Dynamics of trust in medical decision making: an experimental investigation into underlying processes.

BACKGROUND Patient trust in medical decision makers is a crucial facilitator of effective health care. Greater patient involvement in decision making requires improved understanding of how such trust is built, maintained, and lost in medical contexts. OBJECTIVE The study investigates how trust in clinicians is affected by the 4 main diagnostic outcomes proposed by signal detection theory: true positives, true negatives, false positives, and false negatives. Cognitive appraisals of, and affective reactions to, the decisions were measured to investigate the psychological mechanisms underpinning effects on trust. DESIGN Members of an Internet research panel (N = 1162) participated in a between-participant experimental study using hypothetical cancer diagnosis scenarios. RESULTS Overall, correct diagnoses bolstered trust as much as incorrect ones undermined it. Consistent with recent findings in other decision-making domains, trust was not as precarious as generally believed. The influence of decisions and outcomes on trust was mediated through cognitive assessments and affective responses in line with current appraisal theories in psychology. Prior levels of trust in clinicians affected sympathy for doctors, highlighting the role that trust plays in responding to new information. CONCLUSIONS Trust in (hypothetical) clinicians is sensitive to information about their past diagnostic performance. Greater understanding of the cognitive and affective mechanisms by which this occurs may help maintain current high levels of trust. Further research is needed to examine whether findings generalize to real medical decision-making contexts. Clinicians may want to consider the impact their diagnoses have on trust alongside medical and financial considerations.