Medical Racism and Physician Trust Impressions of African-American Breast Cancer Patients Enrolled on the Navigator-Assisted Hypofractionation (NAVAH) Phase I Clinical Trial.

Abstract

Objectives: The historical distrust between the African-American community and the medical system, rooted in systemic racism, continues to affect health care outcomes today. Although Caucasian women have the largest incidence of breast cancer diagnoses, African-American women have the highest mortality rate. Furthermore, studies show African-American women are less likely to receive hypofractionated radiation therapy (RT). The Navigation-Assisted Hypofractionation (NAVAH) program was designed to identify the barriers preventing equal access to adjuvant hypofractionated RT while also addressing the inequities by utilizing patient navigation services to improve breast cancer survivorship in African-American women. This study explored patients' perceptions of racism in medicine, offering new insights into this critical, yet understudied aspect of health care disparities.

Methods: This is a prospective study of African-American breast cancer patients enrolled in the ongoing NAVAH phase I clinical trial. Following consent to receive RT, pretreatment surveys were administered. Surveys assessed participants' distrust of medical professionals and if care was impacted as a result. Each patient answered a series of questions with responses on a scale from strongly agree to strongly disagree. The significance of patients' views on medical racism and physician trust was evaluated using the Kendall tau correlation. A P-value of ≤0.05 was considered statistically significant.

Results: The Kendall tau test was used to analyze the data accounting for the possible nonlinear, monotonic nature of the data. Patients believing harmful events have taken place at medical centers were significantly less likely to trust doctors (P=0.03). Of the remaining sets of questions assessed, only the correlation between the belief that African-Americans receive the same care as other patients and the likelihood of following hospital-given advice approached statistical significance (P=0.055).

Lessons: Patients' perception of treatment within the medical system can greatly impact their decision to seek care and adhere to treatment, which in return can have a substantial impact on oncologic outcomes. Our findings indicate that patient trust in physicians is significantly impacted by patient perceptions of the likelihood of harmful event occurrence at medical centers, with the correlation of perceived medical racism and obeying hospital-given advice trending towards significance.

Trial registration: ClinicalTrials.gov NCT05978232.