Trust In Healthcare Professionals Research Articles

“I’ve had constant fears that I’ll get cancer”: the construction and experience of medical intervention on intersex bodies to reduce cancer risk

ABSTRACT Purpose This paper examines the subjective experience of medical interventions on intersex bodies to reduce cancer risk. Methods Twenty-five individuals with intersex variations took part in semi-structured interviews, analysed through thematic discourse analysis. Results Intersex bodies were positioned as inherently sick and in need of modification, with cancer risk legitimating surgical and hormonal intervention. This resulted in embodied shame, with negative impacts on fertility and sexual wellbeing. However, many participants resisted discourses of bio-pathologisation and embraced intersex status. Some medical interventions, such as HRT, were perceived to have increased the risk of cancer. Absence of informed consent, and lack of information about intersex status and the consequences of medical intervention, was positioned as a human rights violation. This was compounded by ongoing medical mismanagement, including health care professional lack of understanding of intersex variations, and the objectification or stigmatization of intersex people within healthcare. The consequence was non-disclosure of intersex status in health contexts and lack of trust in health care professionals. Conclusions The legitimacy of poorly-evidenced cancer risk discourses to justify medical intervention on intersex bodies needs to be challenged. Healthcare practitioners need to be provided with education and training about cultural safety practices for working with intersex people.

Abstract 796: Exploring the impact of masculine beliefs on colorectal cancer screening participation among Hispanic/Latino men in Florida, New York, and Texas

Abstract Introduction: The existing literature on colorectal cancer-related inequities among Hispanic/Latino men may be poorly descried as most outcome data to date for this ethnic group are reported in aggregate. This study explored how masculine beliefs may influence colorectal cancer screening participation among ethnic subgroups of Hispanic/Latino men aged 45-75 years. Methods: Utilizing a consumer panel, self-identified Hispanic/Latino men that were age-eligible for colorectal cancer screening and fluent in either English or Spanish were recruited from Florida, New York, and Texas (February-March 2022). The Masculinity Barriers to Medical Care (MBMC) scale, comprising six theoretically derived subscales, was assessed masculinity. Multivariable logistic regression was employed to estimate the association between MBMC and colorectal cancer screening participation, adjusting for Hispanic/Latino subgroup, marital status, survey language, age, and health insurance status. Next, to explore differences by Hispanic/Latino subgroups (Mexican/Mexican American/Chicano; Puerto Rican; Cuban; Other Hispanic/Latino), results were stratified by subgroup and adjusted for confounding. Results: There were 611 male participants, with roughly 31% identifying as Puerto Rican, 30% a different Hispanic ethnic background (“Other Hispanic/Latino”), 26% Mexican, and 14% Cuban. More than half (63%) of whom had ever been screened for colorectal cancer. No variations in screening rates were observed across Hispanic/Latino subgroups. Stool-based tests were more commonly used for screening compared to exam-based tests (60% vs. 49%). After adjusting for confounding, masculinity barriers reduced the odds of the screening participation. Differences were observed by Hispanic/Latino subgroup for a few MBMC scale items. Specifically, Cuban men were most likely to report trust in healthcare professionals, but least likely to report receiving quality medical care. Latino men of other Hispanic ethnicity were more likely to report taking risks with their own health if it benefits their family. Among Puerto Rican men, higher scores on the restrictive emotionality subscale were associated with a lower likelihood of screening participation. Conversely, higher scores on the health-related self-reliance subscale were associated with a greater likelihood of screening participation among men of other Hispanic/Latino ethnicity. Conclusion: Differences in colorectal cancer screening participation by Hispanic/Latino ethnicity were not observed, suggesting barriers to screening may be similar among subgroups. Masculinity barriers to colorectal cancer screening may exist among Latino men, particularly among Puerto Rican men. Intervening on these masculinity-related barriers masculinity may improve colorectal cancer screening uptake among Latino men. Citation Format: Ami E. Sedani, Jessica Y. Islam, Derek M. Griffith, Kelly K. Rifelj, Cordero L. McCall, Omar García-Rodríguez, Marlene Camacho-Rivera, Charles R. Rogers. Exploring the impact of masculine beliefs on colorectal cancer screening participation among Hispanic/Latino men in Florida, New York, and Texas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 796.

