Medical Mistrust and Colorectal Cancer Screening Among African Americans
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Despite well-documented benefits of colorectal cancer (CRC) screening, African Americans are less likely to be screened and have higher CRC incidence and mortality than Whites. Emerging evidence suggests medical mistrust may influence CRC screening disparities among African Americans. The goal of this systematic review was to summarize evidence investigating associations between medical mistrust and CRC screening among African Americans, and variations in these associations by gender, CRC screening type, and level of mistrust. MEDLINE, CINAHL, Web of Science, PsycINFO, Google Scholar, Cochrane Database, and EMBASE were searched for English-language articles published from January 2000 to November 2016. 27 articles were included for this review (15 quantitative, 11 qualitative and 1 mixed methods study). The majority of quantitative studies linked higher mistrust scores with lower rates of CRC screening among African Americans. Most studies examined mistrust at the physician level, but few quantitative studies analyzed mistrust at an organizational level (i.e. healthcare systems, insurance, etc.). Quantitative differences in mistrust and CRC screening by gender were mixed, but qualitative studies highlighted fear of experimentation and intrusiveness of screening methods as unique themes among African American men. Limitations include heterogeneity in mistrust and CRC measures, and possible publication bias. Future studies should address methodological challenges found in this review, such as limited use of validated and reliable mistrust measures, examination of CRC screening outcomes beyond beliefs and intent, and a more thorough analysis of gender roles in the cancer screening process.
KeywordsMedical mistrust African Americans Colorectal cancer Preventive screening
We thank Sarah Wright, MLS for her contributions to this manuscript.
This research was partially supported by a National Service Research Award Pre-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. 5T32 HS000032-28.Wizdom Powell is supported by the National Center for Minority Health and Health Disparities (# L60 MD010134), National Institutes of Drug Abuse (#1K01 DA032611-01A1), and the National Cancer Institute (#5U54CA15673306-07). Additional support for Jennifer Richmond was provided by a grant from the Robert Wood Johnson Foundation Health Policy Research Scholars program (#73921).
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.USPTF. Final Update Summary: Colorectal Cancer: Screening. 2015.Google Scholar
- 5.Centers for Disease Control and Prevention (CDC), (2013). Vital signs: Colorectal cancer screening test use–United States, 2012. MMWR Morbidity and Mortality Weekly Report, 62(44), 881–888.Google Scholar
- 8.Gwede, C. K., Ward, B. G., Luque, J. S., Vadaparampil, S. T., Rivers, D., Martinez-Tyson, D., et al. (2010). Application of geographic information systems and asset mapping to facilitate identification of colorectal cancer screening resources. Online Journal of Public Health Informatics, 2(1), 2893.CrossRefPubMedGoogle Scholar
- 9.Wallace, P. M., & Suzuki, R. (2012). Regional, racial, and gender differences in colorectal cancer screening in middle-aged African-Americans and Whites. Journal of Cancer Education : The Official Journal of the American Association for Cancer Education, 27(4), 703–708. doi: 10.1007/s13187-012-0396-2.CrossRefGoogle Scholar
- 10.Martinez,K. A, Pollack C. E., Phelan D. F, Markakis D., Bone L., Shapiro G., et al. (2013). Gender differences in correlates of colorectal cancer screening among black medicare beneficiaries in Baltimore. Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 22(6), 1037–1042. doi: 10.1158/1055-9965.epi-12-1215.CrossRefGoogle Scholar
- 13.Sarfaty, M., & Feng, S. (2006). Choice of screening modality in a colorectal cancer education and screening program for the uninsured. Journal of Cancer Education : The Official Journal of the American Association for Cancer Education, 21(1), 43–49. doi: 10.1207/s15430154jce2101_14.CrossRefGoogle Scholar
- 16.Hammond, W. P., Matthews, D., Mohottige, D., Agyemang, A., & Corbie-Smith, G. (2010). Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men. Journal of General Internal Medicine, 25(12), 1300–1308. doi: 10.1007/s11606-010-1481-z.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.McKinstry, B., Ashcroft, R. E., Car, J., Freeman, G. K., & Sheikh, A. Interventions for improving patients’ trust in doctors and groups of doctors. The Cochrane Database of Systematic Reviews. 2006(3), CD004134. doi: 10.1002/14651858.CD004134.pub2.
