title: Reducing Racial Disparities in Breast Cancer Survivors' Ratings of Quality Cancer Care: The Enduring Impact of Trust.
abstract: Patient satisfaction provides an important illumination of the quality of care that is delivered. Satisfaction with care is often lower in Black women compared with their non-Hispanic White counterparts. Data are lacking regarding quality ratings of breast cancer patients. We examined racial disparities in ratings of the quality of cancer care in newly diagnosed Black (n = 217) and White (n = 152) patients.
  
  
  
  This was a cross-sectional observational study. Patients were recruited through hospitals and community outreach. Women with primary invasive, nonmetastatic breast cancer were eligible. Trained interviewers administered a standardized survey through telephone; clinical data were abstracted from medical records. The primary outcome, healthcare quality, was assessed using the PSQ-18, which assessed patients' ratings regarding four healthcare domains: interpersonal care, financial issues, technical ratings of physicians, and access and convenience. Independent variables included healthcare factors (e.g., suspicion toward the healthcare system), psychosocial factors (e.g., physicians' solicitation behaviors), and socioeconomic factors (e.g., limited access to resources). Multiple linear regression was used to evaluate associations between each healthcare quality domain and independent variables.
  
  
  
  In univariate analysis, Black women reported lower ratings for four domains: technical (Black m = 3.99; White m = 4.26; p < .001), interpersonal (Black m = 4.15, White m = 4.35; p < .01), financial (Black m = 3.81, White m = 4.0, p < .001), and access and convenience (Black m = 3.92, White m = 4.08, p < .01). After adjusting for healthcare characteristics and psychosocial factors, trust in providers was significantly associated with three domains (β = 0.085, p < .001, technical; β = 0.066, p < .0001, interpersonal; β = 0.043, p < .0001, financial).
  
  
  
  Racial disparities in ratings of healthcare quality were diminished across several domains after controlling for psychosocial and healthcare factors. Strategies aimed at improving self-efficacy in women with higher levels of mistrust may improve patient satisfaction.
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Sheppard
authors.forename: Alejandra
authors.initials: A
authors.lastname: Hurtado-de-Mendoza
authors.forename: Costellia H
authors.initials: CH
authors.lastname: Talley
authors.forename: Yihong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Mark L
authors.initials: ML
authors.lastname: Cabling
authors.forename: Kepher H
authors.initials: KH
authors.lastname: Makambi
mesh_terms: D001741:Black or African American; D001943:Breast Neoplasms; D000073116:Cancer Survivors; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D011787:Quality of Health Care; D044465:White People