Women's trust in the healthcare system in Serbia: Validation of the Women's Trust and Confidence in Healthcare System scale.

Women's role as patients is associated with power relationships embedded in society. Although trust in the health care system is a general prerequisite for positive health outcomes, practices regarding women's agency in healthcare systems in Southeastern Europe reinforce women's passivity. Most of the current psychological measures of trust have been constructed and validated in "WEIRD" (samples that are drawn from populations that are White, Educated, Industrialized, Rich, and Democratic) countries, thus having a limited application in other social contexts. We aimed to construct an instrument for assessing women's trust in healthcare systems to describe the structure of trust: Women's Trust and Confidence in the Healthcare System scale. Two independent samples (N1 = 329; N2 = 333) of adult women in Serbia voluntarily completed an online questionnaire. The questionnaire comprised 20 trust-related items which were selected from an extensive collection of women's experiences in the healthcare system and evaluated by experts on a 5-point Likert-type scale. We used exploratory factor analysis of the Women's Trust and Confidence in the Healthcare System scale to analyze the structure of trust in the first sample data set and validated it with the second sample using confirmatory factor analysis. We tested concurrent validity by exploring how women's trust in the healthcare system predicts health-related behaviors (multigroup structural equation modeling). All analyses were conducted using R statistical software. The Women's Trust and Confidence in the Healthcare System scale (Cronbach's alpha = 0.86) indicated a three-factor structure of trust in the healthcare system: trust in healthcare professionals, distrust in the public healthcare system, and confidence in healthcare system. This was validated using an independent sample. Interpersonal trust positively predicted women's desirable health behaviors, while trust in the system had a negative impact. The Women's Trust and Confidence in the Healthcare System scale captures women's trust in a paternalistic healthcare system, is reliable, and has a stable three-factor structure. The study's findings reveal the relationship between women's trust and health-related behavior: in paternalistic environments, trust reinforces women's passivity.

Factors influencing willingness to participate in ophthalmic clinical trials and strategies for effective recruitment.

To explore the factors influencing individuals' willingness to participate in ophthalmic clinical trials. A questionnaire survey was conducted from January to April 2021 among patients and their family members at Zhongshan Ophthalmic Center, Sun Yat-sen University, in Guangzhou, China. The survey gathered data on respondents' willingness, demographic and socioeconomic profiles, as well as their reasons and concerns regarding engagement in clinical trials. Of the 1078 residents surveyed (mean age 31.2±13.1y; 65.8% females) in Guangzhou, 749 (69.5%) expressed a willingness to participate in future ophthalmic clinical trials. Specific characteristics associated with greater willingness included a younger age, lower annual income, higher education, prior participation experience, previous ophthalmic treatment, and a better understanding of clinical trials. With the exception of age, these characteristics were significantly linked to a higher willingness. The primary barrier to participation, expressed by 64.8% of those willing and 54.4% of those unwilling, was "Uncertain efficacy". In terms of motivations, the willing group ranked "Better therapeutic benefits" (35.0%), "Professional monitoring" (34.3%), and "Trust in healthcare professionals" (33.1%) as their top three reasons, whereas the unwilling participants indicated "Full comprehension of the protocol" (46.2%) as the key facilitator. This study reveals a substantial willingness to participate in ophthalmic clinical trials and demonstrates the predictive role of demographic and socioeconomic factors. Variations in motivators and concerns between willing and unwilling participants highlight the significance of tailored recruitment strategies. Importantly, the need for and trust in healthcare professionals stand out as powerful motivations, underscoring the importance of enhancing physician-patient relationships, adopting patient-centered communication approaches, and addressing individualized needs to improve accrual rates.

Disentangling trust of patients with rare cancer in their healthcare professionals and the healthcare system: a qualitative interview study.

