Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use

Authors

  • William R. Carpenter PhD,

    Corresponding author
    1. Department of Health Policy and Management, University of North Carolina School of Public Health, Chapel Hill, North Carolina
    2. University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
    3. University of North Carolina Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina
    4. North Carolina Comprehensive Cancer Program, Raleigh, North Carolina
    • Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1102 McGavran-Greenberg Hall, CB 7411, Chapel Hill, NC 27599===

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    • Fax: (919) 966-6961

  • Paul A. Godley MD, PhD,

    1. University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
    2. University of North Carolina Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina
    3. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
    4. Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina
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  • Jack A. Clark PhD,

    1. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Boston University School of Public Health, Boston, Massachusetts
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  • James A. Talcott MD,

    1. Center for Outcomes Research, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
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  • Timothy Finnegan MD,

    1. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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  • Merle Mishel PhD,

    1. University of North Carolina School of Nursing, Chapel Hill, North Carolina
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  • Jeannette Bensen PhD,

    1. University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
    2. Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina
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  • Walter Rayford MD,

    1. Department of Preventive Medicine, University of Tennessee School of Medicine, Memphis, Tennessee
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  • L. Joseph Su PhD,

    1. Louisiana State University Health Science Center, School of Public Health, New Orleans, Louisiana
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  • Elizabeth T. H. Fontham PhD,

    1. Louisiana State University Health Science Center, School of Public Health, New Orleans, Louisiana
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  • James L. Mohler MD

    1. University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
    2. Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York
    3. Department of Urology, University at Buffalo, State University of New York, Buffalo, New York
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  • *This article is a US Government work and, as such, is in the public domain in the United States of America.

Abstract

BACKGROUND:

Nonmedical factors may modify the biological risk of prostate cancer (PCa) and contribute to the differential use of early detection; curative care; and, ultimately, greater racial disparities in PCa mortality. In this study, the authors examined patients' usual source of care, continuity of care, and mistrust of physicians and their association with racial differences in PCa screening.

METHODS:

Study nurses conducted in-home interviews of 1031 African-American men and Caucasian-American men aged ≥50 years in North Carolina and Louisiana within weeks of their PCa diagnosis. Medical records were abstracted, and the data were used to conduct bivariate and multivariate analyses.

RESULTS:

Compared with African Americans, Caucasian Americans exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical encounters, and historically using any PCa screening. Seeing the same physician for regular care was associated with greater trust and screening use. Men who reported their usual source of care as a physician office, hospital clinic, or Veterans Administration facility were more likely to report prior PCa screening than other men. In multivariate regression analysis, seeing the same provider remained associated with prior screening use, whereas both race and trust lost their association with prior screening.

CONCLUSIONS:

The current results indicated that systems factors, including those that differ among different sources of care and those associated with the continuity of care, may provide tangible targets to address disparities in the use of PCa early detection, may attenuate racial differences in PCa screening use, and may contribute to reduced racial disparities in PCa mortality. Cancer 2009. Published 2009 by the American Cancer Society.

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