Background: Although patient outcomes for esophageal cancer have improved, there remains a reduced survivorship among African Americans compared to Caucasians, possibly due to lower use of surgery in African Americans. While various factors contribute to this disparity, we noted a decreased referral of African American patients to thoracic surgeons in our institution. We hypothesized that interviews with medical providers would provide the reasons behind the barriers that hinder the ability of minority patients to receive optimal care for esophageal cancer.
Methods: Providers (n=20) in the Detroit Metro area that treat African Americans with esophageal cancer participated in 30-minute semi-structured interviews to elicit their perspectives regarding barriers and facilitators in their care for this population. The interview inquired into the challenges faced and techniques employed by providers in establishing trust within this population. Interviewed providers included thoracic surgeons, medical oncologists, gastroenterologists, and radiation oncologists.
Results: Most providers suggested that socioeconomic status, not race, was the primary barrier to accessing adequate cancer care. Within the African American population, 80% of providers reported that mistrust was not an issue in their personal experiences in treating minorities with esophageal cancer, but 95% of providers cited mistrust in the medical system as a contributing factor to unfavorable outcomes. Providers who indicated mistrust in the medical system referred to historical instances that may deter African American patients from trusting the medical system. Many also cited techniques for establishing trust including honesty and patient empowerment. Finally, 3 of 20 respondents referred to direct experiences where patient refusal to participate in clinical trials may have contributed to poorer outcomes.
Conclusions: Medical providers believe that mistrust in the medical system is a key barrier for African American patients with esophageal cancer to receive optimal care. Further investigation to elicit patient perspectives should be explored through direct patient surveys. Particular attention should be directed toward how African Americans' trust of the medical community affects the use of surgical treatment for esophageal cancer.
Citation Format: Sumaiya Sarwar, Michael T. Kemp, Sha'Shonda L. Revels, Benjamin M. Eilender, Steven R. Houtschilt, Clifford Akateh, Rishindra M. Reddy. Medical providers perceive a lack of trust in the medical system leads to suboptimal esophageal cancer care for African American patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4684. doi:10.1158/1538-7445.AM2014-4684