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. 2023 Feb 6:1–8. Online ahead of print. doi: 10.1007/s10880-022-09935-z

Effect of Perspective-Taking on Trust Between Doctors and Patients: A Randomized Controlled Trial

Linghang Kong 1, Yidi Chen 1,2, Lu Wang 1, Kaikai Wang 1, Chen Liu 1, Yiqun Gan 1,✉
PMCID: PMC9902241  PMID: 36746850

Abstract

Tension between doctors and patients as a social problem has existed for a long time; thus far, there is no good solution. From the perspective of trust between doctors and patients, this research studies the relieving effect of perspective-taking interventions on the tension between doctors and patients. This study used a randomized, single-blind online experiment. 133 participants were randomly divided into an intervention group (n = 67) and control group (n = 66). Participants were asked to complete writing tasks from the doctor’s perspective. Patients’ trust in doctors was measured at 3 time points: before intervention, immediately after intervention, and 10 days after the intervention. Findings showed a significant interaction effect between time measurement and group. In the intervention group, a pairwise comparison of time measurements showed a significant difference between T1 and T2. Perspective-taking interventions can improve patients’ trust in doctors, but this effect diminishes over time.

Keywords: Perspective-taking, Trust between doctors and patients, Intervention, Randomized controlled trial

Introduction

The tension between doctors and patients has existed in China for a long time, and thus far, it has not been adequately solved (Wang, 2020). Verbal and physical violence against doctors has reached a very high level in China and worldwide (Zhang et al., 2021). Poor doctor–patient relationships are a social problem with significant public attention. The issue erodes patient confidence in the public health and medical systems; it is, therefore, imperative that it is resolved before more violence occurs.

Doctor–Patient Trust

As an essential component of the doctor–patient relationship, trust helps to build a harmonious relationship between doctors and patients (Hall et al., 2002a, 2002b). Tension, as well as violence against doctors, is a reflection of distrust between doctors and patients. Many studies have demonstrated that trust between patients and doctors is of great importance to the entire medical process, including patients’ acceptance of doctors’ treatment, compliance with doctors’ recommendations, and satisfaction with medical services (Baloush-Kleinman et al., 2011; Janssen et al., 2007; Lee & Lin, 2009; Trachtenberg et al., 2005), and eventually the treatment results (Martin et al., 2005). Accordingly, this study explores ways to improve doctor–patient relationships from the perspective of trust. Trust within the doctor–patient relationship can be divided into two categories: patients’ trust in doctors and doctors’ trust in the patients. In this study, we focus on patients’ trust in doctors and define it as believing that a doctor works in the patient’s best interests (Rolfe et al., 2014).

Interventions of communication skills have been demonstrated to improve trust between doctors and patients (Stewart, 1995). Trust is formed on the basis of people’s interactions, of which communication is the main form: therefore, interventions to improve communication skills (e.g., enhancing doctors’ empathy and building a patient-centered communication style) can effectively enhance patients’ trust in doctors (Fiscella et al., 2004; Tulsky et al., 2011). However, previous research focused on interventions in communication with doctors instead of patients, which may stem from the consideration that when the goal is to improve the patients’ trust in doctors, it is the doctors who need to improve their communication skills, while the patients may not want to change their communication style to increase doctors’ trust in them. However, communication is a two-way process, so relying on doctors’ communication skills may not be sufficient to enhance the communication process. Thus, a major reason why communication improves trust between doctors and patients is that it increases patients’ understanding of doctors. Simple guidance for patients can also serve to promote physician understanding. One approach to achieve this is through perspective-taking, which emphasizes “looking at things from the perspective of others” (Galinsky et al., 2005). This study seeks to enhance patients’ trust in doctors through a perspective-taking intervention.

Perspective-Taking Intervention

Perspective-taking can be defined as the process of considering the world from other people’s viewpoints or imagining other people’s situations (Galinsky et al., 2005). Recently, researchers began to pay attention to the essential role of perspective-taking in improving interpersonal relationships and reducing conflicts between groups (Cohen & Insko, 2008; Peterson et al., 2015). Given the impact of perspective-taking in improving interpersonal and group relationships, we propose that patients’ trust in doctors can be improved through perspective-taking interventions.

