The Arnold P. Gold Foundation defines humanism as “clinically excellent care that is kind, safe, and trustworthy.” In this Research Roundup we will explore the role and importance of trust, which Gold President and CEO Dr. Kathleen Reeves describes as being “at the heart of the best care and is what is most missing in today’s healthcare environment.”
At this year’s Gold Standard Gala, Gold Co-Founder Dr. Sandra Gold shared how her husband, Arnold, heavily relied on “his skills of listening, of kindness, of building trust.” I am taking inspiration from the verb “building” in front of “trust” because it highlights that trust is not automatically given — it must be earned through demonstrating trustworthiness.
Too often in healthcare we hear complaints about patients’ lack of trust in the system. While likely not intended, this lament can sometimes sound nostalgic for the paternalistic era epitomized by 1960s prime-time protagonist Dr. Kildare’s attitude of “the patient has refused this operation but I take full responsibility.”
Instead, the responsibility doctors have is to “build trust” with patients. Highlighted below are four recent articles focused on this task (a later Roundup will take on the question of trust related to AI in medicine). The hope is that readers will come away with a better understanding of the value of the linguistic shift from trust to trustworthy and with a few ideas and tools for how they can better follow in Dr. Arnold P. Gold’s footsteps and build trust.
In case you missed it, please check out the Jeffrey Silver Humanism in Healthcare Research Roundup: A Focus on Kindness and be on the lookout for the next Research Roundup in September, which will explore the nuanced role of safety in humanism.
This first article presents a scoping review led by Dr. Natalie Strokes, a 2012-2013 Medical Student Blogger for the Gold Foundation and a Gold Humanism Honor Society (GHHS) member who graduated from the A.T. Still University’s School of Osteopathic Medicine in Arizona.
Can shared decision-making interventions increase trust/trustworthiness in the physician-patient encounter? A scoping review. Strokes, N., Lloyd, C., Girardin, A. L., Santana, C. S., Mangus, C. W., Mitchell, K.E., Hughes, A.R., Nelson, B. B., Gunn, B. & Schoenfeld, E. M. (2025). Patient Education and Counseling, 108705. Access the article.
What: This scoping review begins with the working hypothesis that patient trust depends on clinician trustworthiness, specifically examining shared decision making (SDM) as a tool healthcare professionals could use to build trust. Inclusion criteria required: SDM focus, intervention/control arms, and trust as an outcome. Among 20 included studies, none had trust as a primary outcome, but eight showed statistically significant trust increases while 12 showed no effect.
So What: Breaking down studies by intervention target reveals key implications. In the 8 studies showing increased trust, common interventions were clinician language manipulation and SDM training, targeting clinician alone (4 studies), both clinician and patient (3 studies), and patient alone (1 study). In contrast, the 12 studies showing no effect used clinician language manipulation and patient decision-aids, targeting both clinician and patient (6 studies), patient alone (5 studies), and clinician alone (1 study). Key takeaway: Interventions targeting clinicians alone had the highest success rate (4 of 5 studies), while patient-only interventions were least effective (1 of 6 studies).
Now What: This scoping review finds that over a decade of studies have demonstrated that higher trust correlates with better health outcomes, increased healthy behaviors, and higher quality of life. Evidence-based practice should therefore mandate greater attention to trust-building. For researchers, the review highlights trust’s problematic peripheralization rather than centering it as a primary outcome and the need for higher-powered studies to explore SDM’s impact on populations frequently exposed to less trustworthy care. For doctors, this review should prompt reorientation toward actively building patient trust as a clinical priority.
This next paper is a short commentary calling on doctors to do just this sort of reorientation toward a focus more on trustworthiness.
Restoring trust with a humanistic touch. Bonk, R. J. (2024). Journal of Communication in Healthcare, 17(4): 314-316. Access the article.
What: This commentary discusses ways that educators can teach with a humanistic touch by exposing students to the humanity of their fellow humans via poetry, film, and narrative ethics — all interventions that give clinicians critical listening skills — a foundation for trust-building.
So What: This commentary is part of the Journal of Communication in Healthcare’s Science of Trust Initiative and centers trust as “inherent in the reciprocity of the social contract defining professional roles in society.” Dr. Bonk makes his case to medical educators that students need to be given time and space to “see and dream” with their classmates beyond the scientific centrality of the medical encounter.
Now What: Dr. Bonk asks readers to refresh their perspective to include more humanism and trust-building time into medical education so that future doctors will be perceived as more fully caring and dedicated to the needs of patients and families.
Next, we have a study out of Portugal that breaks down mediators of patient confidence and trust in one hospital setting.
The role of confidence/trust in the emergency department. Abidova, A., Silva, P. A. D., & Moreira, S. (2025). BMC Research Notes, 18(1): 1-7. Access the free article.
What: Emergency Departments (EDs) are among the busiest and most stressful healthcare environments — for both doctors and patients. This study explored the main determinants of patient confidence and trust in this setting. Using data from 382 patients at a Portuguese hospital, researchers examined how various factors influence trust through two key mediators: patient satisfaction and perceived quality of healthcare (PQHC). The study found that through satisfaction, factors like doctor performance, perceived triage waiting times, information about delays, and meeting expectations explained 61-66% of variance in ED trust. Through PQHC, factors including privacy, doctor performance, accessibility, post-examination waiting times, and meeting expectations explained 63-65% of variance in trust levels.
So What: This research reinforces the importance of humanism in medicine through the finding that patient trust in EDs depends heavily on communication, expectations management, and perceived quality of care — three areas where doctors’ communication and behavior play a critical role.
Now What: For educators, this study supports the need to train future healthcare professionals in communication skills and expectation management, not just clinical competencies. Researchers could explore cross-cultural differences in trust mediators and test targeted interventions. Healthcare administrators can support trust building as well through implementing systems for better patient information sharing.
Finally, because the work of building trust should never fall on single individuals, this last article addresses the important role of healthcare institutions in this endeavor.
Health Systems Must Take Action To Achieve Trustworthiness. Hendricks-Sturrup, R. (2025). Health Affairs. Access the free article.
What: This article describes a process of examining existing research to identify real and potential actions related to health system trustworthiness. Findings were shared with a focus group of patients, patient caregivers and advocates, clinicians, and administrative professionals. From this process, five categories of actions emerged that health systems can use to increase their trustworthiness.
So What: The bulk of this article is describing and providing concrete examples under five key action items: 1) Implement Or Generate Evidence At The Point Of Care, 2) Address And Correct Power Dynamics That Do Not Put Patients First, 3) Protect And Value Transparency And Patient Data Discretion And Representation, 4) Integrate Community-Level Support Into Care, and 5) Address Complexities That May Reduce Or Restrict Access To Care.
Now What: The article ends with an explicit call to action for health systems to assess and share their readiness to implement trustworthy actions via an implementation tool that offers immediate, near future, and longer–term recommended strategic actions. The hope is that health systems can use the tool as a guide for uniting all stakeholders’ complementary goals in trustworthy systems of health.
If you have come to the end of this Roundup and want to learn more about the Gold Foundation’s work on building trust, please explore the Medallia Gold Humanism Trust Tool. We would love to hear from you if you have used this tool in your teaching, practice, or research.
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