Patients with a rare cancer face challenges, e.g., delayed diagnosis, that may affect trust in the healthcare system and the healthcare professionals (HCPs) involved. This study aimed to explore trust of patients with a rare cancer in their HCPs and the healthcare system. Semi-structured interviews were conducted with 20 purposively sampled patients with a rare cancer. The interview guide included topics related to trust, including level, development, barriers and facilitators, importance, and trust dimensions. Thematic analysis was conducted with use of Atlas.ti. The mean age of patients was 50years, 60% were female, and 70% were highly educated. Three themes were constructed: (1) "Confirmed expertise is a prerequisite of trust." Patients need confirmation of their HCPs' expertise, as it could not be assumed due to the rarity of their cancer; (2) "Trust depends on the adequacy of information and how it is provided." Limited information about rare cancer reduced patients' trust in health care, whereas interpersonal trust was mainly affected by how HCPs provided information; and (3) "Trust is built on properly coordinated and supportive care." Proper organization and cooperation within and between hospitals, and integration of supportive care, enhanced trust. Patients with a rare cancer experience challenges that influence trust in HCPs and the healthcare system. Further research should examine trust among subgroups of patients with a rare cancer, to enable development of tailored interventions. HCPs may improve trust by focusing on expertise, effective information provision, proper coordination of care, and provision of adequate supportive care.

Users' Experiences With Online Access to Electronic Health Records in Mental and Somatic Health Care: Cross-Sectional Study.

Patient-accessible electronic health records (PAEHRs) hold promise for empowering patients, but their impact may vary between mental and somatic health care. Medical professionals and ethicists have expressed concerns about the potential challenges of PAEHRs for patients, especially those receiving mental health care. This study aims to investigate variations in the experiences of online access to electronic health records (EHRs) among persons receiving mental and somatic health care, as well as to understand how these experiences and perceptions vary among those receiving mental health care at different levels of point of care. Using Norwegian data from the NORDeHEALTH 2022 Patient Survey, we conducted a cross-sectional descriptive analysis of service use and perceptions of perceived mistakes, omissions, and offensive comments by mental and somatic health care respondents. Content analysis was used to analyze free-text responses to understand how respondents experienced the most serious errors in their EHR. Among 9505 survey participants, we identified 2008 mental health care respondents and 7086 somatic health care respondents. A higher percentage of mental health care respondents (1385/2008, 68.97%) reported that using PAEHR increased their trust in health care professionals compared with somatic health care respondents (4251/7086, 59.99%). However, a significantly larger proportion (P<.001) of mental health care respondents (976/2008, 48.61%) reported perceiving errors in their EHR compared with somatic health care respondents (1893/7086, 26.71%). Mental health care respondents also reported significantly higher odds (P<.001) of identifying omissions (758/2008, 37.75%) and offensive comments (729/2008, 36.3%) in their EHR compared with the somatic health care group (1867/7086, 26.35% and 826/7086, 11.66%, respectively). Mental health care respondents in hospital inpatient settings were more likely to identify errors (398/588, 67.7%; P<.001) and omissions (251/588, 42.7%; P<.001) than those in outpatient care (errors: 422/837, 50.4% and omissions: 336/837, 40.1%; P<.001) and primary care (errors: 32/100, 32% and omissions: 29/100, 29%; P<.001). Hospital inpatients also reported feeling more offended (344/588, 58.5%; P<.001) by certain content in their EHR compared with respondents in primary (21/100, 21%) and outpatient care (287/837, 34.3%) settings. Our qualitative findings showed that both mental and somatic health care respondents identified the most serious errors in their EHR in terms of medical history, communication, diagnosis, and medication. Most mental and somatic health care respondents showed a positive attitude toward PAEHRs. However, mental health care respondents, especially those with severe and chronic concerns, expressed a more critical attitude toward certain content in their EHR compared with somatic health care respondents. A PAEHR can provide valuable information and foster trust, but it requires careful attention to the use of clinical terminology to ensure accurate, nonjudgmental documentation, especially for persons belonging to health care groups with unique sensitivities.

