Trust in Physician Scale
Also known as: TPS, Interpersonal Trust Measure, Patient-Provider Trust Scale
The Trust in Physician Scale (TPS) is an 11-item self-report instrument that measures the degree to which a patient trusts their physician, including dimensions of confidentiality, competence, honesty, and care. Developed by Anderson and Dedrick in 1990, the TPS assesses the patient's confidence that the physician acts in the patient's best interest, respects privacy, possesses the needed expertise, and is truthful. Trust in the physician-patient relationship is foundational to healthcare engagement and is strongly correlated with adherence, disclosure of sensitive information, and health outcomes. The TPS is widely used in research, quality improvement, and studies examining factors that build or erode physician trust.
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When to use it
The TPS is administered to measure the quality of the patient-physician relationship and can be used in various contexts: routine patient satisfaction assessments, quality improvement initiatives focused on therapeutic relationships, research examining factors that influence trust (e.g., communication style, continuity of care, cultural concordance), and studies on the impact of organizational changes (new clinician, EHR implementation, care model redesign) on patient trust.
Strengths & limitations
- Multidimensional trust measurement: captures multiple dimensions (competence, honesty, confidentiality, caring) rather than a single global trust item; provides nuanced understanding of the relationship.
- Validated across populations: extensively tested in diverse patient populations, specialties, and clinical settings; strong psychometric properties.
- Prognostic value: trust scores strongly predict adherence, medication adherence, follow-up appointment attendance, and health behaviors; high trust drives better outcomes.
- Actionable feedback: helps identify specific trust deficits (e.g., 'I don't feel my physician listens to me') that can be targeted for improvement.
- Relationship indicator: serves as an early warning signal of relationship problems; declining trust scores prompt clinical and administrative attention before relationships break down entirely.
- Temporal stability: trust may fluctuate based on recent interactions, treatment outcomes, or life events; a single measurement may not reflect sustained trust.
- Outcome bias: patients whose treatment worked well rate trust higher; those with poor outcomes rate lower, regardless of the physician's actual trustworthiness. Measurement timing and outcome awareness matter.
- Limited to one relationship: TPS measures trust in a specific physician; a patient may highly trust one clinician while distrusting another at the same organization.
- Cultural and individual differences: trust dimensions (e.g., how much caring should be expressed) vary culturally and individually; a single scale may not capture these nuances.
- Not outcome-specific: measures general trust in the physician-patient relationship, not trust in a specific clinical decision or treatment plan.
Frequently asked
What is a good TPS score?
Scores of 40+ (raw 44+) on the 0-100 scale indicate strong trust. National averages are typically 45-55; best-practice clinicians achieve 70-80+. Trust is built gradually; expect modest improvements (2-5 points/year) with consistent positive care experiences. Trust can decline rapidly (5-10 points) after negative incidents, so consistency matters.
Can I use TPS to evaluate individual clinicians for performance review?
Yes, but with care. Individual TPS scores should be part of a multi-source evaluation, not the sole metric. Consider patient case-mix, continuity of care (new vs. established relationships), and recent critical incidents that may artificially depress scores. Combine with clinical outcomes, communication ratings, and peer feedback.
How do I improve low TPS scores?
Investigate which TPS items are lowest (competence, honesty, confidentiality, or caring). Provide targeted interventions: for low competence, ensure adequate expertise or referral; for low honesty, strengthen transparent communication; for confidentiality concerns, clarify privacy policies; for low caring, coaching on empathetic communication.
Should I administer TPS before or after treatment outcomes are known?
Ideally, administer when the relationship is stable and recent outcomes are clear but not so recent as to dominate the response. Administering after treatment success inflates scores; after failure, depresses them. For most conditions, administering 4-8 weeks post-treatment gives fair assessment of trust.
Can declining TPS scores predict patient abandonment?
Declining TPS trends may predict risk of patient-clinician relationship breakdown, particularly if scores drop below 30 (raw <22). Monitor low TPS scores closely and consider relationship repair conversations or, if necessary, supporting patient transition to another provider.
Sources
- Anderson, L. A., & Dedrick, R. F. (1990). Development of the Trust in Physician Scale: A measure to assess interpersonal trust in patient-physician relationships. Psychological Reports, 67(3), 1091-1100. DOI: 10.2466/pr0.1990.67.3f.1091 ↗
- Hall, M. A., Dugan, E., Zheng, B., & Mishra, A. K. (2001). Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Quarterly, 79(4), 613-639. DOI: 10.1111/1468-0009.00223 ↗
How to cite this page
ScholarGate. (2026, June 3). Trust in Physician Scale. ScholarGate. https://scholargate.app/en/patient-centered-care/trust-in-physician-scale
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