A Review of Medical Mistrust Across the Cancer Continuum of Care and Current Interventions.

Abstract

Cancer disparities among populations in the United States are a persistent and ongoing challenge. Medical mistrust (MM), or the tendency to distrust individuals and systems even at the cost of one's own well-being, has been implicated in contributing to worse health outcomes. Thus, understanding the relationship between MM and cancer care disparities may inform effective interventions to improve outcomes for all. We conducted a two-step review: (1) a standard review to examine the relationship between MM and the cancer continuum of care, and (2) a systematic review to assess interventions targeted to mitigate MM in cancer care. The standard review included eleven studies, which revealed that MM impacted cancer screening, treatment adherence, clinical trial participation, and access to social support. Key mediators of MM included patient-provider discordance, health-related and sociodemographic-related discrimination, perceptions of Western medicine, low quality care, and health insurance. Our systematic review yielded twelve interventions-67% tailored towards screening, 17% towards patient navigation services, and 17% towards clinical trial participation. Key methods included adapting patient-centered (e.g. gathering patient perspectives, increasing racial and ethnic representation) and community-based approaches (e.g. use of churches and training family members to disseminate patient education) to overall create culturally tailored interventions against MM across the cancer continuum of care.