When people become patients: fluctuations in trust from the cancer patient’s perspective

Abstract

This study explores the trust relationships between cancer patients and their physicians by discussing the concept of trust and the collection of patients’ medical experiences before and after being diagnosed with cancer. The purpose of the study is to determine changes in patients’ trust during this process. This ethnographic study was conducted from 2009 to 2014 on doctor–patient relationships under the coverage of the National Health Insurance (NHI) in Taiwan. Under the NHI, patients may access physicians and acquire treatment at low cost. In this study, the sample comprised 12 female cancer patients. Data were collected in in-depth interviews with six patients. With the bloggers’ consent, data were collected from six blogs. These data were analyzed to determine how these cancer patients constructed and altered their opinions during their diagnosis and treatment. The results are discussed according to the calculative trust that was constructed based on information collected and/or impressions developed during their initial visits. The findings showed that relational trust was developed and (dis)evolved through interactions and experiences with medical staff. In addition, calculative trust was generated based on the following: eliminating institutions or physicians with which the patients had negative experiences; feeling and perceiving caring and professional competence; yielding to cancer and respecting professional reputations. Relational trust was derived from the following: the doctors’ ability to sooth patients’ anxieties and explain uncertainties; the compatibility of expectations in information sharing between physicians and patients. The results showed that in the early stage of developing a doctor–patient relationship, calculative and relational trusts were intertwined. As the doctor–patient relationship developed, the patients’ relational trust increased. The findings of this study contribute to the knowledge concerning the co-construction of patients’ trust in physicians in medical systems through communication between patients and medical staff.