A team of researchers explored the physician-patient relationship at the heart of the shared decision-making process in the treatment of multiple myeloma (MM). The findings of their qualitative study were published in Cancer Medicine.
In structured interviews with 19 people with multiple myeloma, the researchers delineated 3 main themes: externally validated trust, internally validated trust, and trust in relation to shared decision making.
Within the theme of externally validated trust, the researchers learned patients relied on their perceptions of their clinicians and the institutions where they received care based on reputation or prestige rather than personal experience. Patients’ personal beliefs and preferences they associated with trustworthiness also were factors in this theme.
Within the theme of internally validated trust, the researchers found that factors related to communication skills often rose to the top of the factors patients relied on. Subthemes included competence, responsiveness, honesty, empathy, and taking time with patients and listening to them.
The third theme delved into how trust affected the shared decision-making process. “Many patients expressed confidence relying on decisions made by their clinicians when a trusting relationship had been established,” the researchers observed. But some patients expressed less trust in their physicians, and were more likely to seek second opinions from other clinicians rather than rely on their physicians’ recommendations.
These findings on how trust develops between patients with multiple myeloma and their physicians were consistent with those of previous studies of patients with cancer. But multiple myeloma is an especially complex disease, and multiple clinicians are often involved in the treatment process, which requires patients with the disease to develop relationships with multiple healthcare providers.
The issues that affect trust are sometimes beyond the physician’s control, including many external factors such as the healthcare center’s reputation. But some of the factors within the theme of internally validated trust can be influenced and improved upon by a clinician willing to take the steps to develop a relationship based on trust with the patient.
“Consistent with previous work, our findings suggest that building trust involves specific patient communication approaches, such as taking adequate time for appointments, answering questions, appearing informed and knowledgeable, actively listening, and expressing empathy,” the researchers explained.
Another issue raised in other research is a balance that does not bend too far toward lack of trust or toward blind trust. In these cases, the patient defers to the physician and does not really participate in shared decision-making. Multiple myeloma tends to have a complex and long-term treatment trajectory, which may lend itself to an interactional model of shared decision-making, but additional long-term research on changes in trust over time might further illuminate this concept.
This study was limited in that it was designed to generate robust data on decision making specific to multiple myeloma treatment rather than generalizable results. Most of the participants were White, highly educated, and healthy enough to participate in the study, which raises the possibility that other patient populations might have responded differently. Future research could focus on a more diverse group of patients with MM to glean more about the development of trust and its influence on shared decision-making.
Whitney RL, White AEC, Rosenberg AS, Kravitz RL, Kim KK. Trust and shared decision-making among individuals with multiple myeloma: a qualitative study. Cancer Med. Published October 5, 2021. doi:10.1002/cam4.4322