Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust in Their Inpatient Physicians—A Convergent Mixed-Methods Study

Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients’ trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients’ trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants completed the Trust in Physicians Scale (TPS) and the Philadelphia ACE Survey assessing conventional ACEs (cACEs: abuse, neglect, household challenges) and expanded ACEs (eACEs: neighborhood/community adversity). Descriptive statistics characterized the cohort, and multivariable linear regression examined associations between ACE exposure and TPS scores adjusting for demographic covariates. To contextualize quantitative findings, we conducted in-depth semi-structured interviews with 10 patients with high cACEs; transcripts were analyzed using thematic analysis. Results: The mean cACE score was 3.0 (out of 15) and 40.7% reported ≥ 3 ACEs. After adjustment for race, age, gender, and ethnicity, higher cACEs were associated with higher physician trust (β = 0.49, 95% CI [0.01–0.96]; p = 0.04). Qualitative interviews (mean cACE 7.8/15) demonstrated that trauma-informed, relational communication—including listening, transparency, and collaborative decision-making—strengthened trust during hospitalization. Conclusion: Trauma-informed relational care represents an actionable strategy to strengthen patient trust in inpatient physicians among individuals with high ACEs.