Global inequalities in mental health problems: understanding the predictors of lifetime prevalence, treatment utilisation and perceived helpfulness across 111 countries

Socio-economic inequalities in mental health problems are found in measures covering prevalence, treatment utilisation, and treatment helpfulness. However, whether these inequalities exist globally and what factors explain between-country variation is unclear. We use a nationally representative individual-level survey dataset (Wellcome Global Monitor, 2020) in 111 countries (N = 117,088) to test if socio-economic factors (household income, education), psycho-social factors (stigma perception, trust in health professionals) and country-level factors (GDP, Gini, health expenditure) predict (1) self-reported lifetime prevalence of anxiety and depression symptomology, (2) treatment utilisation and (3) perceived treatment helpfulness talking to a mental health professional and taking prescribed medication. Multi-level logistic regression models were used. Across both HICs and LMICs, being in the richest income quintile within each country is associated with a lower probability of experiencing symptoms of anxiety and depression compared to the poorest quintile (OR = 0.67 CI[0.64–0.70]), as well as a higher probability of talking to a mental health professional (OR = 1.25[1.14–1.36]), and of perceiving this treatment as very helpful (OR = 1.23[1.07–1.40]). However, being among the richest income quintile is not associated with taking prescribed medication (OR = 0.97[0.89–1.06]) and its perceived helpfulness (OR = 1.06[0.94–1.21]) across all countries. Trust in health practitioners is associated with higher mental health professional utilisation (OR = 1.10[1.06–1.14]) and helpfulness (OR = 1.32[1.25–1.40]). This analysis reveals a global ‘triple inequality in mental health’, whereby disadvantages of lower SES individuals persist in three outcomes (lifetime prevalence, treatment utilisation and helpfulness). Treatment utilisation and helpfulness also vary by trust in healthcare professionals and treatment type. Policymakers must address all three inequalities and their fundamental causes.

Trust in healthcare professionals of people with chronic cardiovascular disease.

Trust is an essential phenomenon of relationship between patients and healthcare professionals and can be described as an accepted vulnerability to the power of another person over something that one cares about in virtue of goodwill toward the trustor. This characterization of interpersonal trust appears to be adequate for patients suffering from chronic illness. Trust is especially important in the context of chronic cardiovascular diseases as one of the main global health problems. The purpose of the qualitative study was to gain a deeper understanding of how people with chronic cardiovascular disease experience and make sense of trust in healthcare professionals. Eleven semi-structured interviews with participants analysed using interpretative phenomenological analysis to explore in detail their lived experience of trust as a relational phenomenon. Participants with chronic cardiovascular disease were purposively recruited from inpatients on the cardiology ward of the university hospital located in central Slovakia. The study was approved by the faculty ethics committee. Participants gave their written informed consent. Sense of co-existence; Belief in competence; Will to help; Ontological security with eight subthemes were identified. The findings describe the participants' experience with trust in healthcare professionals as a phenomenon of close co-existence, which is rooted in the participants' vulnerability and dependence on the goodwill and competence of health professionals to help with the consequence of (re)establishing a sense of ontological security in the situation of chronic illness. Findings will contribute to an in-depth understanding of trust as an existential dimension of human co-existence and an ethical requirement of healthcare practice, inspire patient empowerment interventions, support adherence to treatment, and person-centred care.

COVID-19 Vaccination Willingness and Reasons for Vaccine Refusal

Hong Kong was held as an exemplar for pandemic response until it recorded the world's highest daily COVID-19 mortality, which was likely due to vaccine refusal. To prevent this high mortality in future pandemics, information on underlying reasons for vaccine refusal is necessary. To track the evolution of COVID-19 vaccination willingness and uptake from before vaccine rollout to mass vaccination, to examine factors associated with COVID-19 vaccine refusal and compare with data from Singapore, and to assess the population attributable fraction for vaccine refusal. This cohort study used data from randomly sampled participants from 14 waves of population-based studies in Hong Kong (February 2020 to May 2022) and 2 waves of population-based studies in Singapore (May 2020 to June 2021 and October 2021 to January 2022), and a population-wide registry of COVID-19 vaccination appointments. Data were analyzed from February 23, 2021, to May 30, 2022. Trust in COVID-19 vaccine information sources (ie, health authorities, physicians, traditional media, and social media); COVID-19 vaccine confidence on effectiveness, safety, and importance; COVID-19 vaccine misconceptions on safety and high-risk groups; political views; and COVID-19 policies (ie, workplace vaccine mandates and vaccine pass). Primary outcomes were the weighted prevalence of COVID-19 vaccination willingness over the pandemic, adjusted incidence rate ratios, and population attributable fractions of COVID-19 vaccine refusal. A secondary outcome was change in daily COVID-19 vaccination appointments. The study included 28 007 interviews from 20 waves of longitudinal data, with 1114 participants in the most recent wave (median [range] age, 54.2 years [20-92] years; 571 [51.3%] female). Four factors-mistrust in health authorities, low vaccine confidence, vaccine misconceptions, and political views-could jointly account for 82.2% (95% CI, 62.3%-100.0%) of vaccine refusal in adults aged 18 to 59 years and 69.3% (95% CI, 47.2%-91.4%) of vaccine refusal in adults aged 60 years and older. Workplace vaccine mandates were associated with 62.2% (95% CI, 9.9%-139.2%) increases in daily COVID-19 vaccination appointments, and the Hong Kong vaccine pass was associated with 124.8% (95% CI, 65.9%-204.6%) increases in daily COVID-19 vaccination appointments. These findings suggest that trust in health authorities was fundamental to overcoming vaccine hesitancy. As such, engendering trust in health care professionals, experts, and public health agencies should be incorporated into pandemic preparedness and response.

