(Philadelphia – PA) A national survey the
Abramson Cancer Center of the University of Pennsylvania
shows that African-Americans may have lower levels of trust in physicians,
nurses, and other health care providers than whites, especially
if they regularly receive care in a facility other than a physician’s
office. This reduced level of trust may account for continued disparities
in health care outcomes for African-Americans – even when
all other socio-economic factors, including access to care –
are equal, suggest the authors. The results are being published
in the April 24th issue of Archives of Internal Medicine.
According to the article, physicians and researchers are increasingly
recognizing the importance of trust in medical care. “Trust
has been described as an expectation that medical care providers
(physicians, nurses and others) will act in ways that demonstrate
the patient’s interests are a priority,” the authors
write. Many factors contribute to a patient’s trust level,
including perceptions of the provider’s medical and interpersonal
skills. Patients with low trust in their providers may be less likely
to comply with treatment, receive recommended screening exams, or
develop long-term, quality relationships with their physicians.
Chanita Hughes Halbert, PhD, Assistant Professor
of Psychology in Psychiatry at the University of Pennsylvania
School of Medicine, and colleagues from Penn’s Abramson
Cancer Center and Annenberg School for Communication evaluated responses
from a national survey of 954 adults, including 432 African-Americans
and 522 Caucasians. Researchers conducted telephone interviews to
solicit participants’ responses to 46 items that assessed
their socio-demographic characteristics, prior health care experiences,
where they usually receive health care, and whether their provider’s
racial background matched their own. Trust in health care providers
was rated on a scale of one to four, with “one” indicating
that the participant could trust providers to do what is best for
patients almost all of the time, and “four” almost none
of the time. “Low trust” was defined as a rating of
“three or four.”
Low levels of trust were reported by 44.7 percent of blacks and
33.5 percent of whites. Although fewer quality interactions with
providers predicted low trust among all participants, other factors
that influenced trust appeared different between blacks and whites.
African-Americans who usually received medical care at facilities
other than physicians’ offices were most likely to report
low trust; while among whites, lack of health insurance, fewer annual
health care visits, and gender were more likely to predict low trust,
with women more likely to have low trust than men.
Understanding the factors that influence trust in different patient
communities could help physicians take steps to enhance trust and
thereby improve medical care, the authors conclude. “Training
designed to improve provider communication with patients may be
needed to improve trust for African-Americans and whites,”
they write. “However, it may be especially important to direct
these efforts to health care providers practicing in settings where
continuity with patients may be limited to improve trust among African-Americans.
In addition, greater access to health care settings – e.g.
physicians’ offices - where more effective relationships with
providers can be developed may also improve trust in health care
providers among African-Americans.”
This study was funded by a grant from the National Cancer Institute.
The Abramson Cancer Center of the University of Pennsylvania
was established in 1973 as a center of excellence in cancer
research, patient care, education and outreach. It is one of a select
group of only 39 NCI-designated Comprehensive Cancer Centers in
the United States and is one of the top five in National Cancer
Institute (NCI) funding. Home to one of the largest clinical and
research programs in the world, the Abramson Cancer Center of the
University of Pennsylvania has 300 active cancer researchers and
300 full-time Penn physicians involved in cancer prevention, diagnosis
and treatment. For more information about specific types of cancer,
cancer treatment, clinical trials, and research advances, visit
the Abramson Cancer Center’s resource on www.penncancer.org
or OncoLink at www.oncolink.org.
PENN Medicine is a $2.9 billion enterprise
dedicated to the related missions of medical education, biomedical
research, and high-quality patient care. PENN Medicine consists
of the University of Pennsylvania School of Medicine (founded in
1765 as the nation's first medical school) and the University of
Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt
of NIH research funds; and ranked #3 in the nation in U.S.News &
World Report's most recent ranking of top research-oriented medical
schools. Supporting 1,400 fulltime faculty and 700 students, the
School of Medicine is recognized worldwide for its superior education
and training of the next generation of physician-scientists and
leaders of academic medicine.
The University of Pennsylvania Health System includes three
hospitals [Hospital of the University of Pennsylvania, which is
consistently ranked one of the nation's few "Honor Roll"
hospitals by U.S.News & World Report; Pennsylvania Hospital,
the nation's first hospital; and Penn Presbyterian Medical Center];
a faculty practice plan; a primary-care provider network; two multispecialty
satellite facilities; and home care and hospice.