Journal of General Internal Medicine

, Volume 18, Issue 8, pp 617–623

Survivors of intimate partner violence speak out

Trust in the patient-provider relationship
  • Tracy A. Battaglia
  • Erin Finley
  • Jane M. Liebschutz
Original Articles

Abstract

OBJECTIVE: To identify characteristics that facilitate trust in the patient-provider relationship among survivors of intimate partner violence (IPV).

DESIGN: Semistructured, open-ended interviews were conducted to elicit participants’ beliefs and attitudes about trust in interactions with health care providers. Using grounded theory methods, the transcripts were analyed for common themes. A community advisory group, composed of advocates, counselors and IPV survivors, helped interpret themes and interview exerpts. Together, key components of trust were identified.

SETTING: Eastern Massachusetts.

PARTICIPANTS: Twenty-seven female survivors of IPV recruited from community-based IPV organizations.

MAIN RESULTS: Participants’ ages ranged from 18 to 56 years, 36% were African American, 32% Hispanic, and 18% white. We identified 5 dimensions of provider behavior that were uniquely important to the development of trust for these IPV survivors: 1) communication about abuse: provider was willing to openly discuss abuse; 2) professional competency: provider asked about abuse when appropriate and was familiar with medical and social histories; 3) practice style: provider was consistently accessible, respected confidentiality, and shared decision making; 4) caring: provider demonstrated personal concern beyond biomedical role through nonjudgmental and compassionate gestures, empowering statements, and persistent, committed behaviors; 5) emotional equality: provider shared personal information and feelings and was perceived by the participant as a friend.

CONCLUSIONS: These IPV survivors identified dimensions of provider behavior that facilitate trust in their clinical relationship. Strengthening these provider behaviors may increase trust with patients and thus improve disclosure of and referral for IPV.

Key Words

trust domestic violence physician-patient relations patient-centered care participatory research 

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References

  1. 1.
    Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(suppl 3):110–27.CrossRefGoogle Scholar
  2. 2.
    Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.PubMedGoogle Scholar
  3. 3.
    Thom DH. Physician behaviors that predict patient trust. J Fam Pract. 2001;50:323–8.PubMedGoogle Scholar
  4. 4.
    Thom DH, Campbell B. Patient-physician trust: an exploratory study. J Fam Pract. 1997;44:169–76.PubMedGoogle Scholar
  5. 5.
    Thom DH. Training physicians to increase patient trust. J Eval Clin Pract. 2000;6:245–53.PubMedCrossRefGoogle Scholar
  6. 6.
    Thom DH, Bloch DA, Segal ES. An intervention to increase patients’ trust in their physicians. Stanford Trust Study Physician Group. Acad Med. 1999;74:195–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Mechanic D. The functions and limitations of trust in the provision of medical care. J Health Polit Policy Law. 1998;23:661–86.PubMedGoogle Scholar
  8. 8.
    Freund K. Domestic violence. In: Carr PF, Freund KM, Somani S, eds. The Medical Care of Women. Philadelphia, Pa: W.B. Saunders Company; 1995:722–8.Google Scholar
  9. 9.
    Gerbert B, Caspers N, Bronstone A, Moe J, Abercrombie P. A qualitative analysis of how physicians with expertise in domestic violence approach the identification of victims. Ann Intern Med. 1999;131:578–84.PubMedGoogle Scholar
  10. 10.
    Sugg NK, Inui T. Primary care physicians’ response to domestic violence. JAMA. 1992;267:3157–60.PubMedCrossRefGoogle Scholar
  11. 11.
    McCauley J, Yurk RA, Jenckes MW, Ford DE. Inside “Pandora’s Box”: abused women’s experiences with clinicians and health services. J Gen Intern Med. 1998;13:549–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Rodriguez MA, Quiroga SS, Bauer HM. Breaking the silence: battered women’s perspectives on medical care. Arch Fam Med. 1996;5:153–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Strauss A, Corbin JM. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park, Calif: Sage Publications; 1990.Google Scholar
  14. 14.
    McCauley J, Kern DE, Kolodner K, et al. The “Battering Syndrome”: prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med. 1995;123:737–46.PubMedGoogle Scholar
  15. 15.
    Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans P. Inquiry about victimization experiences. Arch Intern Med. 1992;152:1186–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Thom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999;37:510–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Butterfield MI, Frayne SM. Boundary issues in the management of patients with previous victimization. In: Liebschutz JL, Frayne SM, Saxe GN, eds. Violence Against Women: A Physician’s Guide to Identification and Management. Philadelphia, Pa: ACP-ASIM Press; 2003:253–61.Google Scholar
  18. 18.
    Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51:1087–110.PubMedCrossRefGoogle Scholar
  19. 19.
    Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Tracy A. Battaglia
    • 1
  • Erin Finley
    • 1
  • Jane M. Liebschutz
    • 1
  1. 1.Received from the Section of General Internal Medicine, Boston Medical CenterBoston University School of MedicineBoston

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