SYNOPSISObjective. A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross-sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans.Methods. Respondents ages 18-75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals.Results. Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals.Conclusions. Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.

No abstract

No abstract

No abstract

This national registry study examines national trends in racial/ethnic disparities in the receipt of predialysis nephrology care at least 1 year before dialysis initiation among adults with end-stage kidney disease in the United States from 2005 to 2015.

donor and kidney transplant recipient evaluations. This could lead to worsening of existing racial disparities. Overcoming these fears will require that we examine our own implicit biases to ensure that we are providing equitable care worthy of our patients' trust. We should also engage trusted community leaders and organizations as partners in communicating the benefits of timely and appropriate care, even during these tumultuous times. This foundation of trust 14 will become increasingly important as a vaccine and effective treatments for COVID-19 are developed, which we will want to equitably provide to our patients. In all of these efforts, we should be mindful that many of our Black colleagues are also experiencing similar grief and other direct and indirect consequences as are our patients during these dual crises. It is important that they be provided emotional as well as instrumental support to mitigate negative effects on their personal and professional lives, as well as bolstered kidney community support to advance health equity. The COVID-19 pandemic and recent high-profile acts of racism have unleashed new adversity for Black individuals to "weather." Our actions as a kidney community can influence the effect that these crises have on racial disparities and prepare us to better address challenges to come.

Rationale & Objective Chronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients’ preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacement therapy before kidney failure. Study Design Cross-sectional study. Setting & Participants Adults receiving nephrology care at CKD clinics in rural Pennsylvania. Predictors Estimated glomerular filtration rate, 2-year risk for kidney failure, duration and frequency of nephrology care, and preference for SDM. Outcomes Occurrence and extent of kidney replacement therapy discussions and participants’ satisfaction with those discussions. Analytic Approach Multivariable logistic regression to quantify associations between participants’ characteristics and whether they had discussions. Results The 447 study participants had a median age of 72 (IQR, 64-80) years and mean estimated glomerular filtration rate of 33 (SD, 12) mL/min/1.73 m 2 . Most (96%) were White, high school educated (67%), and retired (65%). Most (72%) participants preferred a shared approach to kidney treatment decision making, and only 35% discussed dialysis or transplantation with their kidney teams. Participants who had discussions (n = 158) were often completely satisfied (63%) but infrequently discussed potential treatment-related impacts on their lives. In multivariable analyses, those with a high risk for kidney failure within 2 years (OR, 3.24 [95% CI, 1.72-6.11]; P < 0.01), longer-term nephrology care (OR, 1.12 [95% CI, 1.05-1.20] per 1 additional year; P < 0.01), and more nephrology visits in the prior 2 years (OR, 1.34 [95% CI, 1.20-1.51] per 1 additional visit; P < 0.01) had higher odds of having discussed dialysis or transplantation. Limitations Single health system study. Conclusions Most patients preferred sharing CKD treatment decisions with their providers, but treatment discussions were infrequent and often did not address key treatment impacts. Longitudinal nephrology care and frequent visits may help ensure that patients have optimal SDM experiences.

No abstract