Batson and Ahmad (2009) summarized eight common practical programs using empathy to improve intergroup attitudes and relationships. The programs more relevant to doctor–patient relationships are conflict-resolution workshops, the storytelling method, and media (i.e., books, movies, radio, and TV programs, fiction or nonfiction). However, regardless of the approach, the core is to improve relationships by generating empathy through experiencing the world from others’ perspectives. Perspective-taking interventions are promising tools to enhance trust. Perspective-taking improves individual empathy, thus enhancing interpersonal trust and promoting prosocial behavior (Batson et al., 2007). In addition, perspective-taking can also improve individual evaluations of others in both explicit and implicit processing pathways (Galinsky & Moskowitz, 2000; Todd et al., 2011), which indicates that the relationship improvement brought about by perspective-taking achieves unity in both explicit and implicit aspects of attitudes. Furthermore, the perspective-taking of one person can spread in the group to which that person belongs (Shih et al., 2009). Todd et al. (2012) found that perspective-taking can decrease prejudice and hostility toward external groups in vague situations, which suggests that it can reduce intergroup conflict. According to Galinsky et al. (2005), perspective-taking can make individuals feel a sense of self-other overlap, which helps foster social bonds and facilitate social coordination (Galinsky et al., 2005). Owing to the overlap, perspective-taking not only fosters transposition thinking but also produces a feeling of a change in the relationship toward trust. Meanwhile, individuals can better understand the difference between others’ perspectives and their own, thereby reducing stereotyping and increasing understanding and tolerance. The perception of similarity caused by social bonds can also improve interpersonal relationships and promote trust.

The Present Study

We hypothesized that patients’ trust in doctors could be improved through a perspective-taking intervention in medical settings. Due to the COVID-19 pandemic, we used online interventions. We primed the participants by asking them to imagine a medical situation in which they were doctors. By tracking the change in trust in doctors, we evaluated the effectiveness of perspective-taking in improving patients’ trust in doctors.

Methods

This protocol was preregistered at https://osf.io/g52hw/.

Participants

A total of 226 participants were recruited through voluntary online registration in several WeChat groups in July 2020. During registration, participants were required to provide their contact information and age.

G*Power software was used to estimate the sample size required for the study. Referring to previous research results in the same field (Blatt et al., 2010), the expected effect size was 0.22. When setting the power at 0.8 and the significance level α at 0.05, the estimated correlation was 0.5. Moreover, the aspheric correlation coefficient was 1. This study used a 2 (group) × 3 [time (pre-treatment vs. post-treatment vs. follow-up)] mixed design. We calculated the sample size required for this experiment to be 112.

We used an online questionnaire platform (Qualtrics) for testing and data collection and sent out the experiment invitation to all participants. Ultimately, a total of 133 people participated in the intervention. They were randomly assigned to the experimental and the control groups: 67 and 66, respectively. All participants had at least a high school diploma and had no mental health problems.

This intervention consisted of four sessions. Patients’ trust in doctors was measured at 3 time points: before the first intervention, after the fourth intervention, and 1 week after the fourth intervention. Among the 133 participants, 29 did not complete the entire process or failed to pass the screening questions, including 13 participants in the intervention group and 16 in the control group. During the experimental manipulation, 24 participants did not meet the writing requirements, including 17 in the intervention group and seven in the control group; the data of the above participants were eliminated. Thus, 80 participants were included in the final statistical analysis. The age range of participants finally included in the analysis was 18–58 years old (M = 24.74, SD = 8.13), including 37 in the intervention group and 43 in the control group. The participants in each stage of the experiment are shown in Fig. 1. The attrition analysis results showed no significant difference at baseline (patients’ trust in doctors and gender, age, education level, monthly income, and the average number of medical visits per year) between the participants who completed the study and those who dropped out.

Fig. 1.

Fig. 1

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Flow chart of participants

Procedure

Participants were blind to the purpose of the study. At the beginning of each test, participants were required to click on the informed consent page before entering the formal test. The informed consent form explained that participants had the right to withdraw at any stage of the experimental process. Ethical approval for the study was obtained from the ethical committee of the School of Psychology and Cognitive Sciences.

Participants were asked to complete five tests between July 15 and July 31, 2020. The interval between the first four tests was 1 day, and the interval between the final and previous test was 10 days.

