Association between Trust and Patient-Reported Outcomes and Experience in Prostate Cancer Patients.

Abstract

Purpose: To evaluate the association between patient-physician trust, treatment choice, patient-reported outcomes, and patient-reported experiences among patients with localized prostate cancer.

Materials and methods: We conducted a secondary analysis of data from a multicenter randomized controlled trial among patients with localized prostate cancer. Trust was measured at baseline, prior to treatment, using the Patient Trust-Wake Forest Physician Trust Scale (PTWF). Outcomes were assessed at baseline and at 3, 6, 12, and 24 mo. Treatments were robotic-assisted laparoscopic radical prostatectomy, radiation therapy, and active surveillance. The primary treatment outcome was receipt of active treatment (surgery or radiation therapy) versus active surveillance. Multivariable logistic regression and linear mixed-effects models were adjusted for age, race/ethnicity, marital status, education, employment, insurance, prostate cancer risk group, intervention assignment, and study site. Sensitivity analyses modeling trust as a continuous variable yielded findings that were materially consistent with the primary analyses.

Results: The high-trust group had higher odds of receiving active treatment than the low-trust group did (adjusted odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.14-2.87; P = 0.013). Higher baseline trust was also consistently associated with better physical and mental health-related quality of life and higher satisfaction with care and treatment decision making across follow-up assessments through 24 mo. Sensitivity analyses using trust as a continuous measure produced similar findings.

Conclusions: Higher patient-physician trust was independently associated with treatment choice, patient-reported outcomes, and patient-reported experience. These findings underscore the importance of patient-physician trust as a component of patient-centered cancer care and shared decision making. Future studies should evaluate interventions designed to strengthen trust and improve patient-centered outcomes across diverse clinical settings.