International Journal of Public Health

, Volume 56, Issue 3, pp 319–327 | Cite as

The relationship between social support, shared decision-making and patient’s trust in doctors: a cross-sectional survey of 2,197 inpatients using the Cologne Patient Questionnaire

  • Oliver OmmenEmail author
  • Sonja Thuem
  • Holger Pfaff
  • Christian Janssen
Original Article



Empirical studies have confirmed that a trusting physician–patient interaction promotes patient satisfaction, adherence to treatment and improved health outcomes. The objective of this analysis was to investigate the relationship between social support, shared decision-making and inpatient’s trust in physicians in a hospital setting.


A written questionnaire was completed by 2,197 patients who were treated in the year 2000 in six hospitals in Germany. Logistic regression was performed with a dichotomized index for patient’s trust in physicians.


The logistic regression model identified significant relationships (p < 0.05) in terms of emotional support (standardized effect coefficient [sc], 3.65), informational support (sc, 1.70), shared decision-making (sc, 1.40), age (sc, 1.14), socioeconomic status (sc, 1.15) and gender (sc, 1.15). We found no significant relationship between ‘tendency to excuse’ and trust. The last regression model accounted for 49.1% of Nagelkerke’s R-square.


Insufficient physician communication skills can lead to extensive negative effects on the trust of patients in their physicians. Thus, it becomes clear that medical support requires not only biomedical, but also psychosocial skills.


Physician–patient interaction Trust Social support Shared decision-making Medical education 


Conflict of interest

The authors declare that they have no competing interest.


