Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust in Their Inpatient Physicians—A Convergent Mixed-Methods Study

Marlise Jeanne Pierre-Wright, Northwestern University, Feinberg School of Medicine, Department of Medicine (Division of General Internal Medicine)Follow
Ibrahim Badreldin Mokhtar, Northwestern University, Feinberg School of Medicine
Uma Thachapuzha, Northwestern University, Feinberg School of Medicine
Yashoswini Chakraborty, Northwestern University
Revika Singh, Northwestern University, Feinberg School of Medicine AND New York University—Grossman School of Medicine
Rachel O'Conor, Northwestern University, Feinberg School of Medicine, Department of Medicine (Division of General Internal Medicine)
Jing Song, Northwestern University
Julia Lee, Northwestern University
Maria E. Theodorou, Northwestern University, Department of Medicine (Division of Hospital Medicine)
Christine Schaeffer, Northwestern University, Feinberg School of Medicine, Department of Medicine (Division of General Internal Medicine)
Kimberly Collins, Northwestern University, Feinberg School of Medicine
Muriel Jean-Jacques, Northwestern University, Feinberg School of Medicine, Department of Medicine (Division of General Internal Medicine) AND University of Illinois-Chicago, Division of Academic Internal Medicine and Geriatrics

ORCID

Marlise Jeanne Pierre-Wright: https://orcid.org/0000-0002-6904-1121

Ibrahim Badreldin Mokhtar: https://orcid.org/0009-0001-5832-6156

Uma Thachapuzha: https://orcid.org/0009-0008-8107-0479

Yashoswini Chakraborty: https://orcid.org/0009-0000-8917-6691

Revika Singh: https://orcid.org/0000-0001-6826-3649

Rachel O'Conor: https://orcid.org/0000-0001-5104-9531

Maria E. Theodorou: https://orcid.org/0000-0002-8923-7068

Christine Schaeffer: https://orcid.org/0009-0002-0761-6329

Muriel Jean-Jacques: https://orcid.org/0000-0002-2897-4187

Abstract

Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants completed the Trust in Physicians Scale (TPS) and the Philadelphia ACE Survey assessing conventional ACEs (cACEs: abuse, neglect, household challenges) and expanded ACEs (eACEs: neighborhood/community adversity). Descriptive statistics characterized the cohort, and multivariable linear regression examined associations between ACE exposure and TPS scores adjusting for demographic covariates. To contextualize quantitative findings, we conducted in-depth semi-structured interviews with 10 patients with high cACEs; transcripts were analyzed using thematic analysis. Results: The mean cACE score was 3.0 (out of 15) and 40.7% reported ≥ 3 ACEs. After adjustment for race, age, gender, and ethnicity, higher cACEs were associated with higher physician trust (β = 0.49, 95% CI [0.01–0.96]; p = 0.04). Qualitative interviews (mean cACE 7.8/15) demonstrated that trauma-informed, relational communication—including listening, transparency, and collaborative decision-making—strengthened trust during hospitalization. Conclusion: Trauma-informed relational care represents an actionable strategy to strengthen patient trust in inpatient physicians among individuals with high ACEs.

Recommended Citation

Pierre-Wright M, Mokhtar I, Thachapuzha U, Chakraborty Y, Singh R, O'Conor R, Song J, Lee J, Theodorou M, Schaeffer C, Collins K, Jean-Jacques M. Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust in Their Inpatient Physicians—A Convergent Mixed-Methods Study. Patient Experience Journal. ; 13(2):120-130. doi: 10.35680/2372-0247.2117.