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Acta Psychologica Sinica    2019, Vol. 51 Issue (10) : 1171-1186     DOI: 10.3724/SP.J.1041.2019.01171
Reports of Empirical Studies |
Effect and underlying mechanism of refutation texts on the trust and moral judgment of patients
LYU Xiaokang1,FU Chunye2(),WANG Xinjian1
1 Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin 300350, China
2 Academy of Psychology and Behavior, Tianjin Normal University, Tianjin 300074, China
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Abstract  

Mistrust between doctors and patients is a worldwide concern, especially in China. Among all possible driving factors, the knowledge gap between the two groups plays a key role in the formation of disparate cognitive styles between professional medical workers and laymen. If patients can be educated effectively and prompted to think like experts, they can become more compliant during medical treatment and more tolerant of unexpected diagnosis or treatment results, thus maintaining their trust in doctors. One possible effective way to make patients think like doctors is to conduct knowledge revision in health and medicine, a method that is counterintuitive to ordinary people but familiar to doctors. This process can be facilitated by the adoption of refutation texts, which state previously acquired but incorrect knowledge and then directly refute the wrong information while providing the correct knowledge.

In the present set of experiments, we systematically examined the effect and underlying mechanism of refutation texts under medical situations. Refutation texts were constructed in the pilot study. The texts consisted of five items that were familiar to doctors but peculiar and interesting to laymen. After asking 103 college students to guess “True” or “False” on each question, correct answers were provided for the participants. Subsequently, they were asked to assess if these answers prompted them to reflect that their previous beliefs were incorrect. At least 97 participants (94.2%) made one error in the test, and 81 participants (78.6%) admitted that this process prompted a reflection on their previous beliefs, a result that proved the effectiveness of refutation texts.

Study 1 was designed to test the effect of refutation texts constructed in the pilot study on patient’s trust and moral judgment on doctors using a 2 (intervention: with or without refutation texts) × 2 (compliance: following doctors’ instruction or not) × 2 (check result: common fever or leukemia) between-subject design. Participants were randomly assigned those eight conditions. First, participants were required to read a scenario of doctor-patient dialogue discussing whether bone marrow puncture (BMP) should be applied to a child. Then, they were required to guess the compliance of the child’s father before they were given the different combinations of the father’s decision and medical results. Participants were required to judge the intention of the doctor’s suggestion of BMP and assess how much trust they have in doctors. Results confirmed the significant effect of refutation texts on the participants’ trust and moral judgment. Participants who were provided refutation texts had higher trust scores and were more likely to judge the doctor’s intention positively and unselfishly compared with those who were not provided such texts. The medical inspection results influenced the participants’ judgment style and trust level. When the inspection showed a minor symptom, participants tended to show lower trust in the doctor and had negative attitude toward the doctor’s suggestion.

Study 2 tested the chain mediating role of intolerance of uncertainty and tolerance on medical workers. The same procedure as in Study 1 was used, except that participants’ scores were collected using the Intolerance of Uncertainty Scale and Tolerance on Medical Worker’s Questionnaire. Data were analyzed by using Process Plugin. Results showed a chain mediation effect on moral judgment but failed to confirm the same effect on trust. Moreover, Study 3 confirmed the effectiveness of refutation texts under non-medical-related situations and the chain mediating role of intolerance of uncertainty and tolerance on medical workers’ trust.

Our findings demonstrated the effectiveness of refutation texts in prompting laymen’s knowledge revision and reflection on their existing health beliefs. This result will improve the tolerance on unexpected treatment consequences and the doctors’ possible misdiagnosis, thus sustaining trust in the doctor. On the basis of our results, we recommend that odd but interesting knowledge of the human body and counter-intuitive medical facts can be employed as routine material in patient education to foster a reflexive attitude on possible unsatisfactory diagnosis or treatment results. Future research may construct more useful refutation text items and further explore the possible hindering effect of previous health beliefs and negative emotions of medical refutation texts.

