Health-care system distrust in the intensive care unit

J Crit Care. 2012 Feb;27(1):3-10. doi: 10.1016/j.jcrc.2011.04.006. Epub 2011 Jun 28.

Abstract

Purpose: To examine the performance and properties of the Revised Health Care System Distrust Scale among surrogates in the intensive care unit (ICU).

Materials and methods: Pilot, prospective cohort study of 50 surrogates of adult, mechanically ventilated patients surveyed on days 1, 3, and 7 of ICU admission.

Results: Responses on the Health Care System Distrust Scale on day 1 ranged from 9 to 34 (possible range 9-45, with higher scores indicating more distrust), with a mean and SD of 20.3 ± 6.9. Factor analysis demonstrated a 2-factor structure, corresponding to the domains of values and competence. Cronbach α for the overall scale was .83, for the competence subscale, .76, and for the values subscale, .74. Health-care system distrust was inversely correlated with trust in ICU physicians (Pearson coefficient -.63). When evaluated over the course of each patient's ICU stay, health-care system distrust ratings decreased by 0.31 per patient-day (95% CI 0.55-0.06, P = .015). Correlation between health-care system distrust and trust in ICU physicians decreased slightly over time.

Conclusions: Among surrogates in the ICU, the Health Care System Distrust Scale has high internal consistency and convergent validity. There was substantial variability in surrogates' trust in the health-care system.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Attitude to Health*
  • Delivery of Health Care*
  • Female
  • Health Services Research
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Pennsylvania
  • Pilot Projects
  • Professional-Family Relations
  • Prospective Studies
  • Proxy / psychology*
  • Reproducibility of Results
  • Surveys and Questionnaires*
  • Time Factors
  • Trust*