Abstract
Background/Aims Trust in physicians plays an important role in facilitating cancer patients’ adjustment to their illness. However, patient trust has rarely been examined within the context of post-treatment follow-up care. We used data from the Assessment of Patient Experiences of Cancer Care (APECC) study to evaluate predictors of colorectal cancer survivors’ trust in their follow-up cancer care physicians overall and by stage of cancer.
Methods Our analytic sample included colorectal cancer survivors who were 2–5 years post-diagnosis and saw a follow-up care physician in the past year (n = 371). Trust was assessed using a validated 11-item scale and responses were transformed to a 0–100 metric. Hierarchical linear regressions were conducted to examine predictors of trust with socio-demographic, clinical, and follow-up care variables entered in the first model and patient-physician communication variables (i.e., physician knowledge of the patient, information exchange, and physicians’ affective behavior) in the second. Using American Joint Committee on Cancer (AJCC) stage classification, stratified regressions were conducted to assess differences in predictors of trust by early (0, i, ii) vs. late stage (iii, iv) patients.
Results The mean trust score was 83.58 and did not significantly vary by cancer stage. In the main effects model, older age, increased length of patient-physician relationship, better health status, and male physician gender were associated with greater trust (P <0.05 for all). When communication variables were added, physician knowledge (P <0.001), information exchange (P <0.001), and affective behavior (P <0.05) were significantly associated with greater trust. In stratified analyses, physician knowledge (P <0.001) and information exchange (P <0.05) were associated with greater trust among early stage patients and information exchange (P <0.001) and physician affect (P <0.05) were significant predictors of trust among late stage patients.
Conclusions Patient-physician communication plays a central role in facilitating trust between colorectal cancer survivors and their follow-up care physicians. Information exchange was an important dimension of communication for all survivors, but early stage patients valued physician knowledge while late stage patients valued physician affect. Our findings suggest that to build and sustain patient trust, different aspects of communication may need to be emphasized during follow-up care interactions between physicians and survivors diagnosed with early vs. late stage colorectal cancer.
