Both trusting and understanding medical advice: Assessing patient alliance and confusion after medical consultations




Rivers, Alannah Shelby
Sanford, Keith

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Objective: The current objective is to validate the Medical Consultation Experience Questionnaire (MCEQ) and to examine distinctions between constructs of patient perceived alliance and experienced confusion in relation to key health outcomes.

Methods: A total of 857 participants were recruited online across two samples (adults with various medical conditions and with diabetes and/or hypertension specifically).

Results: A confirmatory factor analysis demonstrated good fit and high item loadings for the theoretical bifactor model. Item response theory analyses showed very high individual item discrimination and good test information across a wide range of values. Confusion was uniquely and significantly more strongly related to psychological distress than was alliance; the same was true for alliance with positive affect. Both alliance and confusion significantly contributed to treatment motivation. Only confusion explained unique variance in control of HbA1C levels and blood pressure after controlling for alliance and other variables.

Conclusions: The MCEQ is a valid instrument for assessing distinct constructs of alliance and confusion. Future research should focus on the unique role of confusion for patient outcomes.

Practice implications: By using the MCEQ to assess patient alliance and confusion, it may be possible to detect and prioritize individual patient needs and improve patient outcomes.


Article originally published in Patient Education and Counseling, 103(2), 376–384. English. Published online 2020.


Patient-practitioner alliance, Patient confusion, Assessment, Patient distress, Mental health, Affect, Treatment motivation, HbA1C, Blood pressure


This is the post-print of an article that is available at Recommended citation: Rivers, A. S., & Sanford, K. (2020). Both trusting and understanding medical advice: Assessing patient alliance and confusion after medical consultations. Patient Education and Counseling, 103(2), 376–384. This item has been deposited in accordance with publisher copyright and licensing terms and with the author’s permission.