In the first test, we measured the baseline of patients’ trust in doctors and conducted the first intervention on the participants’ tendency toward perspective-taking. Participants were required to read a fictional scenario to put themselves into a medical scene. They were then requested to fill in the questionnaire on patients’ trust in doctors as the baseline of the participants’ trust. Subsequently, participants were asked to answer their symptoms in the medical scene to evaluate whether they were seriously involved in the experiment. Finally, participants were asked to complete a writing task of no less than 100 words. Participants in the intervention group needed to recall the imagined medical scene and regard themselves as doctors at that time, imagine their working environment, and engage in a guided expository writing task; the participants in the control group needed to recall the events that impressed them on the test day and describe their experiences, thoughts, and feelings.

In the second, third, and fourth tests, we continuously intervened on the participants’ tendency to perspective-take. Participants were required to complete a writing task of no less than 100 words. The intervention group was asked to recall the medical scene they imagined before, imagine themselves as doctors at that time, and write down their imagined content according to the requirements. To prevent participant fatigue and the exercise effects of completely repeated intervention content, we asked participants to imagine and write down different information each time. The degree of view selection ranged from simple to sophisticated, including experience and feelings in daily work, thoughts about the patient in the scene, and the patient’s emotions. Participants in the control group were asked to recall the events that impressed them on the test day and describe their experiences, thoughts, and feelings. After the fourth writing task, all participants took a second measurement of patients’ trust in doctors to evaluate the intervention’s effect.

Ten days after the fourth test, we conducted a follow-up test on all participants to measure their trust in doctors. In this test, we collected the following as control variables: participants’ gender, gender, age, education level, marital status, monthly income, whether they were in healthcare-related industries, whether they had medical treatment experience in the past month, and an average number of medical visits per year in the past 3 years.

Interventions and Instruments

Medical Situation Scenario

We asked participants to imagine the medical situation and then measured their doctor–patient trust. Referring to Blatt (2010) and other similar studies, participants were asked to read a scenario about going to a doctor for foot paie and imagine that the event had happened to them. The Scenario is as follows:

Please read the following situation carefully and try to put yourself into the situation. Imagine that you are the patient in the situation.

Recently, your right foot often aches, making walking difficult. You cannot go to work by bike, which has caused much trouble in your life. So, you decide to go to the hospital to see a doctor. You go to the hospital where you often go. The number of people in the hospital today is almost the same as usual. After queuing up for registration, you sit on the bench outside the clinic and wait quietly. After a while, it is your turn to see a doctor. You go into the clinic, sit on the stool, and describe your condition to the doctor. After the diagnosis, the doctor prescribes some medicines for you and tells you to go to the pharmacy to get the medicine after payment.

The Chinese Version of the Vickers Forest Physician Trust Scale (WFPTS)

The VFPTS was originally developed by Hall et al., (2002a, 2002b) with ten items to measure patients’ trust in doctors. The higher the total score, the higher the degree of trust. Later, Dong and Bao (2012) constructed a Chinese version of the VFPTS. The internal consistency reliability of the Chinese version of the scale was 0.89. Specific items include “I feel that the treatment chosen by the doctor is the most suitable for me” and “I can give my life safety to my doctor without hesitation.” In this study, Cronbach’s α coefficients of the three measurements were 0.847 (T1), 0.847 (T2), and 0.854 (T3).

Intervention

There are two types of perspective-taking manipulation: non-real interactive static research manipulation and real interactive dynamic research manipulation. Static research includes presenting experimental materials to participants and asking them to imagine other people’s views or their own views in other people’s situations (Zhao et al., 2012).

Considering the feasibility of online research, we adopted a static control method. We asked the participants to take others’ perspectives by completing a writing task.

Examples of materials in the intervention group were as follows:

Please recall the scene: You are a patient with right foot pain. You come to a nearby hospital for treatment. When you imagine the orthopedic doctor in the situation, please regard yourself as an orthopedic doctor and describe it from his perspective.

What is your working environment (as a doctor)? (1st intervention)

What have you experienced (as a doctor) in your day’s work, and how do you feel? (2nd intervention)

What do you think when you look at the patient in front of you, who has pain in their right foot? Why do you think this? (3rd intervention)

What kind of mood do you have when you look at this patient with right foot pain in front of you? Why do you feel this? (4th intervention)

Please write your thoughts (from the doctor’s point of view) in no less than 100 words.

In the control group, participants were asked to write neutral content describing an event that happened on the day. Examples of these materials are as follows:

Please record any event that you want to describe today, including but not limited to experience, thoughts, and mood, in no less than 100 words.

All participants’ writing content was evaluated by the research team to determine whether they met the requirements of the topic. The final statistical analysis excluded data whose writing content did not meet the requirements.

