Journal of General Internal Medicine

, Volume 26, Issue 1, pp 51–57

The Import of Trust in Regular Providers to Trust in Cancer Physicians among White, African American, and Hispanic Breast Cancer Patients

  • Karen Kaiser
  • Garth H. Rauscher
  • Elizabeth A. Jacobs
  • Teri A. Strenski
  • Carol Estwing Ferrans
  • Richard B. Warnecke
Original Research



Interpersonal trust is an important component of the patient-doctor relationship. Little is known about patients’ trust in the multiple providers seen when confronting serious illness.


To characterize breast cancer patients’ trust in their regular providers, diagnosing physicians, and cancer treatment team and examine whether high trust in one’s regular provider confers high trust to cancer physicians.


In-person interviews.


704 white, black, and Hispanic breast cancer patients, age 30 to 79, with a first primary in situ or invasive breast cancer who reported having a regular provider.


We measure trust in: (1) regular provider, (2) diagnosing doctors, and (3) cancer treatment team. Other variables include demographic variables, preventive health care, comorbidities, time with regular provider, time since diagnosis, cancer stage, and treatment modality.


Sixty-five percent of patients reported high trust in their regular provider, 84% indicated high trust in their diagnosing doctors, and 83% reported high trust in their treatment team. Women who reported high trust in their regular provider were significantly more likely to be very trusting of diagnosing doctors (OR: 3.44, 95% CI: 2.27–5.21) and cancer treatment team (OR: 3.09, 95% CI: 2.02–4.72 ). Black women were significantly less likely to be very trusting of their regular doctor (OR: 0.58, 95% CI: 0.38–0.88) and cancer treatment team (OR: 0.45, 95% CI: 0.25–0.80). English-speaking Hispanic women were significantly less trusting of their diagnosing doctors (OR: 0.29, 95% CI: 0.11–0.80).


Our results suggest that patients are very trusting of their breast cancer providers. This is an important finding given that research with other populations has shown an association between trust and patient satisfaction and treatment adherence. Our findings also suggest that a trusting relationship with a regular provider facilitates trusting relationships with specialists. Additional work is needed to increase interpersonal trust among black women.


