Qualitative Evaluation of Healthcare Provider Trust (And Mistrust) Among Patients with Symptomatic Peripheral Artery Disease

Abstract

Communication between patients and providers is required for shared decision making, and their interpersonal interaction directly impacts treatment choices. We conducted a focus group study of patients with symptomatic peripheral artery disease (PAD) to identify factors relevant for treatment decisions. This analysis specifically explores provider trust and communication as an important, process-related theme. Patients with symptomatic PAD were recruited to participate in moderated focus groups. Focus groups lasted for approximately one hour, used a structured moderator’s guide, and were audio recorded. Verbatim transcripts were imported into a qualitative analytic software program and analyzed to identify key attributes and themes. Comments related to patient-provider interaction, communication, and trust were extracted and analyzed using thematic analysis, word frequency coding, and hierarchy charts. 51 participants with symptomatic PAD were recruited. Mean participant age was 66.2 ±13.9 years, 35% were women, and 43% were white. Provider trust and interaction emerged as unanticipated but important themes. Interpersonal interaction was discussed in terms of provider specialty, treatment venues, and information sharing. Provider trust was discussed in terms of need for second opinions, disclosure of treatment alternatives and risks, and access to outpatient clinic visits and specific treatments. Participants expressed positive attitudes toward involvement in shared decisions, receipt of educational information, detailed counseling, and discussion of treatment options under consideration. Negative attitudes were expressed toward treatment in the emergency room, delay of appropriate treatment, provider misinformation or withholding of information, inconsistent recommendations between providers, patient abandonment, and pain medication as a treatment. Attitudes about provider specialty, provider trust, and experienced decision roles were mixed. Provider trust is inconsistent among patients with symptomatic PAD and may be affected by a variety of factors, some of which are not provider-specific. Understanding barriers to patient-provider trust may identify opportunities to improve interaction, facilitating shared decision-making.