Strategies to Build Trust
Trust, the critical factor… Perception Participant Multi-disciplinary Oncology Team Navigator Clinical Trial Health Care System 2
Trust
Community Family Provider Treatment Cancer Center Palliative Care
Presentation Objectives Understand the important concepts of building and maintaining a trusting relationship:
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Explore strategies for establishing and building trust:
Levels of Trust
Psychological Contract The Pinch Model
Troubleshooting when trust is compromised.
Rebuilding trust when it is lost.
Trust “Trust is a peculiar resource: it is built rather than depleted with use.”
Assured reliance on the character, ability, strength, or truth of someone or something.
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One in whom confidence is placed.
www.beyondintractability.org/bi-essay/trust-building
Why is Trust Important? Trust is the primary lens through which minority participants make decisions to:
Enroll in, complete or leave a trial.
Recommend clinical trials participation to friends and family.
Share their cancer center experience with community and providers
Focus on building levels of trust through a process of establishing, maintaining and restoring trust with minorities in clinical trials. 5
Constructs of Trust in Minority Recruitment
TRUST
Capacity to Trust
Perception of Competence
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Perception of Intentions
http://www.benjaminkoh.com/GigabitCon.html Graphic - Tway DC: A Construct of Trust 1993
Types of Trust
Calculus Based Trust
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Identification Based
Calculus Based Trust • Participant calculates the probability of a trustee’s behavior in a given situation depending upon the rewards for being trustworthy and penalties for being untrustworthy. • Cost-benefit analysis. • Driven by assessment of the trustees predictability and reliability.
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Identification Based Trust • Each person has internalized the others’ desires and intentions to the point where each can act as an agent for the other. • Shared goals and values.
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How Are They Built? Calculus Based Trust
Identification Based Trust
Perform competently
Establish a common identity
Establish consistency and predictability
Capitalize on co-location
Communicate accurately, openly and communicatively
Create and achieve joint goals
Share and delegate control
Promote shared values
Show care and concern for others
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Presentation Objectives Understand the important concepts of building and maintaining a trusting relationship:
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Explore strategies for establishing and building trust:
Levels of Trust
Psychological Contract The Pinch Model
Troubleshooting when trust is compromised.
Rebuilding trust when it is lost.
The Psychological Contract
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Informal agreement
Beliefs, shaped around an agreement for a balanced exchange between people and perception of a promise of future return for their contributions thus obligating them to contribute.
Process begins at first encounter with participant
Characteristics: respect, compassion, trust, empathy, fairness objectivity.
How Do You Develop a Psychological Contract with Participants? Shared ownership of the clinical trial.
Participants should be encouraged to articulate specific, realistic, and concrete expectations. 13
Ask yourself and each other…
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What specific goals do we each have for participating in this trial?
How do you want to relate to the clinical team... each other?
Who will be responsible for making sure that your goals are met?
What aspects of our relationship will need greater emphasis?
Psychological Contract Pitfalls Recognize and remember these pitfalls
Promises mean different things in different cultures. 15
Certain aspects of negotiation may differ.
Group identity Common cultural or ethnic background.
Strengthening your Psychological Contract People’s expectations are not necessarily your own. Continually identify and share your mutual expectations. Recognize that the contract is always being altered for better or for worse. 16
The Pinch Model A Tool to Strengthen the Psychological Contract with Participants Renegotiation under duress Resentful Termination
Gathering Data, Sharing, and Clarifying Expectation
Planned Termination
Role clarity and commitment phase Return to the way things were Period of Stability, Productivity, Confidence
Crunch
Pinch
Resentment and Anxiety Doubts and Uncertainty 17
Disruption of Shared Expectation
Modified Pinch Model from Sherwood and Glidewell, 1972; John Schere, 1995. www.SchereCenter.com
Planned Renegotiation
What are the different levels of trust? LOYALTY RELATIONSHIP TRANSACTIONAL SITUATIONAL 18
Situational Trust Engage in two way discussion of how your services can best meet their needs by: • Gaining the participant’s undivided attention • Eliminating or minimizing reflex rejection • Converting the encounter from a monologue to a dialogue
Exchange of information! LOYALTY RELATIONSHIP
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MS. LEWIS’ STORY
TRANSACTIONAL SITUATIONAL
Transactional Trust Engage the participant in a mutually beneficial way to strengthen your psychological contract
“I trust you enough to see what you can do for me.”