breast cancer doctor-patient relationships primary care specialty care 


  1. 1.
    Calnan M, Rowe R. Researching trust relations in health care. J Organisat Manag. 2006;20(5):349–58.CrossRefGoogle Scholar
  2. 2.
    Hall MA, et al. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79(4):613–39.CrossRefPubMedGoogle Scholar
  3. 3.
    Safran, D.G., et al. Linking primary care performance to outcomes of care. J Fam Pract, 1998. v47(n3): p 213(8).Google Scholar
  4. 4.
    Kraetschmer N, et al. How does trust affect patient preferences for participation in decision-making? Health Expect. 2004;7(4):317–26.CrossRefPubMedGoogle Scholar
  5. 5.
    Piette JD, et al. The role of patient-physician trust in moderating medication nonadherence due to cost pressures. Arch Intern Med. 2005;165(15):1749–55.CrossRefPubMedGoogle Scholar
  6. 6.
    Altice FL, Mostashari F, Friedland GH. Trust and the acceptance of and adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2001;28(1):47–58.PubMedGoogle Scholar
  7. 7.
    Schneider J, et al. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med. 2004;19(11):1096–103.CrossRefPubMedGoogle Scholar
  8. 8.
    Mostashari F, et al. Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility. J Acquir Immune Defic Syndr Human Retrovirol. 1998;18:341–8.Google Scholar
  9. 9.
    Safran DG, et al. Switching doctors: predictors of voluntary disenrollment from a primary physician’s practice. J Fam Pract. 2001;50(2):130–6.PubMedGoogle Scholar
  10. 10.
    Thom DH, et al. Patient trust in the physician: relationship to patient requests. Fam Pract. 2002;19(5):476–83.CrossRefPubMedGoogle Scholar
  11. 11.
    Ahmed NU, et al. Empowering factors for regular mammography screening in under-served populations: pilot survey results in tennessee. Ethn Dis. 2005;15(3):387–394.PubMedGoogle Scholar
  12. 12.
    Sheppard V, et al. Are health-care relationships important for mammography adherence in latinas? J Gen Intern Med. 2008;23(12):2024–30.CrossRefPubMedGoogle Scholar
  13. 13.
    O'Malley AS, et al. The role of trust in use of preventive services among low-income African-American women. Prev Med. 2004;38(6):777–85.CrossRefPubMedGoogle Scholar
  14. 14.
    Lansdown M, Martin L, Fallowfield L. Patient-physician interactions during early breast-cancer treatment: results from an international online survey. Curr Med Res Opin. 2008;24(7):1891–904.CrossRefPubMedGoogle Scholar
  15. 15.
    Penman DT, et al. Informed consent for investigational chemotherapy: patients' and physicians' perceptions. J Clin Oncol. 1984;2(7):849–55.PubMedGoogle Scholar
  16. 16.
    Mainous AG III, et al. The relationship between continuity of care and trust with stage of cancer at diagnosis. Fam Med. 2004;6(1):35–9.Google Scholar
  17. 17.
    Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.CrossRefPubMedGoogle Scholar
  18. 18.
    Hickner J, et al. Physicians' and patients' views of cancer care by family physicians: a report from the american academy of family physicians national research network. Fam Med. 2007;39(2):126–31.PubMedGoogle Scholar
  19. 19.
    Bulsara C, Ward AM, Joske D. Patient perceptions of the GP role in cancer management. Aust Fam Physician. 2005;34(4):299–300.PubMedGoogle Scholar
  20. 20.
    Klabunde C, et al. The role of primary care physicians in cancer care. J Gen Intern Med. 2009;24(9):1029–36.CrossRefPubMedGoogle Scholar
  21. 21.
    Keating N, et al. Patient Characteristics and experiences associated with trust in specialist physicians. Arch Intern Med. 2004;164:1015–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Grumbach K, et al. Resolving the gatekeeper conundrum: what patients value in primary care and referrals to specialists. JAMA. 1999;282(3):261–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Boulware LE, et al. Race and trust in the health care system. Public health reports (Washington, DC: 1974), 2003. 118(4): p 358-365.Google Scholar
  24. 24.
    Gordon HS, et al. Racial differences in trust and lung cancer patients' perceptions of physician communication. J Clin Oncol. 2006;24(6):904–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Halbert CH, et al. Racial differences in trust in health care providers. Arch Intern Med. 2006;166(8):896–901.CrossRefPubMedGoogle Scholar
  26. 26.
    Masi C, Gehlert S. Perceptions of breast cancer treatment among african-american women and men: implications for interventions. J Gen Intern Med. 2009;24(3):408–14.CrossRefPubMedGoogle Scholar
  27. 27.
    Balkrishnan R, et al. Trust and satisfaction with physicians, insurers, and the medical profession. Med Care. 2003;41(9):1058–64. doi:10.1097/01.MLR.0000083743.15238.9F.CrossRefPubMedGoogle Scholar
  28. 28.
    Shenolikar R, Balkrishnan R, Hall M. How patient-physician encounters in critical medical situations affect trust: results of a national survey. BMC Health Serv Res. 2004;4(1):24.CrossRefPubMedGoogle Scholar
  29. 29.
    Mechanic D, Meyer S. Concepts of trust among patients with serious illness. Soc Sci Med. 2000;51(5):657–68.CrossRefPubMedGoogle Scholar
  30. 30.
    Thom DH, Hall MA, Pawlson LG. Measuring patients' trust in physicians when assessing quality of care. Health Aff. 2004;23(4):124–32.CrossRefGoogle Scholar
  31. 31.
    Haywood C, et al. The association of provider communication with trust among adults with sickle cell disease. J Gen Intern Med. 2010;25(6):543–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Cooper LA, et al. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15.PubMedGoogle Scholar
  33. 33.
    Bowles EJA, et al. Understanding high-quality cancer care. Cancer. 2008;112(4):934–42.CrossRefGoogle Scholar
  34. 34.
    Jacobs EA, et al. Understanding African Americans' views of the trustworthiness of physicians. J Gen Intern Med. 2006;21(6):642–7.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Karen Kaiser
    • 1
  • Garth H. Rauscher
    • 2
  • Elizabeth A. Jacobs
    • 3
  • Teri A. Strenski
    • 4
  • Carol Estwing Ferrans
    • 5
  • Richard B. Warnecke
    • 1
  1. 1.Institute for Health Research and PolicyUniversity of Illinois at Chicago (UIC)ChicagoUSA
  2. 2.Division of Epidemiology and BiostatisticsUIC School of Public HealthChicagoUSA
  3. 3.Cook County Hospital and Rush University Medical CenterChicagoUSA
  4. 4.UIC School of Public HealthChicagoUSA
  5. 5.UIC College of NursingChicagoUSA

Personalised recommendations