Journal of General Internal Medicine

, Volume 25, Issue 6, pp 543–548

The Association of Provider Communication with Trust among Adults with Sickle Cell Disease

  • Carlton HaywoodJr
  • Sophie Lanzkron
  • Neda Ratanawongsa
  • Shawn M. Bediako
  • Lakshmi Lattimer
  • Neil R. Powe
  • Mary Catherine Beach
Original Article



Adults with sickle cell disease often report poor interpersonal healthcare experiences, including poor communication with providers. However, the effect of these experiences on patient trust is unknown.


To determine the association between patient ratings of the previous quality of provider communication and current trust in the medical profession among adults with sickle cell disease.

Research design

Cross-sectional survey.


A total of 95 adults with sickle cell disease.


The four-item Provider Communication Subscale from the Consumer Assessment of Healthcare Plans and Systems Survey; The five-item Wake Forest Trust in the Medical Profession Scale.

Main results

Better ratings of previous provider communication were significantly associated with higher levels of trust toward the medical profession. A 10% increase in provider communication rating was associated with a 3.76% increase in trust scores (p < 0.001, 95% CI [1.76%, 5.76%]), adjusting for patient-level demographic, clinical, and attitudinal characteristics.


Poorer patient ratings of provider communication are associated with lower trust toward the medical profession among adults with sickle cell disease. Future research should examine the impact of low trust in the medical profession on clinical outcomes in this population of patients.


