Can patient-centered communication reduce the effects of medical mistrust on patients' decision making?

Objective: Mistrust in medical institutions has been implicated as a barrier that disproportionately affects the quality of health care received by patients. Although patient-centered communication has been shown to improve patient-provider relationships, little is known as to whether it may reduce the effects of medical mistrust on patients' decision-making and trust in physicians (physician mistrust). Method: In a laboratory study, 231 primary care patients (101 African American and 130 White participants) were randomly assigned to one of two conditions in which they viewed video recorded, standardized vignettes depicting a cardiologist recommending coronary bypass surgery to a patient diagnosed with angina and 3-vessel coronary artery disease. In each vignette, the cardiologist-actor demonstrated either low or high patient-centered communication behavior. Participants were asked to assume the role of the patient interacting with the video-recorded physician. Results: Hypotheses were partially supported. High levels of medical mistrust were associated with greater physician mistrust and lesser endorsement of the hypothetical bypass surgery. Among patients exposed to high patient-centered communication, the relationships between medical mistrust and both physician mistrust and surgery endorsement were weaker than among patients exposed to low patient-centered communication. Although African American patients reported greater medical mistrust compared with White patients, respondents' race did not moderate the relationships. Conclusions: Results suggest that mistrust toward health care may unfavorably affect interactions and patients' health-related outcomes. Physicians may buffer the effects of mistrust by using patient-centered communication skills such as soliciting the patient's concerns and priorities and being responsive to the health care needs which patients identify.