Mediation Effect Of Patient-Physician Trust In The Relationship Between Clinician Empathy And Illness Perception Of Patient

Background and objectiveIn recent years,research on illness perception is receiving increasingly attention in the field of health management.Illness perception plays an important role in patients’ coping behaviors and decision-making,as well as directly affecting patients’ adherence to treatment and medical behavior.Physicians,as providers of information about the illness and its treatment,affect directly the patient’s understanding of the illness.Good physician-patient relationship can improve patients’ negative illness perception,and thus improve patients’ health behavior and therapeutic effects.Physician-patient trust and clidician empathy are important prerequisites for physician-patient relationship and play important roles in improving patients’ illness perception.But the relationship between illness perception,physician-patient trust and clinician empathy needs further discussion.Therefore,this study will explore the current state of illness perception and the psychosocial factors which affecting the patient’s illness perception from the perspective of both physician and patient.And further explore the relationship between illness perception,physician-patient trust and physician’s empathy,.The current study will provide theoretical basis for strengthening the health education for the medical staff,improving the patient’s bad illness cognition,and promoting the patient’s mental health.Patient-physician trust and empathy of physician play important roles in affecting the occurrence,development and outcome of patients’ illnesss.Good physician-patient relationship can improve patients’ health behaviors and therapeutic effects,but little research has been done on this issue.Therefore,this study will explore the current state of illness perception and the psychosocial factors which affecting the patient’s illness perception from the perspective of both physician and patient.And further explore the relationship between illness perception,physician-patient trust and physician’s empathy,.The current study will provide theoretical basis for strengthening the health education for the medical staff,improving the patient’s bad illness cognition,and promoting the patient’s mental health.Study 1 Investigation on the status and influencing factors of patient’s illness perception1 Subjects and Methods1.1 Sampling methods and subjectsDuring January to March 2018,outpatients and inpatients of eight general hospitals in Guangdong Province were selected for investigation through on-site testing.All participants were informed of the confidentiality of the purpose of the survey and its answers,and informed consent was obtained.A total of 500 questionnaires were distributed in this study,and 384 questionnaires were effectively recovered,with a effective rate of 76.8%.The age of the participants ranged from 16 to 78 years(mean age 34.95 ± 13.0 years);151 were men(39.3%)and 233 were women(60.7%).1.2Assessment toolsBasic information questionnaire,Brief illness perception questionnaire(BIPQ),Wake Forest Physician Trust Scale(WFPTS),Big Five Personality Scale-China Edition(TIPI-C),and Patient Health Questionnaire-2(PHQ-2).1.3 Data processingData entry was performed using EpiData3.1,and data analysis was performed using SPSS23.0 software.Harman single factor test method,independent sample t test,one-way ANOVA,Pearson correlation analysis and multiple linear regression analysis were used.2.Results2.1 Status quo of patients’ illness perceptionThe total score of patients,illness perception was 38.5±9.07,the "cognitive"dimension was 22.09±6.99,the "emotion" dimension was 13.29±3.98,and the"understanding ability" was 3.18±2.23.2.2 Demographic differences in illness perceptionThere were significant differences in the degree of cognitive scores among different occupations,education levels,personal monthly income,financial situation of the family,medical expenses(p<0.05);emotional scores were significant different in different medical treatment methods(p<0.05);comprehension ability scores were significant different in different occupations(p<0.05);the total score of illness perception was significant different in occupations and medical expenses(p<0.05).2.3 Correlation between Illness perception and Patient-physician trust,Big Five personality and DepressionThe patient’s illness perception total score was significantly negatively correlated with the patient-physician trust total score and its benevolence and technical ability dimension scores(p<0.01).The illness perception total score was significantly negatively correlated with the pleasantness and emotional stability of the Big Five personality(p<0.01);the total score of illness perception was significantly positively correlated with the PHQ-2 score(p<0.01).2.4 Regression analysis of illness perceptionIllness Perception score as the dependent variable,the patient-physician trust and Big Five personality dimensions and PHQ-2 score set arguments,fitted linear regression equation.The influencing factors on patients’ illness perception were the total score of PHQ-2,emotional stability,and benevolence(p<0.001).3.ConclusionChinese patients have insufficient understanding of their own illness,showing more negative emotions,and lack of confidence in themselves and treatment which can overcome the illness.Trust in the physician can improve the patient’s understanding of his or her own illness.The level of depression is a risk factor for illness perception.The emotional stability of the Big Five personality and the benevolence of physician are the protective factors for illness perception.Study 2 The effect of clinician empathy on patient-Physician trust and illness perception1.Subjects and Methods1.1 Sampling methods and subjectsFrom October to December 2018,a purpose sampling method was used to investigate 90 physician and their 90 patients in the four general hospitals in Guangdong Province through on-site testing.All participants were informed of the confidentiality of the purpose of the survey and its answers,and informed consent was obtained.A total of 90 matching questionnaires were distributed in this study,and 79 questionnaires were effectively recovered,with a effective rate of 87.8%.1.2 Assessment tools(1)Physician’s questionnaires:Self-compiled general situation questionnaire,Jefferson Sympathy Scale(JSE),Interpersonal Response Indicator Scale(IRI),and Pain pictures.