- 20.Carpenter, W. R., Godley, P. A., Clark, J. A., Talcott, J. A., Finnegan, T., Mishel, M., et al. (2009). Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use. Cancer, 115(21), 5048–5059. doi: 10.1002/cncr.24539.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99(8), 879–885.PubMedPubMedCentralGoogle Scholar
- 24.Gordon,T. F., Bass,S. B., Ruzek,S. B., Wolak,C., Rovito,M. J., Ruggieri,D. G., et al. (2014). Developing a typology of African Americans with limited literacy based on preventive health practice orientation: Implications for colorectal cancer screening strategies. Journal of Community Health, 19(11), 1259–1277. doi: 10.1080/10810730.2013.872725.CrossRefGoogle Scholar
- 28.Jandorf, L., Cooperman, J. L., Stossel, L. M., Itzkowitz, S., Thompson, H. S., Villagra, C., et al. (2013). Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system. Health Education Research, 28(5), 803–815. doi: 10.1093/her/cyt003.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Brittain, K., Christy, S. M., & Rawl, S. M. (2016). African American Patients’ intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter? Journal of Health Care for the Poor and Undeserved, 27(1), 51–67. doi: 10.1353/hpu.2016.0022.CrossRefGoogle Scholar
- 31.Bynum, S. A., Davis, J. L., Green, B. L., & Katz, R. V. (2012). Unwillingness to participate in colorectal cancer screening: Examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. American Journal of Health Promotion, 26(5), 295–300. doi: 10.4278/ajhp.110113-QUAN-20.CrossRefPubMedGoogle Scholar
- 37.Born, W., Engelman, K., Greiner, K. A., Bhattacharya, S. B., Hall, S., Hou, Q., et al. (2009). Colorectal cancer screening, perceived discrimination, and low-income and trust in doctors: A survey of minority patients. BMC Public Health, 9, 363. doi: 10.1186/1471-2458-9-363.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Purnell, J. Q., Katz, M. L., Andersen, B. L., Palesh, O., Figueroa-Moseley, C., Jean-Pierre, P., et al. (2010). Social and cultural factors are related to perceived colorectal cancer screening benefits and intentions in African Americans. Journal of Behavioral Medicine, 24–34(1), 11. doi: 10.1007/s10865-009-9231-6.Google Scholar
- 41.Bass, S. B., Gordon, T. F., Ruzek, S. B., Wolak, C., Ward, S., Paranjape, A., et al. (2011). Perceptions of colorectal cancer screening in urban African American clinic patients: Differences by gender and screening status. Journal of Cancer Education, 26(1), 121–128. doi: 10.1007/s13187-010-0123-9.CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Brandzel, S., Chang, E., Tuzzio, L., Campbell, C., Coronado, N., Bowles, E. J., et al. (2016). Latina and Black/African American women's perspectives on cancer screening and cancer screening reminders. Journal of Racial and Ethnic Health Disparities. doi: 10.1007/s40615-016-0304-2.PubMedGoogle Scholar
- 50.Lumpkins, C. Y., Vanchy, P., Baker, T. A., Daley, C., Ndikum-Moffer, F., & Greiner, K. A. (2016). Marketing a healthy mind, body, and soul: An analysis of how African American men view the church as a social marketer and health promoter of colorectal cancer risk and prevention. Health Education and Behavior, 43(4), 452–460. doi: 10.1177/1090198115604615.CrossRefPubMedGoogle Scholar
- 51.Nicholson, R. A., Kreuter, M. W., Lapka, C., Wellborn, R., Clark, E. M., Sanders-Thompson, V., et al. (2008). Unintended effects of emphasizing disparities in cancer communication to African-Americans. Cancer Epidemiology, Biomarkers and Prevention, 17(11), 2946–2953. doi: 10.1158/1055-9965.epi-08-0101.CrossRefPubMedPubMedCentralGoogle Scholar
- 54.Thompson, V. L., Kalesan, B., Wells, A., Williams, S. L., & Caito, N. M. (2010). Comparing the use of evidence and culture in targeted colorectal cancer communication for African Americans. Patient Education and Counseling, 81(Suppl 1), S22–33. doi: 10.1016/j.pec.2010.07.019.CrossRefPubMedGoogle Scholar