePuy, J Sugarman, K Weinfurt (2006)
• Reference: Measuring trust in medical researchers.. Medical Care 44(11), 1048 to 1053.
• Administration: 12-item self-administered questionnaire and a short 4-item version..
• Constructs Measured: Overall patient trust in medical researchers.
• Reliability and Validity: The TMR2 has good internal reliability. Prior participation in medical research studies and hypothetical participation in a future study were both positively associated with high trust scores.
• Assessment in Minorities and Elderly: African-Americans scored significantly lower than Whites on the Trust Scale.
• Costs: None

Trust in Physician Scale (TPS)

• Authors: L.A. Anderson, R.F. Dedrick (1990)
• Administration: 11 self-administered question taking less than 10 minutes.
• Constructs Measured: The TPS was developed to measure interpersonal trust in a patient's individual physician The TPS has no subdomains.
• Reliability and Validity: Internal reliability is excellent. Validity of the measure, by comparison with other trust scales, showed moderate correlations. TPS has good one-month test-retest correlation. TPS score correlated well several measures of the patient’s preferences regarding the physician’s role. In six-month followup surveys, TPS score was significantly correlated with continuity of care, adherence to prescribed medication, and overall satisfaction with care.
• Assessment in Minorities and Elderly: While the TPS has not been assessed specifically in minorities and elderly; using the TPS, ethnic minorities have been show to have lower trust in their physicians than whites. Elderly patients tend to have greater trust than younger patients.
• Costs: None