sickle cell disease trust quality of healthcare 


  1. 1.
    Hassell K. “Sickle cell disease population estimation: application of available contemporary data to traditional methods” Oral Presentation: 35th Anniversary Convention of the National Sickle Cell Disease Program and the Sickle Cell Disease Association of America. September 20th. 2007.Google Scholar
  2. 2.
    Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, Klug PP. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N.Engl.J Med. 1994;1639-44.Google Scholar
  3. 3.
    Alleyne J, Thomas VJ. The management of sickle cell crisis pain as experienced by patients and their carers. J Adv.Nurs. 1994;725–32.Google Scholar
  4. 4.
    Strickland OL, Jackson G, Gilead M, McGuire DB, Quarles S. Use of focus groups for pain and quality of life assessment in adults with sickle cell disease. J Natl.Black Nurses Assoc. 2001;36–43.Google Scholar
  5. 5.
    Harris A, Parker N, Barker C. Adults with sickle cell disease: Psychological impact and experience of hospital services. Psychology, Health and Medicine 1998;171–9.Google Scholar
  6. 6.
    Shelley B, Kramer KD, Nash KB. Sickle cell mutual assistance groups and the health services delivery system. J Health Soc.Policy 1994;243–59.Google Scholar
  7. 7.
    Butler DJ, Beltran LR. Functions of an adult sickle cell group: education, task orientation, and support. Health Soc.Work 1993;49–56.Google Scholar
  8. 8.
    Maxwell K, Streetly A, Bevan D. Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study. BMJ 1999;1585–90.Google Scholar
  9. 9.
    Thom DH. Physician behaviors that predict patient trust. J Fam.Pract. 2001;323–8.Google Scholar
  10. 10.
    Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc.Sci.Med 2000;657–68.Google Scholar
  11. 11.
    Hall MA, Camacho F, Dugan E, Balkrishnan R. Trust in the Medical Profession: Conceptual and Measurement Issues. Health Services Research 2002;1419–39.Google Scholar
  12. 12.
    Dugan E, Trachtenberg F, Hall M. Development of abbreviated measures to assess patient trust in a physician, a health insurer, and the medical profession. BMC Health Services Research 2005;64.Google Scholar
  13. 13.
    Armstrong K, Rose A, Peters N, Long JA, McMurphy S, Shea JA. Distrust of the health care system and self-reported health in the United States. J Gen.Intern Med 2006;292–7.Google Scholar
  14. 14.
    Segal J, Strouse J, Beach M, Haywood C, Witkop C, Park H, Wilson RBE, Lanzkron S. Hydroxyurea for the Treatment of Sickle Cell Disease. Evidence Report/Technology Assessment No. 165. (Prepared by Johns Hopkins University Evidence based Practice Center under contract No. 290-02-0018). AHRQ Publication No. 08-E007. Evidence Report/Technology Assessment No. 165. Rockville, MD: Agency for Healthcare Research and Quality; 2008.Google Scholar
  15. 15.
    Hall MA, Dugan E, Zheng B, Mishra AK. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q 2001;613–39.Google Scholar
  16. 16.
    Hays RD, Shaul JA, Williams VS, Lubalin JS, Harris-Kojetin LD, Sweeny SF, Cleary PD. Psychometric properties of the CAHPS 1.0 survey measures. Consumer Assessment of Health Plans Study. Med Care 1999;MS22–31.Google Scholar
  17. 17.
    Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients' assessments of care in Medicaid managed care. Health Serv.Res. 2003;789–808.Google Scholar
  18. 18.
    Morales LS, Elliott MN, Weech-Maldonado R, Spritzer KL, Hays RD. Differences in CAHPS adult survey reports and ratings by race and ethnicity: an analysis of the National CAHPS benchmarking data 1.0. Health Serv.Res. 2001;595–617.Google Scholar
  19. 19.
    Lurie N, Zhan C, Sangl J, Bierman AS, Sekscenski ES. Variation in racial and ethnic differences in consumer assessments of health care. Am J Manag.Care 2003;502–9.Google Scholar
  20. 20.
    Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers.Soc.Psychol. 1994;1063–78.Google Scholar
  21. 21.
    Wallston KA. The validity of the multidimensional health locus of control scales. J Health Psychol. 2005;623–31.Google Scholar
  22. 22.
    StataCorp. Stata Statistical Software: Release 9. 2005. College Station, TX, StataCorp LP.Google Scholar
  23. 23.
    Jacobs EA, Rolle I, Ferrans CE, Whitaker EE, Warnecke RB. Understanding African Americans' views of the trustworthiness of physicians. J Gen.Intern Med 2006;642–7.Google Scholar
  24. 24.
    Thom DH, Campbell B. patient–physician trust: an exploratory study. J Fam.Pract. 1997;169–76.Google Scholar
  25. 25.
    Gordon HS, Street RL Jr, Sharf BF, Kelly PA, Souchek J. Racial Differences in Trust and Lung Cancer Patients' Perceptions of Physician Communication. Journal of Clinical Oncology 2006;904–9.Google Scholar
  26. 26.
    O'Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Prev Med 2004;777–85.Google Scholar
  27. 27.
    Hall MA. Researching medical trust in the United States. J Health Organ Manag. 2006;456–67.Google Scholar
  28. 28.
    Steiner C, Miller J. Sickle cell disease patients in U.S. Hospitals, 2004. HCUP Statistical Brief #21. Agency for Healthcare Research and Quality . 2006. Agency for Healthcare Research and Quality, Rockville, Md.Google Scholar
  29. 29.
    Epstein K, Yuen E, Riggio JM, Ballas SK, Moleski SM. Utilization of the office, hospital and emergency department for adult sickle cell patients: a five-year study. J Natl.Med Assoc. 2006;1109–13.Google Scholar
  30. 30.
    Carroll CP, Haywood C Jr, Fagan P, Lanzkron S. The course and correlates of high hospital utilization in sickle cell disease: Evidence from a large, urban Medicaid managed care organization. Am J Hematol. 2009;666–70.Google Scholar
  31. 31.
    Armstrong FD, Pegelow CH, Gonzalez JC, Martinez A. Impact of children's sickle cell history on nurse and physician ratings of pain and medication decisions. J Pediatr.Psychol. 1992;651–64.Google Scholar
  32. 32.
    Thom DH, Hall MA, Pawlson LG. Measuring patients' trust in physicians when assessing quality of care. Health Aff.(Millwood.) 2004;124–32.Google Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Carlton HaywoodJr
    • 1
  • Sophie Lanzkron
    • 2
  • Neda Ratanawongsa
    • 3
  • Shawn M. Bediako
    • 4
  • Lakshmi Lattimer
    • 5
  • Neil R. Powe
    • 3
  • Mary Catherine Beach
    • 6
  1. 1.Division of HematologyThe Johns Hopkins University School of Medicine, The Johns Hopkins Berman Institute of BioethicsBaltimoreUSA
  2. 2.Division of HematologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.University of California, San Francisco, San Francisco General HospitalSan FranciscoUSA
  4. 4.Department of PsychologyUniversity of Maryland, Baltimore CountyBaltimoreUSA
  5. 5.The Johns Hopkins University School of MedicineBaltimoreUSA
  6. 6.The Johns Hopkins Berman Institute of BioethicsThe Johns Hopkins University School of MedicineBaltimoreUSA

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