ASPO Abstracts
Multilevel Approaches Needed to Address Medical Mistrust in Black Women at Risk of Hereditary Breast and Ovarian Cancer
Category: Cancer Health Disparities, Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2018
Abstract Body:
Background: The benefits of genetic counseling and testing (GCT) for hereditary breast and/or ovarian cancer (HBOC) are well documented; however, Black women are less likely to use these services compared to White women. Mistrust of the medical system has been associated with Black women’s underuse of GCT. However, relatively little is known about the factors that increase a woman’s likelihood to have higher medical mistrust. Methods: A convenience sample of 94 Black women at increased risk of HBOC were recruited to examine the prevalence of medical mistrust to assess whether sociodemographic (e.g. age, education), sociocultural (e.g. religiosity, fatalism), and psychosocial (attitude toward GTC, self-efficacy in accessing GCT) factors contribute to levels of mistrust. Categorical variables were calculated according to Chi-Square, while the F-test was employed for continuous variables. The Lasso method of linear regression assessed the relationships between the independent variables and medical mistrust. Results: Most women were married (48.7%) and had at least some collegiate education (57.1%). Levels of mistrust ranged from moderate (16) to high (35); m=24.9, SD=3.9. Sociodemographic factors were not associated with medical mistrust in bivariate analysis, but fatalism (p=0.04), perceptions of discrimination (p=0.01), and self- efficacy in accessing GCT (p=0.01) were. In multivariable analysis, women who reported higher levels of discrimination (beta=0.80) and less confidence in obtaining GCT (beta=-0.33) expressed greater medical mistrust. Conclusion: Mistrust of the medical system was common among this group of Black women at increased risk of HBOC; mistrust did not vary by demographic factors. There is a continued need to address structural barriers, such as perceived race-based discrimination in healthcare, to address medical mistrust. Additionally, education about accessing GCT services may enhance women’s confidence in GCT, therefore reducing levels of mistrust. Interventions that target multiple levels of influence may help mediate levels of medical mistrust and in turn enhance uptake of GCT in this at-risk population.
Keywords: Genetic Counseling Medical Mistrust Black Women