SKEPTICAL LOYALTY RELATIONSHIP TRANSACTIONAL 20
SITUATIONAL
MS. LEWIS’ STORY
TRUSTING
Relationship Trust A participant values your perspective and advice after a series of successful encounters • Reasons relationship trust may not be realized are: – Inconsistent service – Willingness to compromise on the process of building trust – Lack of patience and knowledge of how to develop a win-win approach LOYALTY RELATIONSHIP
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MS. LEWIS’ STORY
TRANSACTIONAL SITUATIONAL
Loyalty • Participant sees you and your services as absolutely indispensable to their long term success. • Strongest relationship bond. • Long term perspective.
LOYALTY RELATIONSHIP TRANSACTIONAL 22
SITUATIONAL
MS. LEWIS’ STORY
Personal Strategies to Build Trust Establish Your Credentials
Look for Common Ground – Find out in advance what they are interested in so you can have a conversation. – Be aware of common friends or colleagues. 23
http://frogpond.com/How-To-Build-Trust-And-Rapport-Quickly-FP1-jboe33
Personal Strategies to Build Trust Understand Body Language
Adjust facial expression and posture to accommodate those of the participant. (Do they sit up? Slouch? Cross their legs?) 24
Be aware that body language expression differs among cultures. (Eye contact, tone, posture in relation to authority)
Personal Strategies to Build Trust Use Active Listening Skills
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Critical in creating shared ownership and facilitating the process of promoting shared decision making in clinical trials.
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Ex. listen, avoid interruptions, use similar speech patterns (including volume, tempo and overall energy), humor and vocabulary.
Presentation Objectives Understand the important concepts of building and maintaining a trusting relationship:
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Explore strategies for establishing and building trust:
Levels of Trust
Psychological Contract The Pinch Model
Troubleshooting when trust is compromised.
Rebuilding trust when it is lost.
When Trust is Lost… Violated expectations – confident expectations of the truster are not met by the person they are trusting Common signs: • Emotional reaction (anger, disappointment) • Frustration • Blaming
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When Trust is Lost… Determinants of response to trust violation
Extent of violation
Magnitude of the offense
Number of prior violations 28
Presentation Objectives Understand the important concepts of building and maintaining a trusting relationship:
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Explore strategies for establishing and building trust:
Levels of Trust
Psychological Contract The Pinch Model
Troubleshooting when trust is compromised.
Rebuilding trust when it is lost.
Personal Strategies to Rebuild Trust • Act immediately after the violation. • Apologize and give a thorough accounting of what happened. • Be cognizant of the daily history of the relationship. • Provide restitution and penance. • Reinstate and renegotiate the psychological contract of the future. • Be trustworthy in future interactions. 30
Personal Strategies to Rebuild Trust To rebuild an established trust relationship: • Reaffirm commitment to the relationship. • Re-establish the emotional connection. • Make clear sacrifices to establish the importance of the relationship over your own self interests.
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Obstacles to Rebuilding Trust Both parties have shared ownership for rebuilding lost trust. Obstacles: • Not aware of the other person’s reactions. • Not able to understand the consequences of violating trust. • Doesn’t know how to take corrective action. • Ego or self-esteem threatened. • Legal implications. 32
Activity: Rebuilding Trust • Think about a situation in which trust was lost between you and a minority participant or potential participant.
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What were the warning signs?
How did they respond?
How did you respond?
What would you do differently?
Parting thoughts… Thank you for viewing and participating in this module. We hope that the information, strategies and techniques that we have shared will be useful to you and your cancer center as you enhance minority participation in clinical trials.
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