Discrimination and medical trust among breast cancer outpatients in an urban safety net setting.

Abstract

e13726 Background: Discrimination in health care is prevalent and linked to poorer patient-reported experiences, including reduced trust and engagement. In breast oncology, trust is central to longitudinal, preference-sensitive care. Prior work has largely focused on health system distrust or conceptual frameworks, with fewer quantitative assessments of how experienced discrimination relates to trust in the treating clinician in outpatient care. We evaluated the association between perceived discrimination and trust in one’s clinician in a safety-net setting and examined whether patterns differed by age, race, and income. Methods: A cross-sectional survey was administered to 100 English- and Spanish-speaking patients receiving breast cancer care at Boston Medical Center. 98 had complete responses. Perceived discrimination was measured using the Everyday Discrimination Scale. Trust was assessed by the Trust in Physician Scale, measuring perceived fairness, communication, and confidence in care. The association between discrimination and trust was estimated by a linear regression with stratified models by age, race, and income. Results: Among 98 participants (mean age 64.5 years [SD 11.45]), Black (n=39) and White (n=39) patients were equally represented. Fifty patients reported annual income <$40,000 and 35 >$40,000. Most had early-stage disease (stage I: 56.1%; stage II: 32.7%). Overall trust scores were high (mean 4.51/5 (SD 0.67)). Reported discrimination levels were low (mean 1.57/5 (SD 0.61)). Higher discrimination was associated with lower trust (β=−0.33; p<0.001). The inverse association was significant among patients <65 but not ≥65. Associations persisted across income strata. Among Black patients, the association was significant whereas for White patients, the association was borderline (Table 1). Conclusions: Perceived discrimination was associated with lower trust in one’s provider. Subgroup patterns suggest discrimination may be particularly consequential for trust among Black and younger individuals, for whom trust erosion may increase vulnerability to disengagement during complex cancer care. Trust is a modifiable determinant of engagement across multimodality treatment. These findings underscore the importance of addressing discrimination and support equity-focused quality improvement efforts to reduce discrimination and strengthen trust, particularly in groups disproportionately affected. Association of discrimination and trust by subgroups. Participants (n) Association (β) p-value 95% confidence interval Overall 98 -0.33 <0.001* [-0.507, -0.163]* Black 39 -0.66 <0.001* [-0.928, -0.387]* White 39 -0.59 0.05* [-1.190, 0.002] Age <65 49 -0.60 <0.001* [-0.617, -0.193]* Age >65 45 -0.17 0.28 [-0.479, 0.141] Income <$40k 50 -0.37 <0.001* [-0.585, -0.146]* Income >$40k 35 -0.64 0.02** [-1.159, -0.121]*