Patients’ knowledge and their trust in healthcare personnel in elective surgery. A mixed methods study including an extended theoretical discussion

Abstract

Introduction: This thesis aims to provide a better understanding of how patient knowledge relates to trust in healthcare personnel in a surgical setting. In this context, there is a paucity of scholarly contributions on the subject that combine different empiric research methods and theoretically rooted analyses. I have endeavoured to combine both qualitative and quantitative empirical methods in researching this issue, as well as developing a theoretical discussion that aims to understand the dynamics of knowledge and trust in surgery. Theories of trust from the fields of sociology, philosophy and pedagogy are combined in this attempt. Methods: In the empirical part, an emerging exploratory sequential mixed methods design was applied. This consisted of first performing a qualitative study with patients undergoing hip or knee arthroplasty. We then performed a multicentre survey of elective surgery patients by providing questions on their knowledge, mental well-being and trust. The latter study aimed to test the hypotheses developed in the former study. Subsequently, the current thesis provides an extended theoretical and conceptual discussion of the empirical findings. The purpose is twofold: to develop a theoretical understanding of the relationship between patients’ trust and knowledge in a healthcare context and to provide recommendations for professional practice. Results: The qualitative study resulted in three themes of how patients experienced their preoperational information: 1) realistic information preparing for surgery, 2) involvement and sense of control, and 3) trust in staff. The survey study was first analysed using a correlational analysis (Pearson’s r) to assess how different kinds of information were associated with trust in surgical doctors. Patients’ received knowledge about their medical condition, including the treatment they received, was the strongest one associated with trust. Received knowledge about economic issues had the lowest correlation with trust in doctors. All dimensions of knowledge correlated positively with trust, and these correlations were statistically significantly. However, the total correlation was .416, which is considered as being at a low to moderate level. Furthermore, the survey was analysed using a multiple linear regression to compare the received knowledge and mental wellbeing with trust in surgical doctors. These variables were controlled for various sociodemographic factors. Both received knowledge and mental well-being were calculated into four levels to assess whether there were differences in the levels of these variables in terms predicting trust in surgical doctors. The lowest level of mental wellbeing, level one out of four, indicating depression, significantly predicted lower trust than all the other levels of mental well-being. The two lowest levels of received knowledge significantly predicted lower trust than levels three and four. Discussion and conclusion: A teleological perspective was the focus when discussing the findings theoretically because knowledge and trust are forward-pointing and action-oriented concepts. The concept of continuity, as described by John Dewey, was used to describe how experiences form knowledge—and trust—that provides a basis for future experiences and action. In the thesis I propose the concept of the ‘knowledge–trust continuity’ to provide a basis for further theoretical and empirical efforts in the field. This concept describes a view of how trust is learned and on how the future orientation of both knowledge and trust explains their interrelation. Furthermore, the concept suggests that different learning experiences provide different kinds and levels of trust; finally, there may be a threshold value for how great a degree of knowledge predicts a ceiling level of trust in healthcare personnel. Implications for practice and research: Information efforts from surgical units should be oriented towards the future situations of patients, both in the very short term and on likely issues following in the days and months after operation. This communication needs to be perceived as ‘realistic’ by patients. Information should, both in terms of the content and style, provide patients with a sense of control over the situation. Healthcare personnel and hospitals should take the mental health of surgical patients into account, and patients with depressive symptoms should be payed attention to by adapted communication strategies because they are at risk for having less trust in hospital staff. Future comparative studies should be conducted to understand the effects of context in knowledge–trust relations. It is also necessary to develop research questionnaires based on explicit theoretical foundations to make research questionnaires easier for respondents to use and better for researchers to analyse. The theoretical framework developed in the current thesis may provide a deeper understanding of the importance of patients’ knowledge and trust in a surgical setting, which may provide a smoother path for future research on this topic.