eP346 - Trust and Surgery in the Deep South

ePoster Presenter(s)

• 

  Wendelyn M. Oslock, MD, MBA (she/her/hers)

  General Surgery Resident
  University of Alabama Birmingham Department of Surgery; Birmingham Veterans Affairs Medical Center
  University of Alabama Birmingham
  Birmingham, AL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Bayley A. Jones, MD

  Resident
  University of Alabama at Birmingham Department of Surgery
  Birmingham, AL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• NE

  Nathan C. English, MBChB (he/him/his)

  Resident
  University of Cape Town, Department of General Surgery
  University of Cape Town
  Birmingham, AL, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• BS

  Burkely Smith, MD, MSPH

  Resident
  University of Alabama at Birmingham
  Birmingham, Alabama, United States

  Disclosure information not submitted.
• IH

  Ivan Herby, MPH

  Consultant
  University of Alabama Birmingham
  Birmingham, Alabama, United States

  Disclosure information not submitted.
• LM

  Luke Mondia, MBA

  Medical Student
  University of Alabama Birmingham
  Birmingham, Alabama, United States

  Disclosure information not submitted.
• NI

  Nataliya Ivankova, PhD, MPH

  Professor
  University of Alabama at Birmingham, School of Health Professions
  Birmingham, Alabama, United States

  Disclosure information not submitted.
• YS

  Yu-Mei Schoenberger, PhD

  Assistant Professor
  Division of Preventive Medicine and O’Neal Comprehensive Cancer Center
  Birmingham, Alabama, United States

  Disclosure information not submitted.
• MP

  Maria Pisu, PhD

  Professor
  University of Alabama at Birmingham Division of Preventive Medicine and O’Neal Comprehensive Cancer Center
  Birmingham, Alabama, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Daniel I. Chu, MD MSPH

  Professor
  University of Alabama at Birmingham
  University of Alabama at Birmingham
  Birmingham, Alabama, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: A key foundation of the patient-clinician relationship and the decision to pursue surgery is trust. Black patients have been found to be more likely to experience mistrust. Nonetheless, facilitators and barriers to developing trust among cancer patients requiring surgery are not well understood.Methods/Interventions: As part of a mixed-methods study through the Advancing Surgical Cancer Care and Equity in the Deep South (ASCENDS), we conducted open ended qualitative interviews with gastrointestinal (GI) surgery cancer survivors and providers from Alabama and Mississippi. Survivors were English-speaking adults who were 18-years or older, diagnosed with stage I-III colorectal, pancreatic, or esophageal cancer from 2018-2021 and underwent surgical resection. Providers included surgeons as well as oncologists, nurses, and navigators. Interview questions focused on pre-operative, perioperative, and postoperative time periods. All interviews were recorded and transcribed then analyzed using inductive thematic analysis and content analysis approaches with NVivo 12.6 Plus.Results/Outcomes: Twenty-seven clinicians and 36 GI surgery cancer survivors were interviewed. Geographically, 22% of clinicians practiced in rural areas. Patients who were interviewed had the following demographics: age ranged from 44-87 years old, 42% were male, and 30% were Black. Table 1 shows the themes, subthemes and example quotes from the interviews. Within the first theme of “Trust Facilitators,” clinicians shared approaches they used to garner trust with patients such as facilitating accurate self-education, having a positive reputation, and giving patients choice. Patients highlighted trusting their care teams because they trusted God, surgeon reputation, and experiences with clinicians going above expectations. The second theme was “Trust Barriers,” in which patients highlight the damage done when there is inconsistency in communication or perceived withholding of information. Within the last theme, “Impact of Mistrust,” clinicians share experiences in which patients have discomfort raising concerns or refuse treatment, financial assistance, or specific facilities.Conclusion/

Discussion: Both patients and clinicians found that clinician reputation is important in creating trust. Clinicians highlighted several approaches that helped create trust. Further research should explore how these approaches impact the sense of trust experienced by patients.Table 1. Themes and Subthemes Regarding Trust for GI Surgery Cancer Patients and Providers