Factors affecting patients’ trust in physicians in the cases of prescribing invasive interventions among musculoskeletal patients referring to clinics in Shiraz, 2023: a discrete choice experiment

Trust is an essential component of the physician-patient relationship, influencing treatment compliance and satisfaction. Lack of trust, particularly in surgical prescriptions, can lead to more visits, lower treatment quality, and higher healthcare costs. This study aimed to identify the attributes influencing musculoskeletal patients' trust in surgeons. In the current study the discrete choice experiment (DCE) was administered to 400 musculoskeletal patients. Attributes were identified through a literature review and 28 patient interviews, and a fractional factorial design (D-efficient) produced eight choice sets. Participants completed eight binary choice tasks; data were analyzed using conditional logit choice models (Stata 17), overall and by subgroups. Reputation of the physician (OR = 3.363) compared to not being famous, male physician (OR = 1.307), performing surgery by the physician themselves (OR = 1.366) compared to performing surgery probably by a physician, appropriate communication (OR = 1.212), recommended by friends/relatives (OR = 3.137), and recommendation by other physicians (OR = 2.099) compared to not recommended, were significantly related to patient trust in physicians (P-value < 0.05). Men (OR = 3.597) have more trust in famous physicians than women (OR = 3.141). Trust is higher in all age groups, especially in those over 51 (OR = 4.197). Rural residents value a physician's reputation more (OR = 6.110) than urban residents (OR = 3.256). The results indicated that several attributes are involved in patients' trust. In general, the reputation of the physician, male physician, performing the surgery by the physician themselves, establishing proper communication with the patient, and recommendations by friends/relatives and other physicians were strongly associated with on patients' trust in the surgeon prescription.