Racial Differences In Trust And Regular Source Of Patient Care And The Implications For Prostate Cancer Screening Use

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Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 31 Oct 2009 - 5:00 PDT

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UroToday.com - An article in the online edition of Cancer assesses differences in prostate cancer (CaP) treatment, trust and regular patient care based upon patient race. The North Carolina-Louisiana prostate Cancer Project (PCaP) is a population-based study of men identified shortly after CaP diagnosis. Enrollment began in 2004, however there was a temporary study enrollment lapse in Louisiana due to Hurricane Katrina. A study nurse visited the patients to obtain consent, collect biospecimens and conduct a 749 question structured survey. Following screening guidelines, the participants were limited to men 50 years of age or older. The sample size was 1,031 men (503 African American (AA) and 528 Caucasian).

Trust was assessed as a 100-point index based on a 12-item patient survey instrument. Two independent variables captured systems factors; seeing the same care provider at each visit, a measure of pre-diagnosis care patterns and continuity of care was based upon survey questions as was the patient's usual source of care. Also, health, social and economic characteristics that have been associated previously with care-seeking behaviors, support for care-seeking, and access to care were examined. Co-morbidities, health literacy, and patient-physician communication were also assessed.

Caucasian men with CaP had higher trust scores (62.7) than AA men (58.5) and greater past use of CaP screening of any kind (93.9% vs. 81.4%). Caucasian men saw the same provider at each medical encounter more often that AA men (89.4% vs. 78.5%). At diagnosis, Caucasian men were older, wealthier, more likely to have been married, more likely to have health insurance and reported better patient-physician communication. In multivariable analysis, mean levels of trust by race differed with AA men expressing lower trust than Caucasian men. Communication and greater self-reported mental health and well-being had a positive association with trust, whereas men who were high school graduates or beyond expressed lower trust than less educated men. This was true for men from North Carolina relative to men from Louisiana. Trust was not associated directly with CaP screening, however seeing the same provider, ever having been married, and having any form of health insurance were all associated with prior CaP screening. Low income was negatively associated with CaP screening. Trust was greater for men seeing the same provider at each visit.

Carpenter WR, Godley PA, Clark JA, Talcott JA, Finnegan T, Mishel M, Bensen J, Rayford W, Su LJ, Fontham ET, Mohler JL
Cancer. 2009 Jul 27. (Epub ahead of print)
10.1002/cncr.24539

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