While trust in the provider may initially begin as confidence
in the institution and its representatives (de Raeve 2002),
healthcare providers should not assume the idea that being
part of a trustworthy profession implies patient trust. Trust
in the patient–provider relationship is fragile due to the
power inequity between the patient and the provider
(Delmar 2012). Unfortunately, healthcare relationships have
been polluted by failures to protect vulnerable patients
(Sellman 2007). Most notably, the IOM (1999) report, To
Err is Human: Building a Safer Health System, brought
distrust of the USA healthcare system to the forefront. In
addition, external threats to trust in the patient–provider
relationship have been imposed by organizational and
fiduciary constraints in the healthcare system (Kao et al.
1998). Consequently, mistrust in the healthcare system has
been associated with underuse of health services (LaVeist
et al. 2009). Thom et al. (2004) proposed that lack of trust
in the provider may reduce treatment adherence, inhibit
seeking needed care and increase healthcare costs (Thom
et al. 2004). Globally, attention to trust in the patient–provider
relationship has increased; a recent systematic mapping
review of trust in the healthcare provider–patient
relationship identified that although most of studies (44%)
were conducted in the United States (US), 20% were carried
out in ‘other’ European countries with smaller percentages from other countries