Respect is an attitude of valuing another person, and is demonstrated by behaviors that express that attitude (Beach et al. 2007
). Trust develops in relationships, in part due to the presence of respect. In relationships between healthcare providers and patients, respect and trust develop in a process that begins with providers’ attitudes toward patients, which are reflected in provider behaviors when interacting with patients. Patients’ experiences of those behaviors, and their perceptions and beliefs about their treatment, then contribute to the degree of trust between patient and provider, which in turn influences how subsequent behaviors are interpreted. shows a simplified model of the relationship between respect and trust, and the ways they are usually measured.
The relationship between respect and trust.
Patients can judge fairly well how much respect their physicians have for them, for physicians offer more information and express more positive affect toward patients for whom they report having more respect (Beach et al. 2006
), and physicians’ ratings of how much they like and respect their patients are related to patients’ ratings of how well they are treated and how satisfied they are with their care (J. Hall et al. 2002
Trust in the context of healthcare has been examined mainly from the perspective of patients’ trust in healthcare providers, with much less research about providers’ trust in patients, although that is also important. Self-report measures have been used to measure patients’ trust in individual providers (M. Hall et al. 2002
), and in healthcare systems, hospitals or physicians in general (Rose et al. 2004
). In both cases, ‘trust’ means a patient believes the provider will act in their interests, whereas mistrust or distrust, which are not simply the absence of trust, mean that a patient believes they may be hurt or harmed by the provider (Rose et al. 2004
). Across a range of settings and medical conditions, patient reports of respect and trust are associated with satisfaction with care, continuity of care, adherence to therapy, and preventative health behaviors (M. Hall et al. 2002
, Beach et al. 2005
In western countries, respect and trust are lower for patients who are members of minority ethnic groups. In one study of physicians’ attitudes, African-American patients were rated more negatively, compared with White patients, in intelligence, educational level, adherence with medical advice, and likelihood of abusing drugs and alcohol, even after controlling for many of those factors (Van Ryn and Burke 2000
). Observational studies of physician–patient interactions with African-American and White patients have shown that, with African-American patients, physicians were more verbally dominant (Beach et al. 2011
), used a more negative emotional tone (Johnson et al. 2004
), adopted a more narrowly biomedical communication style (Roter et al. 1997
), exhibited less non-verbal attention, empathy, courtesy and information-giving (Hooper et al. 1982
), and spent less time chatting, answering questions, and providing health education (Oliver et al. 2001
Less respectful provider behavior when interacting with patients belonging to minority ethnic groups has been found across many medical conditions and types of treatment, and may contribute to systematic inequalities in quality of care and health outcomes (Van Ryn and Fu 2003
). This includes the treatment of pain, for patients who belong to minority ethnic groups have been shown to receive poorer pain management across a range of different treatment settings (Green et al. 2003
), including hospital emergency departments (Todd et al. 1993
Acute episodes of vaso-occlusive pain are the most common reason for hospital treatment among people with sickle cell disease (SCD), but treatment for SCD-related pain often falls short of that recommended in established treatment guidelines (National Institutes of Health 2002
), and there is considerable evidence about under-treatment of SCD pain (Haywood et al. 2009
). Patients with SCD rated the quality of their treatment in hospital lower than did a national sample of adults (Lattimer et al. 2010
), and SCD patients’ reports of poor communication with healthcare providers were associated with less trust in providers (Haywood et al. 2010
Qualitative methods have been used in a number of studies to explore SCD patients’ experiences of hospital pain management, including five conducted in the UK and three in the USA, whose key features are summarized in . The key themes reported from those studies focus almost exclusively on interpersonal aspects of pain management, rather than analgesic methods or types, and are highly interpretable in terms of an absence of respect and trust. There is considerable convergence between studies, with negative experiences predominating in both countries and no striking differences between patients’ experiences in the USA and UK.
Qualitative studies of SCD patients’ experiences of hospital pain management (in alphabetical order by author).