Recognising socio-cultural barriers while seeking early detection services for breast cancer: a study from a Universal Health Coverage setting in India

BackgroundBreast cancer is the commonest cancer among women in India, yet the uptake of early detection programs is poor. This leads to late presentation, advanced stage at the time of diagnosis, and high mortality. Poor accessibility and affordability are the most commonly cited barriers to screening: we analyse socio-cultural factors influencing the uptake of early detection programmes in a Universal Health Coverage (UHC) setting in India, where geographical and financial barriers were mitigated.MethodsTwo hundred seventy-two women engaging in an awareness-based early detection program were recruited by randomization as the participant (P) group. A further 272 women who did not participate in the early detection programme were recruited as non-participants (NP). None of the groups were previously screened for breast cancer. Interviews were conducted using a 19-point questionnaire, consisting of closed-ended questions regarding demographics and social, cultural, spiritual and trust-related barriers.ResultsThe overall awareness about breast cancer was high among both groups. None of the groups reported accessibility-related barriers. Participants were more educated (58.09% vs 47.43%, p = 0.02) and belonged to nuclear families (83.59% vs 76.75%, p = 0.05). Although they reported more fear of isolation due to stigma (25% vs 14%, p = 0.001), they had greater knowledge about breast cancer and trust in the health system compared to non-participants.ConclusionsThe major socio-cultural barriers identified were joint family setups, lower education and awareness, and lack of trust in healthcare professionals. As more countries progress towards UHC, recognising socio-cultural barriers to seeking breast health services is essential in order to formulate context-specific solutions to increase the uptake of early detection and screening services.

Sex trafficking survivors' experiences with the healthcare system during exploitation: A qualitative study.

While most individuals who have experienced sex trafficking will seek medical attention during their exploitation, very few will be identified by healthcare professionals (HCP). It constitutes a lost opportunity to provide appropriate support, resources, and services. In this study, we examined the experiences of accessing care of sex trafficking survivors in the Greater Montreal area and their interactions with HCPs to inform trafficking education programs for HCPs and allied health professionals regarding the needs of this patient population. We conducted seven semi-structured in-depth interviews with purposively selected sex trafficking survivors participating in "Les Survivantes," a program of the SPVM (Service de Police de la Ville de Montréal), designed to support trafficked individuals' exit journey. We used interpretive description to understand the lived experiences of trafficked individuals with direct applications to clinical education and care. Our results revealed that trafficked individuals accessing care present with a fragile trust in HCPs and how HCPs have many opportunities to conduct comprehensive examinations and query trafficking. Trafficked individuals' initial trust in HCPs can be strengthened by non-judgemental approaches or damaged by stigmatizing conduct, serving to isolate further and alienate this patient population. Health professionals' attitudes combined with healthcare settings' cultures of care (i.e., community vs emergency) and exposure to marginalized groups were key influencers of survivors' perception of healthcare interactions. The findings also emphasized the importance of routinely querying trafficking through sensitive psychosocial questioning based on observation of trafficking cues. Survivors reported a list of trafficking cues to recognize and emphasized the importance of trust as a condition of disclosure. Finally, survivors identified the need for exit planning to be centered around trafficked individuals' agency and holistic needs, and for streamlined community-based multidisciplinary collaboration to better serve this population. Our results highlight that most challenges experienced by trafficking survivors in accessing care and resources are modifiable through HCP education and training. Our study also provides new insights and concrete advice to improve care and support throughout the exiting process. We argue that healthcare services for this population be modeled harm reduction approaches that focus on victims' agency and needs, independent of their desire to exit trafficking. We emphasize the urgent need for proper case management and intersectoral and multidisciplinary care coordination in community-based settings as well as facilitated access to mental health support.

