In primary care settings, a patient’s trust is more strongly associated with improved health than other characteristics of the patient-provider relationship.  Trust affects patient satisfaction with health care services, willingness to disclose sensitive information, adherence to treatment, and continuity with that health care provider.  Trust among adolescent patients is formed for different characteristics than adults.  Among adults, trust is based on perceived caring, competence, and communication skills of the professional treating them.  Distrust that confidentiality will be broken is a barrier to health care use and compliance among adolescents. 

In this study, 54 adolescents were divided into focus groups (ages 11-14, and 15-19 years).  Approximately half of the study population had an underlying chronic illness (cystic fibrosis, inflammatory bowel disease, juvenile rheumatoid arthritis, or sickle-cell anemia).  The others were healthy.  Among the many topics of exploration, trust of their doctor was discussed.  Transcripts of the focus groups were analyzed using software that searched for comments relating to trust. 

The study found that adolescents hold varied perspectives of trust.  Younger adolescents express most concern about confidentiality of their health information.  Adolescents with chronic illnesses are more interested in involving parents in their care than adolescents without a chronic illness.  Examples of specific health care provider behaviors to improve trust include asking for an adolescent’s opinion, keeping private information confidential, not withholding information, and engaging in small talk to show concern. 

(Klostermann BK et al.  J Family Practice 2005. 54(8):679-687.)

Comment:  School nurses can find themselves in difficult situations, with regards to trust.  District policies may require them to report sensitive health-related information to school administrators (e.g., pregnancy, drug possession).  Such disclosure may not only diminish the trust of the affected student for a reporting school nurse.  It may affect this student’s and his/her colleagues’ trust of other health professionals for many years.  I’ve often recommended that school nurses regard (and record) adolescent reports of pregnancy or drug use as “alleged” facts, as opposed to certainties.  As “alleged” facts, the school nurse can arrange to transfer the adolescent’s care to appropriate health care providers and agencies without necessarily having to report them to school administrators (and avoid breaking any rules).     -- H.T.