Healthcare team trust, care coordination, and care access among cancer survivors with multiple chronic conditions: a...

Cancer survivors with multiple chronic conditions (MCC) are a growing population with complex health needs, yet little is known about their care experiences and healthcare team trust.

This mixed methods study used a convenience sample of 441 adult cancer survivors recruited through online survey platforms. Participants completed surveys assessing care coordination, care access, healthcare team trust, and whether their care team included a social worker, navigator, or care coordinator during the 12 months after diagnosis. Twelve survivors also participated in semi-structured interviews. Relationships between care coordination and care access with healthcare team trust were examined using multivariable logistic regression followed by qualitative analysis of interviews.

Overall 20.4% reported low trust in their healthcare team, 51.5% reported at least one care coordination problem, and 27.2% reported at least one care access issue. The adjusted prevalence odds ratios for low healthcare team trust were 14.5 times higher for cancer survivors who reported problems with care coordination (95% CI, 6.73, 31.29) and 6.3 times higher for care access problems (95% CI, 3.66, 10.69) compared with survivors reporting no problems. Having a social worker, coordinator, or navigator did not moderate these associations (p-values > 0.05). Participants described medical paternalism, transparency, honesty, established relationships, intergenerational trust, empathy and respect, and credibility as key experiences and attributes associated with trust.

Experiencing care problems was associated with reporting lower trust in one's healthcare team among cancer survivors with MCC, which represents potential modifiable points for intervention to improve trust, health outcomes, and quality of life.