Patient-perceptions of, emotional responses to, and disengagement from, physician-services for HIV: The relationship of trust and the mental and social effects of HIV to perceived service-adequacy

Abstract An exploratory, two-language, online survey assessed patients in relation to physician-services for HIV-infection. Most respondents had experienced primarily mental rather than physical illness due to HIV or its treatment, as well as a marked HIV-related impact on social networks. Mental and social factors were identified that predicted patients’ relationship to, and disengagement from, physicians’ services, including patients’ satisfaction, trust, physicians’ relational skills, time-pressure, the opportunity for clinical intimacy, physician-credibility; ‘heart-sink’ physicians, anxiety, passivity, self-efficacy, experience of HIV-related illness, experience of medication-toxicity, degree of loss in social networks, and ‘changing physician due to disagreement’, with ramifications for physicians’ concept of the ‘difficult patient’. The prevalence and significance of such issues and the related risk of distrust of, and disengagement from, physician-services confirm the still-remaining need for evidence-based treatment to be implemented for people with HIV, to include the delivery of integrated, multi-professional, and biopsychosocial health-services. What do we know already about this topic? Mental and social aspects of illness affect services’ ability to help patients to get well and stay well (i.e., health-effectiveness), but since the advent of HAART few clinics provide integrated, biopsychosocial services necessary to address these issues, despite the extensive evidence-base demonstrating such need. How does this research contribute to the field? This research: confirms the significance of biopsychosocial aspects of illness and identifies pervasive factors that intensify such challenges to the provision of health-effective services—and which can act as signal-events in quality-related service-audit—as well as analysing other factors, such as patients’ satisfaction, that have no value except to consumerism but relate to other variables, such as trust, that need to be used in service-evaluation. What are the implications of this research for theory, practice, or policy? The implications of this research are that each services needs a competent, multi-professional team to address the biopsychosocial factors identified, and to integrate the factors into the audit of services’ health-effectiveness, supported by specific policy such as treatment-guidelines that require the evidence-based formulation and delivery of health-services, not solely pharmaceuticals of choice.