Is patients' trust in clinicians related to patient-clinician racial/ethnic or gender concordance?

The effect of patient participation on trust in primary health care physicians among patients with chronic diseases: the mediating role of perceived value

Background

Low levels of trust in primary health care physicians (PHCPs) significantly decrease primary health care utilization among patients with chronic diseases. In the context of the Chinese government having made considerable efforts to strengthen the development of chronic disease management within Chinese primary health care institutions, it is of great theoretical and practical significance to investigate ways to improve the trust in PHCPs among patients with chronic diseases. This study aimed to explore the impact of patient participation on patient trust in PHCPs, and to examine the mediating role of patient perceived value on this relationship.

Methods

This study included 884 patients with chronic diseases from a cross-sectional survey conducted in Shandong Province, China, from July to August 2023, using a multistage stratified sampling method. Structural equation modeling was conducted to investigate the relationships between patient participation, patient perceived value, and patient trust.

Results

Patient participation had a direct effect on patient trust (Bias-corrected 95%CI = 0.10-0.20; Percentile 95%CI = 0.10-0.20). Furthermore, patient perceived value mediated the relationship between patient participation and patient trust (Bias-corrected 95%CI = 0.15-0.32; Percentile 95%CI = 0.15-0.32).

Conclusion

Patient participation cannot only directly and positively predict patient trust in PHCPs, but also indirectly affect patient trust through patient perceived value. These findings highlight the importance of patient participation and perceived value to improve the trust in PHCPs among patients with chronic diseases. Therefore, health managers and policymakers should facilitate patient participation and recognize patient perceived value during the service delivery process.

Integrating a trauma recovery center into an urban hospital setting serving multiply marginalized patients in the Southeastern United States

BACKGROUND

Few interpersonal violence survivors receive psychosocial services, and those who are multiply marginalized are among the least likely to receive needed care. Trauma recovery centers (TRCs) aim to reduce health disparities by increasing access to trauma-focused care. This study describes the initial adoption, implementation, and reach of the first TRC in the southeastern USA.

METHODS

Funding was awarded to support the adoption of the Grady TRC within an urban safety net hospital in Atlanta, Georgia, and interdisciplinary collaboration was leveraged to support implementation. The electronic health records of 3,238 adult patients seeking medical care were screened for TRC eligibility to determine the program's reach (2020-2023).

RESULTS

53% (n = 1,712) of patients were eligible for TRC services; of these, 16.8% completed TRC intake assessments (n = 288; 84.4% Black, 58.3% female, 47.1% referred for gunshot wounds). Most TRC patients (68.1%; n = 196) screened positive for probable posttraumatic stress disorder (PTSD); many endorsed severe anxiety (44.8%, n = 129) or depressive (23.6%, n = 68) symptoms. Most reported no/low alcohol and drug use.

CONCLUSIONS

A demonstrable need for trauma-focused services was found among violence-exposed patients seeking public healthcare. Integrating the TRC model into institutions serving multiply marginalized patients may help increase access to trauma-focused care for those who may not otherwise receive it.

Promoting Racial Justice in Cancer Clinical Trials: Community Engaged Solutions for Bridging Gaps

INTRODUCTION

Racially and ethnically diverse populations are disproportionately burdened with and more likely to die from cancer than White populations but remain persistently underrepresented in cancer clinical trials. Thus, the safety and efficacy assessments of novel therapies may not apply to all populations, and guidelines are developed using trials that inadequately reflect our population. This study aims to explore healthcare experiences, cancer clinical trial perceptions, and solutions for bridging gaps in cancer clinical trials among communities of color.

METHODS

We held a series of five focus groups with 23 survivors and caregivers of color. These sessions explored perspectives around cancer care and research, clinical trials recruitment and messaging, and priorities around addressing the current insufficiency in representation in cancer research.

RESULTS

Our focus group data was analyzed using an inductive thematic approach. Four themes were present including (1) high motivation to participate in cancer trials and desire for better outreach and education within communities of color; (2) examples of just care as a model for improving access to clinical trials; (3) manifestations of power and inequity in healthcare inhibiting opportunities for clinical trial participation; and (4) the need for trust-building at the healthcare, community, and interpersonal levels.

CONCLUSION

Our findings demonstrate that people of color strongly desire clinical trial options and discussions during cancer care, and trust-building is foundational to opening pathways to research participation. We offer concrete steps for increasing racial justice in cancer clinical trials that serve as a point of reflection and guidance for healthcare professionals, researchers, and clinical trials teams.

Diversity and Inclusion in Anesthesia Practice

The concept of diversity is vital to the practice of medicine and anesthesia practice due to its beneficial effects on multiple aspects of health care practice. However, the current reality is that the workforce fails to adequately reflect the changing demographics of society and the patient population. This article aims to elucidate the benefits, evaluate and provide suggestions identifying some of the obstacles encountered when attempting to advance diversity efforts, and explore and confront challenges that are on the horizon for diversity efforts.

The African American Transplant Access Program: Mitigating Disparities in Solid Organ Transplantation

Black Americans experience end-stage kidney disease (ESKD) at a disproportionately higher rate than other racial and ethnic groups in the United States. Kidney transplantation provides the best outcomes for patients with ESKD. However, Black patients frequently have decreased access to kidney transplantation. This article summarizes the robust literature on disparities in transplantation for Black patients and presents a practical solution to this complex issue by redesigning the transplant access process for Black patients challenged by structural and institutional barriers. The authors provide a detailed overview of a novel African American Transplant Access Program (AATAP) with its pillars of cultural congruency, trust, health literacy, and psychosocial support. This overview includes a thorough description of the program's conceptualization, the process of creating the program, the preliminary results, and guidance to establish similarly culturally congruent transplant access programs.