Medical Mistrust Among Black Patients with Serious Illness: A Mixed Methods Study.

Area of Science:

• Health Services Research
• Health Equity
• Racial Justice in Healthcare

Background:

• Racial inequities in end-of-life care disproportionately affect Black patients.
• Medical mistrust among Black patients is often cited but patient perspectives on racism's impact are understudied.
• Understanding patient experiences is vital for addressing healthcare disparities.

Purpose of the Study:

• To characterize racism and discrimination experiences in Black patients with serious illness.
• To examine the association between these experiences and medical mistrust.
• To inform strategies for improving healthcare trustworthiness.

Main Methods:

• Convergent mixed-methods study with 72 Black patients hospitalized with serious illness.
• Data collected via surveys (Group-Based Medical Mistrust scale) and semi-structured interviews.
• Explored experiences of medical racism, communication, and decision-making.

Main Results:

• High levels of race-based medical mistrust were reported (GBMM scale mean 36.6).
• Key themes included suspicion of healthcare workers, personal experiences of discrimination, and frustration with communication.
• Qualitative findings aligned with quantitative mistrust subscales (suspicion, group disparities, lack of support).

Conclusions:

• Black patients with serious illness exhibit significant medical mistrust.
• Mistrust is influenced by suspicion of healthcare workers, perceived racial disparities, and inadequate support.
• Race-conscious strategies are essential to enhance healthcare institution and worker trustworthiness.