Statistical Analyses

This study analyzed the data from participants who completed all interventions and measurements. We conducted a 2 (intervention group vs. control group) × 3 [time (pre-treatment vs. post-treatment vs. follow-up)] repeated-measures analysis of variance (ANCOVA). The patients’ trust in doctors was the dependent variable, and age was a covariate. The analysis was conducted using SPSS 26.0.

Results

Baseline Demographic and Outcome Variables

Table 1 provides descriptive statistics on the demographic and outcome variables of the 80 participants who completed the program. We used MANOVA and chi-square analyses to determine whether the intervention group and the control group were equivalent at baseline on demographic and outcome variables, which included patients’ trust in doctors at T1, gender, age, education level, monthly income, and the average number of medical visits per year. As shown in Table 1, there were no significant differences between the intervention and control groups for any variable.

Table 1.

Comparison of background information and baseline between the two groups

Variable Intervention group (n = 37) Control group (n = 43) F (1,78) p Partial η2
M (SD) M (SD)
Gender (male/female) 5/32 8/35 0.379 .538 –
Age 26.46 (9.75) 23.26 (6.16) 3.173 .079 0.039
Education level 4.22 (0.63) 4.30 (0.51) 0.454 .502 0.006
Monthly income 2.16 (0.90) 2.12 (0.93) 0.050 .824 0.001
Average number of medical visits per year 1.78 (0.67) 1.91 (0.78) 0.562 .456 0.007
Patients’ trust in doctors 35.41 (6.10) 35.86 (4.32) 0.151 .698 0.002
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Report the number of people and performs a chi-square test

Analysis of Intervention Effects

We conducted a 2 (intervention group vs. control group) × 3 [time (pre-treatment vs. post-treatment vs. follow-up)] repeated-measures analysis of variance (ANCOVA). Patients’ trust in doctors was the dependent variable. Covariates included gender, age, education level, marital status, monthly disposable income, whether they had medical treatment experience in the past month, the average number of medical visits in the past 3 years, and whether they worked in healthcare-related industries.

The patients’ trust in doctors in the intervention and control groups at the three measurement times are shown in Fig. 2. The interaction effect between measurement time and the group was significant, F(2, 140) = 3.190, p = 0.044, partial η2 = 0.044. However, the main effect of measurement time was not significant, F(2, 140) = 0.705, p = 0.496, partial η2 = 0.010; the main effect of the group was not significant, F(1, 70) = 0.312, p = 0.578, partial η2 = 0.004.

Fig. 2.

Fig. 2

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The patients’ trust in doctors of the intervention group and the control group

Simple effect analysis showed that there was no significant difference between T1 and T2 (p = 0.644), T1 and T3 (p = 0.052), and T2 and T3 (p = 1.000) in the control group. In contrast, in the intervention group, the patients’ trust in doctors at T2 was significantly higher than that at T1 (p = 0.005), but there was no significant difference between T1 and T3 (p = 0.098).

Discussion

The Impact of Perspective-Taking Interventions on Trust Between Doctors and Patients

In this study, participants were asked to complete a writing task as a perspective-taking intervention on trust between doctors and patients. Compared to the control group, the experimental group had significantly higher scores on patients’ trust in doctors after the perspective-taking intervention. However, in the follow-up test administered 10 days later, the experimental group’s scores on patients’ trust in doctors did not differ significantly from their pre-intervention scores.

The results partially support the findings of previous studies on perspective-taking interventions and trust between doctors and patients (Galinsky & Moskowitz, 2000; Batson et al., 2007; Galinsky & Ku, 2016). To some extent, perspective-taking interventions can enhance trust between doctors and patients (Blatt et al., 2010; Erle et al., 2018; Vescio et al., 2018). Thinking from another person’s perspective allows individuals to devote more attentional resources to the other person in social interactions, which can lead to more positive evaluations of the other person (Wang, 2020; Reidy et al., 2015). By imagining themselves in the doctor’s shoes, individuals can form a social bond with the doctor and become more aware of the difference between the doctor’s perspective and their own, which helps them better understand the doctor’s position and recognize the rationale and necessity of the doctor’s actions, thus increasing their trust.

