Exploring the relationship among cancer patient experience, trust in physician and intention of changing physician

Background and aims: Since 1982, cancer has been ranked top of death cause for 33 years, also the rate of occurrence and mortality have been increased. It had become a threat to the health of population. WHO, IOM and OECD indicated that responsiveness and patient-centered were the key elements of health care system. These two elements have gradually become the trend of medical quality development. Recently, the measure of medical quality has turned to develop the survey of patient perspective or experience which become the critical basis for quality improvement. Trust is the crucial element of building good physician-patient relationship, and is affected by patient experience. Patient trust will cause many positive and negative results, such as health outcomes, changing physician etc. This study attempts to explore the relationship among patient reported experience, patient trust and the intention of changing physician, and find out the influential factors to increase the degree of patient trust and reduce the possibility of changing physician. Method: This is a cross-sectional study and adopt self-report questionnaire to collect the data. The subjects of study include six kinds of cancer patients that receive care in hospital. The questionnaire adopt Cancer Patient Experience Survey (CPES) and Trust in Oncologist Scale (TiOS) as investigative tools. There were 277 valid samples with collection period from November 16th 2015 to June 8th 2016. In CPES, the cancer patient during a medical procedure practical experience, is converted into a percentage calculated under dimensions. In TiOS, using the sum of Likert five-point scale as the scores of high and low degree. The part of change physician is to divide into two sections. The data is analyzed by methods of factor analysis, descriptive analysis, independent-sample T test, one-way ANOVA, chi-square test, Pearson Product-Moment Correlation, multiple linear regression and logistic regression. Results: Age and race are the factors of influencing cancer patient trust, and age also affects the intention of changing physician. In the part of medical treatment experience, controlling for other variables, the patient receives patient-centered care experience in the process, communication experience with physicians, providing cancer information, providing emotional support, patient involvement in treatment-related decision-making and care planning, continuity of care, financial and work support are significant with patient trust. Patient trust will significantly affect the intention of changing physician. Except for financial and work support, the rest six dimensions will also significantly affect the intention of changing physician, and the relation between these dimensions and the intention of changing physician will totally intermediate by patient trust. Conclusion: The better the cancer patient experience in the dimensions of receiving patient-centered care experience in the process, communication experience with physicians, providing cancer information, providing emotional support, patient involvement in treatment-related decision-making and care planning, continuity of care, and financial and work support, the higher degree of patient trust. Increasing the degree of patient trust will reduce the possibility of changing physician. Except for financial and work support, the better the rest six dimensions of cancer patient experience, the lower the possibility of changing physician. Furthermore, these dimensions will affect the intention of changing physician through patient trust. After further analysis, communication experience with physicians is the most important dimension. It is recommended that hospitals could include communication skill in education training to improve the ability of physicians and let communication more efficient and beneficial. In addition, it is recommended that physicians could cooperate with case managers during the outpatient service to help cancer patients to obtain more elaborate explanations.