Health-care system distrust in the intensive care unit

作者：Schenker Yael^*; White Douglas B; Asch David A; Kahn Jeremy M

来源：Journal of Critical Care, 2012, 27(1): 3-10.

DOI：10.1016/j.jcrc.2011.04.006

• Health-care system
• Distrust
• Critical care
• Surrogate

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 alpha 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 healthcare system.

• 出版日期2012-2