Medical mistrust continues to pose significant challenges for clinical trial participation, particularly among Black patients, but healthcare experts at Rutgers Cancer Institute are highlighting effective strategies to overcome these barriers through improved communication and understanding.
Dr. Coral O. Omene, associate professor of medicine and breast medical oncologist at Rutgers Cancer Institute, emphasizes that historical atrocities have created deeply ingrained mistrust within Black communities. "It's in their DNA, in their thinking, in their consciousness, passed down for generations—that you cannot trust the system," explains Dr. Omene.
Historical Context of Medical Mistrust
The roots of medical mistrust run deep, stemming from events like the 40-year Tuskegee trial, where Black men were denied penicillin treatment for syphilis without proper consent. Additionally, the exploitation of Black women during slavery, including procedures performed without anesthesia, and the unauthorized use of Henrietta Lacks' cervical cancer cells in research have contributed to this legacy of mistrust.
Building Trust Through Understanding
Healthcare providers must acknowledge this historical context when approaching Black patients about clinical trials. Dr. Omene advises that standard explanations often prove insufficient. "You have to know that the person in front of you probably thinks X, Y, and Z, and you can ask them questions to get a sense of what they're thinking," she states.
Effective Strategies for Engagement
Key approaches to building trust include:
- Dedicating additional time for patient discussions
- Implementing consistent follow-up communication
- Including family members in conversations
- Addressing specific concerns and questions
- Explaining that trials are not merely experimental
Breaking Down Barriers
Dr. Mariam F. Eskander, assistant professor of surgery at Rutgers Cancer Institute, cautions against using medical mistrust as a reason to avoid discussing clinical trials with Black patients. "There's good data showing that when Black patients are engaged about clinical trials and told about clinical trials, the rates of agreement or joining a clinical trial are actually high," she notes.
The Role of Provider-Patient Relationships
Success in overcoming mistrust largely depends on the relationship between healthcare providers and patients. Providers must recognize that current systemic racism and ongoing healthcare disparities continue to affect patients' daily experiences. This understanding should inform every interaction with patients from historically marginalized communities.
"It's not going to be overnight, but it helps," Dr. Omene acknowledges. "Understanding and trying to make a dent that way helps, because it's clear that the issue of mistrust, ingrained for generations, is a barrier that prevents patients from hearing the provider."