The effect of the interventions receded at follow-up, and the level of trust in doctors was not significantly different from the baseline. This may be because the intervention in this study was conducted in a specific medical treatment context, and the object of the perspective-taking interventions was also a specific doctor. Patients’ interpersonal trust in specific doctors is developed based on general trust in the whole profession (Rhodes & Strain, 2000; Goold, 2002). Perspective-taking interventions may have affected the participants’ interpersonal trust in the specific doctor, but general trust is derived from multiple sources of information and is more difficult to affect through the interventions. Therefore, although the perspective-taking interventions were effective, the increase in trust was easily produced and diminished because it only affected the participant’s trust in a specific doctor. In this case, it is difficult for perspective-taking interventions to have a long-term impact on trust. Another important reason for the short duration of the intervention effect may be the insufficient sample size. Therefore, further studies are needed to demonstrate whether the effects can be maintained.

Study Implications

In the context of Chinese society, with frequent incidents of doctor–patient disputes, trust between doctors and patients is of high research value as an important component of the doctor–patient relationship (Cusack, 2000; Safran et al., 2001). This study demonstrates that online perspective-taking interventions can enhance the public’s trust in the physician community, provide an effective solution to reduce physician–patient conflict, and promote the harmonious development of the physician–patient relationship. Compared with traditional psychological interventions, online interventions are not restricted by time and location and are more economical because they do not require the participation of medical professionals. Online intervention is also better suited to the requirements of maintaining social distancing in a pandemic.

This study was conducted during the COVID-19 outbreak, when patients’ trust in doctors was relatively high. Studies have shown that media communication could impact the development of doctor–patient relationships (Chai, 2017; Sartorius et al., 2010). During the epidemic, there was a great deal of media coverage regarding the contributions made by healthcare workers, which also enhanced patients’ trust in doctors (Chen et al., 2022). Similarly, the relationship between patients and doctors improved during the outbreak of severe acute respiratory syndrome (SARS) in 2003, but the effect did not last. Therefore, the COVID-19 outbreak provides a good opportunity to enhance the trust of doctors and patients (Gan et al., 2020). If the public accepts online perspective-taking interventions in this situation, it may have a long-term impact.

Finally, given the important roles of workshops, storytelling, and extensive media outreach in improving the doctor–patient relationship, the findings of this paper may also provide insights for guiding media outreach efforts (Batson & Ahmad, 2009). More scenes of doctors’ daily work could be added to medical dramas and films to initiate perspective-taking for doctors among patients and the general public, thus enhancing doctor–patient trust (Chen et al., 2021). In particular, the results of this study suggest that the effect of perspective-taking interventions on doctor–patient trust is relatively short-term; media may help doctor–patient trust remain at a high level for a longer period because TV programs, movies, and other media can provide continuous intervention.

Limitations and Future Research

There were some limitations to this study. First, the sample representation was limited. We recruited the participants through WeChat, and most were university students who may have had less experience in medical care. In addition, their opinions about doctors were more likely to come from others or media reports, which limits the generalizability of the findings. Chen et al. (2017) showed that patients from different occupations and age groups also had different feelings of trust in doctors, with patients younger than 35 years old having a more negative assessment of trust between doctors and patients.

Second, patients’ trust in doctors is based on their general trust in the whole group of doctors and interpersonal trust in specific doctors (Rhodes & Strain, 2000). This study targeted interpersonal trust in specific doctors, used scales that target interpersonal trust to detect the effects of the interventions, and did not examine the changes in general trust levels. Individuals’ general trust in the entire physician population has greater value, and more interventions and trust scales could be used to explore how to improve general trust.

Finally, most current research on the doctor–patient relationship is from the patient’s perspective, focusing on patients’ trust in doctors and ignoring doctors’ trust in patients (Brennan et al., 2013). Blatt et al. (2010) demonstrated that a perspective-taking intervention with medical students improved patient satisfaction, suggesting that interventions with doctors are worth exploring in future research.

Funding

This study was funded by National Social Science Foundation of China, 20BSH139, Yiqun Gan.

Data Availability

The data that support the findings of this study are openly available in [Figshare] at. 10.6084/m9.figshare.21863952.v1

Declarations

Conflict of interest

Linghang Kong, Yidi Chen, Lu Wang, Kaikai Wang, Chen Liu1, and Yiqun Gan declare that they have no conflict of interest.

Footnotes

Preparation of this manuscript was supported by 20BSH139 from National Social Science Foundation of China.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are openly available in [Figshare] at. 10.6084/m9.figshare.21863952.v1

Articles from Journal of Clinical Psychology in Medical Settings are provided here courtesy of Nature Publishing Group

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