Keywords refutation texts      doctor-patient relationship      patient’s trust;      moral judgment      tolerance of uncertainty     
ZTFLH:  R395  
  B849: C91  
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Corresponding Authors: Chunye FU     E-mail: chunyefu1919@163.com
Issue Date: 19 August 2019
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LYU Xiaokang
FU Chunye
WANG Xinjian
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LYU Xiaokang,FU Chunye,WANG Xinjian. Effect and underlying mechanism of refutation texts on the trust and moral judgment of patients[J]. Acta Psychologica Sinica, 2019, 51(10): 1171-1186.
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http://journal.psych.ac.cn/xlxb/EN/10.3724/SP.J.1041.2019.01171     OR     http://journal.psych.ac.cn/xlxb/EN/Y2019/V51/I10/1171
类别 条件 n %
错答情况 全部正确 6 5.8
错1题 16 15.5
错2题 20 19.4
错3题 25 24.3
错4题 30 28.6
全部错误 6 5.8
干预有效性自评 非常不同意 2 1.9
不同意 4 3.9
一般 16 15.5
同意 48 46.6
非常同意 33 32.0
  
  
反驳文本 遵医嘱行为 检查结果 n 道德判断(后测) 患方信任
M ± SD M ± SD
实验组 做检查 普通发烧 40 7.63 ± 1.72 44.85 ± 8.01
淋巴细胞白血病 41 8.39 ± 1.26 49.10 ± 5.83
不做检查 普通发烧 36 6.92 ± 1.61 43.17 ± 9.48
淋巴细胞白血病 38 8.82 ± 1.14 47.18 ± 8.06
控制组 做检查 普通发烧 42 5.95 ± 2.32 35.40 ± 10.97
淋巴细胞白血病 38 7.13 ± 1.61 41.05 ± 9.41
不做检查 普通发烧 38 5.21 ± 2.04 34.39 ± 8.31
淋巴细胞白血病 36 7.78 ± 1.40 45.64 ± 8.22
  
  
  
反驳文本 检查结果 n 道德判断得分 患方信任
M ± SD M ± SD
实验组 普通发烧 44 7.20 ± 1.49 41.57 ± 8.72
淋巴细胞白血病 39 8.44 ± 0.88 45.25 ± 7.58
控制组 普通发烧 42 6.62 ± 1.67 40.71 ± 7.26
淋巴细胞白血病 40 7.76 ± 1.25 45.17 ± 8.41
  
变量 不确定性容忍度 (M1) 对医宽容度 (M2) 道德判断 (Y1)
回归系数 SE p 回归系数 SE p 回归系数 SE p
反驳文本(X) 0.76 0.15 < 0.001 0.09 0.15 0.583 0.26 0.17 0.113
不确定性容忍度(M1) 0.37 0.08 < 0.001 0.37 0.09 0.676
对医宽容度(M2) 0.20 0.08 0.018
常量 1.27 0.26 < 0.001 0.10 0.27 0.712 0.35 0.28 0.221
R2 = 0.143 R2 = 0.199 R2 = 0.089
F(2, 162) = 13.50
p < 0.001
F(3, 161) = 13.34
p < 0.001
F(4, 160) = 3.93
p = 0.005
  
  
变量 不确定性容忍度 (M1) 对医宽容度 (M2) 患方信任 (Y2)
回归系数 SE p 回归系数 SE p 回归系数 SE p
反驳文本(X) 0.68 0.23 0.004 0.56 0.20 0.583 0.41 0.21 0.056
不确定性容忍度(M1) 0.41 0.09 < 0.001 0.01 0.10 0.918
对医宽容度(M2) 0.55 0.11 < 0.001
常量 0.09 0.56 0.876 0.37 0.47 0.712 0.61 0.47 0.201
R2 = 0.133 R2 = 0.410 R2 = 0.420
F(2, 80) = 6.15
p = 0.003
F(3, 79) = 18.30
p < 0.001
F(4, 78) = 14.09
p < 0.001
  
  
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