  1. Allison PD (2001) Missing data. Sage, Thousand OaksGoogle Scholar
  2. Arora NK, David HG (2009) Perceived helpfulness of physicians’ communication behavior and breast cancer patients’ level of trust over time. J Gen Intern Med 24:252–255Google Scholar
  3. Berrios-Rivera JP, Street RL Jr, Garcia Popa-Lisseanu MG, Kallen MA, Richardson MN, Janssen NM, Marcus DM, Reveille JD, Warner NB, Suarez-Almazor NE (2006) Trust in physicians and elements of the medical interaction in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 55:385–393CrossRefGoogle Scholar
  4. Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, Ford DE (1999) Race, gender, and partnership in the patient—physician relationship. JAMA 282:583–589PubMedCrossRefGoogle Scholar
  5. Coulter A (2002) Patients’ views of the good doctor. BMJ 325:668–669PubMedCrossRefGoogle Scholar
  6. Doty DH, Glick WH (1998) Common methods bias: does common methods variance really bias results? Org Res Methods 1:374–406CrossRefGoogle Scholar
  7. Duberstein P, Meldrum S, Fiscella K, Shields CG, Epstein RM (2007) Influences on patients’ ratings of physicians: physicians’ demographics and personality. Patient Educ Couns 65:270–274PubMedCrossRefGoogle Scholar
  8. Epstein RM (2006) Making communication research matter: what do patients notice, what do patients want, and what do patients need? Patient Educ Couns 60:272–278PubMedCrossRefGoogle Scholar
  9. Fiscella K, Meldrum S, Franks P, Shields CG, Duberstein P, McDaniel SH, Epstein RM (2004) Patient trust: is it related to patient-centered behavior of primary care physicians? Med Care 42:1049–1055PubMedCrossRefGoogle Scholar
  10. Flocke A, Miller WL, Crabtree BF (2002) Relationships between physician practice style, patient satisfaction, and attributes of primary care. J Fam Pract 51:835–840PubMedGoogle Scholar
  11. Graham JW, Cumsille PE, Elek-Fisk E (2003) Methods for handling missing data. In: Schinka JA, Velicer WF (eds) Research methods in psychology. Wiley, New York, pp 87–114Google Scholar
  12. Hall MA, Dugan E, Zheng B, Mishra AK (2001) Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q 79:613–639PubMedCrossRefGoogle Scholar
  13. Hall MA, Zheng B, Dugan E, Camacho F, Kidd KE, Mishra A, Balkrishnan R (2002) Measuring patients’ trust in their primary care providers. Med Care Res Rev 59:293–318PubMedCrossRefGoogle Scholar
  14. Helmert U, Mielck A, Classen E (1993) Social inequalities in cardiovascular disease risk factors in East and West Germany. Soc Sci Med 35:1283–1292CrossRefGoogle Scholar
  15. House JS (1981) Work stress and social support. Addison-Wesley, Reading MAGoogle Scholar
  16. Icks A, Rosenbauer J, Strassburger K, Grabert M, Giani G, Holl RW (2007) Persistent social disparities in the risk of hospital admission of paediatric diabetic patients in Germany—prospective data from 1277 diabetic children and adolescents. Diabet Med 24:440–442Google Scholar
  17. Janssen C, Pfaff H (2005) Psycho-social environments. In: Kerr J, Weitkunat R, Morett M (eds) ABC of behavior change: a guide to successful disease prevention and health promotion. Elsevier, London, pp 153–165Google Scholar
  18. Janssen C, Ommen O, Neugebauer E, Lefering R, Pfaff H (2007) How to improve satisfaction with hospital stay of severely injured patients. Langenbecks Arch Surg 392:747–760PubMedCrossRefGoogle Scholar
  19. Kaplan GA, Wilson TW, Cohen RD, Kauhanen J, Wu M, Salonen JT (1994) Social functioning and overall mortality: prospective evidence from the Kuopio Ischemic Heart Disease Risk Factor Study. Epidemiology 5:495–500PubMedGoogle Scholar
  20. Keating NL, Gandhi TK, Orav EJ, Bates DW, Ayanian JZ (2004) Patient characteristics and experiences associated with trust in specialist physicians. Arch Intern Med 164:1015–1020PubMedCrossRefGoogle Scholar
  21. Kraetschmer N, Sharpe N, Urowitz S, Deber S (2004) How does trust affect patient preferences for participation in decision-making? Health Expect 7:317–326PubMedCrossRefGoogle Scholar
  22. Krupat E, Bell R, Kravitz R, Thom D, Azari R (2001) When physicians and patients think alike: patient-centred beliefs and their impact on satisfaction and trust. J Fam Pract 50:1057–1062PubMedGoogle Scholar
  23. Laveist TA, Nuru-Jeter A (2002) Is doctor–patient race concordance associated with greater satisfaction with care? J Health Soc Behav 43:296–306PubMedCrossRefGoogle Scholar
  24. Lerman CE, Brody DS, Caputo GC, Smith DG, Lazaro CG, Wolfson HG (1990) Patients’ perceived involvement in care scale: Relationship to attitudes about illness and medical care. J Gen Int Med 5:29–33CrossRefGoogle Scholar
  25. Loh A, Leonhart R, Wills CE, Simon D, Härter M (2007) The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Educ Couns 65(1):69–78PubMedCrossRefGoogle Scholar