(2)Patient’s questionnaires:Self-compiled general situation questionnaire,Brief illness perception questionnaire(BIPQ),Wake Forest Doctors Trust Scale(WFPTS),and Diagnostic Relationship Sympathy Scale(CARE).1.3 Data analysisData entry was performed using EpiData3.1,data analysis was performed using SPSS23.0 software,Harman single factor test method,two independent samples t test,one-way ANOVA,Pearson correlation Analytical test,and Bias-Corrected Bootstrap mediation effect test were used.2.Results2.1 Clinician empathy(1)Demographic differences in clinician empathyThe JSE score was 79.54±4.69,IRI score was 43.22±9.87,pain empathy total score was 6.39±1.18,CARE was 38.26± 8.19.There were statistical differences in gender on CARE(p<0.05).(2)Correlation analysis of JSE,IRI,pain empathy and CAREThere was no significant correlation between JSE and total score of other scales(p>0.05);there was no significant correlation between CARE and total score of other scales(p>0.05);IRI was significantly positively correlated with pain empathy each other(p<0.01).2.2 The influence of clinician empathy on patient-physician trust and illness perception(1)Correlations between BIPQ,WFPTS and clinician empathyBIPQ was significant negative correlated with WFPTS and CARE respectively(p<0.01).WFPTS was significantly positively correlated with CARE(p<0.01);the total score and emotion score of BIPQ were negatively correlated with JSE(P<0.05).(2)Differences in illness perception and physician-patient trust among different clinical empathy ability groupsAccording to the clinician empathy,the physicians were divided into high and low empathy groups,and the differences in illness perception and physician-patient trust between patients who consulted by different groups of doctors were compared.The results showed that the patients who consulted by physician with high CARE had lower scores of negative illness cognition and illness perception(P<0.05),and higher scores of benevolence,technical ability,and physician-patient trust(p<<0.001);The patients who consulted by physician with high JSE had lower scores of negative emotion and illness perception(p<0.05).2.3 The mediating effects of patient-physician trust in the relationship between clinician empathy and illness perception(1)The patient-physician trust played a mediation role in the relationship between diagnosis-treatment relationship and empathy.The mediating effect was 47.33%.(2)Patient-Physician trust has no mediating effect between Jefferson,s empathy and illness perception.3.ConclusionsThere was a significant difference between the patient’s perceived empathy and the physician self-evaluation.Different clinician empathy play different roles in the treatment process.The patient’s perceived empathy was the core factor affecting the patient-Physician trust and illness perception.The physician’s care and understanding that the patient felt can improve the patient’s trust in the physician,which in turn reduced the patient’s poor cognitive and emotional response to the illness.Research features and innovations1.Expansion of the research object.In the past,only the patient or the physician was selected as the research object.This study was conducted from the perspective of both the patient and physician,and further explored the relationship and influence of the patient’s illness perception,patient-physician trust and clinician empathy.2.Deepening of the research content.There were many studies that believe that effective communication between patients and physicians can improve the health of patients,but little research has been done on the causes.In addition,domestic research on illness perception mostly stayed in the analysis of general influencing factors,and it is difficult to reflect the complex relationship between illness perception and other factors.This study started from the intermal and external factors that affect illness perception,and comprehensively examined the relationships between illness perception,patient-physician trust and cliiician empathy,deepened the research content of illness perceptlon,and further explored the possible mechanism of the influence of physician-patient communication on the health of patients.Research limitations and prospects1.This study conducted a cross-sectional study to explore tihe relationships between clinician empathy,patient-physician trust and illness perception.However,it was not included in the patient’s subjective self-reported health level and the health level of objective physiological indicators,so it is not possible to visually measure the relationships between the three and health.2.This study explores the relationship between clinician empathy,physician-patient trust,and illness perception in the general patients.Future research can focus on the patients with specific chronic illness.3.Future research can further expand the sample size,conduct follow-up studies on patients,and examine the impact of these three variables on subjective and objective health and long-term dynamic relationships.