“Oh! How Modern! And... Are You Ok with That?”: Consensually Non-Monogamous People’s Experiences When Accessing Sexual Health Care

ABSTRACT The current research explored consensually non-monogamous peoples’ experiences accessing sexual healthcare. Using a mixed method approach, a sample of 67 consensually non-monogamous individuals (48% Polyamorous; 42% Relationship Anarchy/Solo polyamory; 6% Swingers; 4% Uncategorized) reported having significantly lower rates of trust in healthcare professionals compared to standardized scores. Sixty-three percent of participants reported disclosing their relationship status to a clinician when accessing sexual health services, whereas 37% sometimes or never disclosed. Qualitative responses identified that some participants reported a willingness to be open about their relationships, but many chose to “pass” as monogamous to both simplify and streamline their interactions as well as to avoid potential stigma. Participants reported a wide range of experiences with clinicians from those who were accepting and professional, to some who displayed prejudice and withheld treatment. This research outlines some of the experiences and challenges presented to consensual non-monogamists when accessing sexual healthcare as well as providing suggestions for clinicians to help remove some of the barriers to appropriate patient care.

Prevalence, predictors and reasons for COVID-19 vaccine hesitancy: Results of a global online survey

Vaccine hesitancy has the potential to cripple efforts to end the COVID-19 pandemic. Policy makers need to be informed about the scale, nature and drivers of this problem, both domestically and globally, so that effective interventions can be designed. To this end, we conducted a statistical analysis of data from the CANDOUR survey (n = 15,536), which was carried out in 13 countries representing approximately half of the global population. Both pooled and country-level ordered regression models were estimated to identify predictors of vaccine hesitancy and reasons for not getting vaccinated. We found high levels of hesitancy, particularly in high-income countries. Factors driving moderate hesitancy differed from those driving extreme hesitancy. A lack of trust in health care providers was consistently the underlying driver of more extreme hesitancy. Predictors of moderate hesitancy varied across countries, though being younger and female was typically associated with greater hesitancy. While political ideology played a role in vaccine hesitancy in some countries, this effect was often moderated by income level, particularly in the US. Overall, the results suggest that different interventions such as mass-media campaigns and monetary incentives may be needed to target the moderately versus extremely hesitant. The lack of trust in health care professionals that drives extreme hesitancy may reflect deep societal mistrust in science and institutions and be challenging to overcome.

Trusting relationships between patients with non-curative cancer and healthcare professionals create ethical obstacles for informed consent in clinical trials: a grounded theory study

BackgroundClinical trial participation for patients with non-curative cancer is unlikely to present personal clinical benefit, which raises the bar for informed consent. Previous work demonstrates that decisions by patients in this setting are made within a ‘trusting relationship’ with healthcare professionals. The current study aimed to further illuminate the nuances of this relationship from both the patients’ and healthcare professionals’ perspectives.MethodsFace-to-face interviews using a grounded theory approach were conducted at a regional Cancer Centre in the United Kingdom. Interviews were performed with 34 participants (patients with non-curative cancer, number (n) = 16; healthcare professionals involved in the consent process, n = 18). Data analysis was performed after each interview using open, selective, and theoretical coding.ResultsThe ‘Trusting relationship’ with healthcare professionals underpinned patient motivation to participate, with many patients ‘feeling lucky’ and articulating an unrealistic hope that a clinical trial could provide a cure. Patients adopted the attitude of ‘What the doctor thinks is best’ and placed significant trust in healthcare professionals, focusing on mainly positive aspects of the information provided. Healthcare professionals recognised that trial information was not received neutrally by patients, with some expressing concerns that patients would consent to ‘please’ them. This raises the question: Within the trusting relationship between patients and healthcare professionals, ‘Is it possible to provide balanced information?’. The theoretical model identified in this study is central to understanding how the trusting professional-patient relationship influences the decision-making process.ConclusionThe significant trust placed on healthcare professionals by patients presented an obstacle to delivering balanced trial information, with patients sometimes participating to please the ‘experts’. In this high-stakes scenario, it may be pertinent to consider strategies, such as separation of the clinician-researcher roles and enabling patients to articulate their care priorities and preferences within the informed consent process. Further research is needed to expand on these ethical conundrums and ensure patient choice and autonomy in trial participation are prioritised, particularly when the patient’s life is limited.