  26. Mahler H, Kulik J (1990) Preferences for health care involvement, perceived control and surgical recovery: a prospective study. Soc Sci Med 31:743–751PubMedCrossRefGoogle Scholar
  27. Marmot MG (2006) Status syndrome: a challenge to medicine. JAMA 295:1304–1307PubMedCrossRefGoogle Scholar
  28. Martin LR, Jahng KH, Golin CE, DiMatteo MR (2003) Physician facilitation of patient involvement in care: correspondence between patient and observer reports. Behav Med 28:159–164PubMedCrossRefGoogle Scholar
  29. Mechanic D, Meyer S (2000) Concept of trust among patients with serious illness. Soc Sci Med 51:657–681PubMedCrossRefGoogle Scholar
  30. Melchior M, Berkman LF, Niedhammer I, Chea M, Goldberg M (2003) Social relations and self-reported health: a prospective analysis of the French Gazel cohort. Soc Sci Med 56:1817–1830PubMedCrossRefGoogle Scholar
  31. Meyers LS, Gamst G, Guarino AJ (2006) Applied multivariate research: design and interpretation. Sage Publications, Thousand OaksGoogle Scholar
  32. Mollborn S, Stepanikova I, Cook KS (2005) Delayed care and unmet needs among health care system users: when does fiduciary trust in a physician matter? Health Serv Res 40:1898–1917PubMedCrossRefGoogle Scholar
  33. Murray E, Pollack L, White M, Lo B (2007) Clinical decision-making: patients’ preferences and experiences. Patient Educ Couns 65:189–196PubMedCrossRefGoogle Scholar
  34. Nguyen GC, LaVeist TA, Harris ML, Datta LW, Bayless TM, Brant SR (2009) Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. Inflamm Bowel Dis 15:1233–1239PubMedCrossRefGoogle Scholar
  35. Ommen O, Janssen C, Neugebauer E, Bouillon B, Rehm K, Rangger C, Erli HJ, Pfaff H (2008) Trust, social support and patient type—associations between patients perceived trust, supportive communication and patients preferences in regard to paternalism, clarification and participation of severely injured patients. Patient Educ Couns 73:196–204PubMedCrossRefGoogle Scholar
  36. Perneger TV (2004) Adjustment for patient characteristics in satisfaction surveys. Int J Qual Health Care 16:433–435PubMedCrossRefGoogle Scholar
  37. Pfaff H, Freise D, Mager G, Schrappe M (2003) Der Kölner Patientenfragebogen (KPF): Entwicklung und Validierung eines Fragebogens zur Erfassung der Einbindung des Patienten als Kotherapeuten. Asgard-Verlag, Sankt AugustinGoogle Scholar
  38. Rehman SU, Nietert PJ, Cope DW, Kilpatrick AO (2005) What to wear today? Effect of doctor’s attire on the trust and confidence of patients. Am J Med 118:1279–1286PubMedCrossRefGoogle Scholar
  39. Rowe R, Calnan M (2006) Trust relations in health care: the new agenda. Eur J Pub Health 16:4–6CrossRefGoogle Scholar
  40. Safran DG, Taira D, Rogers WH, Kosinski M, Ware JE, Tarlov AR (1998) Linking primary care performance to outcomes of care. J Fam Pract 47:213–220PubMedGoogle Scholar
  41. Schafer JL, Graham JW (2002) Missing data: our view of the state of the art. Psychol methods 7:147–177PubMedCrossRefGoogle Scholar
  42. Scheibler F, Janßen C, Pfaff H (2003) Shared decision making: ein Überblicksartikel über die internationale Forschungsliteratur. Soz Präventiv Med 48:11–23Google Scholar
  43. Statistical Yearbook 2008 for the Federal Republic of Germany (2008) WiesbadenGoogle Scholar
  44. Steffen P, Ommen O, Pfaff H (2008) The ‘tendency to excuse’ of inpatients. The relevance of the ‘tendency to excuse’ in the interpretation of patient surveys. Gesundheitswesen 70:532–540PubMedCrossRefGoogle Scholar
  45. Thom DH (2001) Physician behaviors that predict patient trust. J Fam Pract 50(4):323–328PubMedGoogle Scholar
  46. Thom DH, Campbell B (1997) Patient–physician trust: an exploratory study. J Fam Pract 44:169–176PubMedGoogle Scholar
  47. Thom D, Ribisi K (1999) Further validation and reliability testing of the trust in physician scale. Med Care 37:510–517PubMedCrossRefGoogle Scholar
  48. Trachtenberg F, Dugan E, Hall MA (2005) How patients’ trust relates to their involvement in medical care. Fam Pract 54:344–352Google Scholar
  49. Wirtz M (2004) Über das Problem fehlender Werte: Wie der Einfluss fehlender Informationen auf Analyseergebnisse entdeckt und reduziert werden kann. Rehabilitation 43:109–115PubMedCrossRefGoogle Scholar
  50. Zimmermann C, Del Piccolo L, Finset A (2007) Cues and concerns by patients in medical consultations. A literature review. Psychol Bull 133:438–463PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2010

Authors and Affiliations

  • Oliver Ommen
    • 1
    Email author
  • Sonja Thuem
    • 1
  • Holger Pfaff
    • 1
  • Christian Janssen
    • 2
  1. 1.Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR)University of CologneCologneGermany
  2. 2.Department of Applied Social SciencesUniversity of Applied Sciences MunichMunichGermany

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