Research Assistant Professor University of Pennsylvania
Introduction: Trust is an important aspect of healthcare and of the patient-physician relationship. Differences in levels of trust among patients may help explain variations in care seeking and use of medical services. However, these associations remain understudied. Objective is to study the association between patient-physician trust and treatment choice and outcomes among low, intermediate and high-risk, White and African American prostate cancer patients. Methods: We used data from a multi-centered randomized controlled study among localized prostate cancer patients. Trust was measured at baseline using Patient Trust - Wake Forest Physician Trust Scale (PTWF). Outcomes were assessed at baseline, and at 3, 6, 12 and 24-month follow-up. Treatments were robotic-assisted laparoscopic radical prostatectomy, radiation therapy and active surveillance. Participants were categorized into risk groups as: low risk (PSA <10 ng/ml, Gleason = 6, clinical stage T1-2a), intermediate risk (PSA 10 -20 ng/ml, Gleason 7, clinical stage T2b), and high risk was (PSA > 20, Gleason =8, clinical stage T2c-3a). Association between treatment type, and trust (PTWF score) and race for each risk category was assessed using multinomial logistic models. Results: Of the 743 localized prostate cancer patients recruited for the study, 82% were White and 14% were African American. Retention rate was > 75% during follow-up. Proportion of risk categories was: 34% low-risk, 32% intermediate-risk and 34% high-risk. Baseline trust was comparable between White and African American patients (mean=19.5, standard deviation (std)=6.1 vs. mean=20.5, std=6.8, p=0.8032). Also, baseline trust was comparable between intervention group and usual care group (mean= 19.3, std=6.0 vs mean=19.8, std=6.4; p=0.397). Results of multinomial regression indicated that trust and race were not associated with treatment choice independently. Conclusions: This is one of the largest study that has assessed the relationship between trust, race and outcomes in localized prostate cancer patients. We observed that baseline trust was comparable between White and African American patients. Also, neither trust, not race was associated with treatment choice and outcomes. Thus, other factors such as patient-centered preference assessment, may be associated with treatment choice in prostate cancer patients. SOURCE OF Funding: PCORI CE-12-11-4973.
