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.
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