Vaccine Hesitancy and the Concept of Trust: An Analysis Based on the Israeli COVID-19 Vaccination Campaign.

This paper examines the trust relations involved in Israel's COVID-19 vaccination campaign, focusing on vaccine hesitancy and the concept of 'trust'. The first section offers a conceptual analysis of 'trust'. Instead of analyzing trust in the vaccination campaign as a whole, a few objects of trust are identified and examined. In section two, the Israeli vaccination campaign is presented, and the focus is placed on vaccine hesitancy. In section three, different trust relations are examined: public trust in the Israeli government and health institutions, interpersonal trust in healthcare professionals and experts, trust in the pharmaceutical companies that make the COVID-19 vaccine, the US FDA, and trust in the new vaccine and the new technology. Through this complexity of trust relations, I argue that it is impossible to completely separate the trust that the vaccine is safe and effective from social aspects of mistrust. Additionally, practices of silencing and censoring the concerns of vaccine hesitaters - both experts and among the public, are pointed out. I contend that these cases further minimize vaccine hesitaters' trust in vaccine-related entities. In contrast, in section four, I suggest the 'trust-based approach': since vaccine hesitancy is not solely the result of knowledge deficiency but also a lack of trust relations, any campaign that addresses vaccine hesitancy should also focus on trust. The advantages of this approach are spelled out. For governments, a discussion based on trust is, ultimately, the best democratic way to encourage hesitaters to take the plunge and get vaccinated.

Exploring Sociocultural Influences On Colorectal Cancer Screening Among Latino Men: Results From a Multi-State Survey

Background: The incidence of and mortality from early-onset colorectal cancer (CRC), which occurs in individuals under age 50 years, have been increasing among Latinos. In 2018, the American Cancer Society endorsed a reduction from 50 to 45 years in the recommended age at which average-risk adults should initiate screening. Methods: We partnered with Qualtrics to recruit a multi-state convenience sample of self-identified Latino men from sources such as targeted email lists and social media. Eligibility criteria include men who: self-identified as Hispanic or Latino, resided in New York, Florida, or Texas, and understood English or Spanish. Survey was fielded from February to March 2022; 1,371 responses collected. Primary exposure was masculinity barriers, measured using validated Masculinity Barriers to Medical Care (MBMC) scale. Additional exposures were two subscales from the Male Role Norms, Attitudes, and Perceptions associated with CRC Screening instrument, as well as Hispanic or Latino ethnicity: (1) Mexican or Mexican American; (2) Cuban; (3) Puerto Rican; (4) Other Hispanic or Latino. Our main outcomes were self-report of CRC screening and fecal immunochemical test. Intention to obtain CRC screening secondary outcome. Preliminary analyses restricted to participants in the 45–59, 60–75 age categories (N = 611). Results: Among participants, 26% were of Mexican descent, 31% were Puerto Rican, 14% Cuban, 29% other Latino background. Eighty-one percent planned to obtain CRC screening in the future, although only 40% have used a fecal immunochemical test, and 51% have ever had a sigmoidoscopy or colonoscopy. Latino men of other Hispanic ethnicity were more likely to report taking risks with their own health if it benefits their family (P = 0.018). Mexican men were least likely to report trust in healthcare professionals (P = 0.002), and Cuban men were most likely to report receiving quality medical care (P = 0.001). Conclusions: Masculinity barriers to medical care may play an important role in screening attitudes, intentions, and behaviors. It is important to understand the roles of intersecting social identities including race, ethnicity, gender identity and norms in reducing colorectal cancer disparities.

