Medical racism and physician trust impressions of African-American breast cancer patients enrolled on the navigator-assisted hypofractionation (NAVAH) phase I clinical trial.

Abstract

e13731 Background: The historical distrust between the African-American community and the medical system, rooted in systemic racism, continues to affect healthcare outcomes today. Although Caucasian women have the largest incidence in 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 healthcare disparities. Methods: This is a prospective study of African-American breast cancer patients enrolled in the ongoing NAVAH Phase I clinical trial (clinicaltrials.gov, NCT05978232). Following consent to receive RT, pre-treatment 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 Kendall's Tau Correlation to assess the possibly nonlinear, monotonic correlation with limited sample size. A p-value of ≤ 0.05 was considered statistically significant. Results: A series of questions were asked of the first 36 clinical trial participants. Six sets of questions were analyzed to explore the relationships between responses. 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 likelihood of following hospital-given advice approached statistical significance (p = 0.055). Conclusions: 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. These findings highlight the importance of NAVAH in addressing historical and systemic inequities to strengthen patient-physician relationships and improve breast cancer outcomes. Clinical trial information: NCT05978232 .