April 24, 2006

Racial Disparities in Medicine: A Matter of Trust?
Penn Researcher Finds African-Americans Trust Health Care Providers Less than Whites

(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.

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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.

This release is available online at http://www.uphs.upenn.edu/news/News_Releases/apr06/racedisp.htm