Insights from Psychology: Medical Mistrust and Patients’ Decision Making

A recent article in Health Psychology discusses the concept of Medical Mistrust – a general lack of trust in the health system – that can influence a patient’s decision-making when seeking services, adhering to treatment, or feelings of satisfaction with their care. KJT Group’s Medical Decision-Making Scale has been used to identify how respondents may differ in their willingness to accept their doctor’s recommendation for treatment along with their motivation to seek out information about treatment options. Medical Mistrust is a broader concept that can contribute to explaining why respondents may have these attitudes towards doctor’s recommendation and seeking out treatment information.

The research conducted by Cuevas, O’Brien, and Saha in “Can Patient-Centered Communication Reduce the Effects of Medical Mistrust on Patients’ Decision Making?” tested whether conversations with doctors that included elements like positive affect, empathic statements, and eliciting and validating patient concerns would influence participants’ willingness to elect for hypothetical coronary bypass surgery. Respondents were provided a patient profile of a 55-year old, gender-matching person with hypertension and gradually worsening chest pain. The patient had recently had an angiogram, and this “visit” was to discuss the results with the gender-matching physician recommending bypass surgery. The “visits” were video vignettes that controlled for all elements except the demonstration of PCC qualities.

The High-PCC vignettes used more layperson language, built more rapport with the patient, and was more empathic and understanding in listening to the patient’s concerns. The Low-PCC vignettes were more emotionally sterile – using biomedical language, less rapport building, with neutral affect and lower attentiveness to the patient as a whole. After viewing the vignette, participants were asked to rate their likelihood to undergo the surgery as well as feelings of mistrust towards the specific physician they saw.

As expected, results showed that, in general, people with higher levels of medical mistrust demonstrated higher levels of mistrust towards the specific physician in the video as well as less likelihood to endorse the bypass surgery recommended by the doctor. In support of the hypotheses of the study, PCC was found to mitigate these relationships. Those who saw the High PCC video had a weaker relationship between medical mistrust and physician mistrust than those who saw the Low PCC video. Likewise, for those who saw the High PCC video there was no longer a relationship between medical mistrust and likelihood to endorse getting the surgery.

Medical mistrust is a barrier to patient willingness to initiate and adhere to treatment, but the results from this study suggest that physicians who adopt patient-centered communication can buffer this influence and increase patient willingness to elect treatment recommended by their doctor. KJT Group’s Medical Decision-Making autonomy subscale can help identify respondents who may most benefit from this effect.

Cuevas, A. G., O’Brien, K., & Saha, S. (2019). Can patient-centered communication reduce the effects of medical mistrust on patients’ decision making? Health Psychology, 38, 4, 325-333. doi: 10.1037/hea0000721