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Racial Differences in Trust and Lung Cancer Patients' Perceptions of Physician Communication

From the Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Internal Medicine, Baylor College of Medicine, Houston; and Department of Communication, Texas A&M University, College Station, TX

Address reprint requests to Howard S. Gordon, MD, Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Blvd, Houston, TX 77030; e-mail: hgordon{at}bcm.tmc.edu

PURPOSE: Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment.

PATIENTS AND METHODS: Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients' perceptions of the quality of the physicians' communication and were used to assess patients' previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale.

RESULTS: Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P = .80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P = .02). Black patients, compared with white patients, judged the physicians' communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients' perceptions of physicians' communication were statistically significant (P < .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P > .05) predictors.

CONCLUSION: Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients' lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication.

Supported in part by Career Development Awards (H.S.G. and P.A.K.), from the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs and by Grant No. P01 HS10876 from the Agency for Healthcare Research and Quality.

Presented in part at the 23rd Annual Meeting of the Veterans Affairs Health Services Research and Development, Baltimore, MD, February 17, 2005; and the 28th Annual Meeting of the Society of General Internal Medicine, New Orleans, LA, May 11-14, 2005.

At the time this work was conducted, H.S.G., P.A.K., and J.S. were employed at the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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