A Comparative Study of Patients’ Trust in Physicians and Nurses in COVID-19 and Non-COVID 19 Wards in a Reference Hospital in Tehran, Ira

"Trust in health care professionals is considered as a basis for patients’ care. This study aimed to compare the level of patients' trust in physicians and nurses in both general and COVID-19 wards in a reference hospital in Tehran during the pandemic. This was a cross-sectional descriptive study. The study population comprised patients from Baqiyatallah Hospital in 2022. The data collection tool was the scale of patients’ trust in nurses and the Wake-Forest physician trust scale. Data analysis was performed using SPSS-26 software. The level of patients’ trust in physicians in COVID-19 wards was significantly lower than in Non-COVID-19 wards (P&lt;0.001), but there was no difference between the two groups in the trust of nurses. The lowest level of trust was in the receiving of required information from nurses, which had a lower score compared to other questions in the questionnaire, and the average amount of receiving required information for patients in general wards was significantly lower than that of patients in COVID-19 (P=0.006). Trust in nurses and physicians in both COVID-19 and general wards was optimum. During the COVID-19 pandemic, the medical staff worked tirelessly and despite the difficulties and complications of the pandemic, patients have high trust in physicians and nurses. "

Participation, challenges and needs in children with down syndrome during cancer treatment at hospital: a qualitative study of parents' experiences.

Studies report that it can be challenging to assess and treat side-effects and symptoms among children who have impairments and difficulties in expressing their needs. Children with Down syndrome have an increased vulnerability and an increased risk for contracting leukaemia. There is sparse knowledge about the parental experience of how treatment and side-effects affect children with Down syndrome with leukaemia, as well as the role of participation during treatment. This study aimed to explore the perceptions of parents of children with Down syndrome and leukaemia regarding their child's treatment, side effects and participation during hospital care. A qualitative study design was used, and interviews were conducted with a semi-structured interview-guide. Fourteen parents of 10 children with Down syndrome and acute lymphoblastic leukaemia from Sweden and Denmark, 1-18 years of age, participated. All children had completed therapy or had a few months left before the end of treatment. Data was analysed according to qualitative content analysis. Four sub-themes were identified: (1) Continuously dealing with the child's potential susceptibility; (2) Confidence and worries regarding decisions related to treatment regulation; (3) Challenges in communication, interpretation, and participation; and (4) Facilitating participation by adapting to the child's behavioural and cognitive needs. The sub-themes were bound together in an overarching theme, which expressed the core perception "Being the child's spokesperson to facilitate the child's participation during treatment". The parents expressed this role as self-evident to facilitate communication regarding the needs of the child, but also regarding how the cytotoxic treatment affected the vulnerable child. Parents conveyed the struggle to ensure the child's right to receive optimal treatment. The study results highlight parental challenges regarding childhood disabilities and severe health conditions, as well as communication and ethical aspects regarding to act in the best interests of the child. Parents played a vital role in interpreting their child with Down syndrome. Involving parents during treatment enables a more accurate interpretation of symptoms and eases communication and participation. Still, the results raise questions regarding issues related to building trust in healthcare professionals in a context where medical, psychosocial and ethical dilemmas are present.

Spillover effects of the COVID-19 pandemic on attitudes to influenza and childhood vaccines

The current study sought to determine whether public perceptions of other vaccines and diseases than COVID-19 have been impacted by the COVID-19 pandemic. We longitudinally examined whether there had been a change from before the COVID-19 pandemic to during the pandemic in: (a) influenza vaccination behaviour and intentions; (b) the perceived benefit of childhood vaccines and influenza vaccines; (c) the perceived safety of childhood vaccines and influenza vaccines; (d) the perceived severity of measles and influenza; and (e) trust in healthcare professionals in two samples of Finnish adults (N = 205 in Study 1 and N = 197 in Study 2). The findings showed that during the pandemic, more people than before had received or wanted to receive the influenza vaccine. The respondents also believed that influenza was more dangerous during the pandemic and that vaccinations were safer and more beneficial. On the other hand, for childhood vaccines only perceived safety increased. Finally, in one of the studies, people had more confidence in medical professionals during the pandemic than they had before. Together, these findings imply a spillover of the COVID-19 pandemic on how people view other vaccines and illnesses.

Factors associated with contact tracing compliance among communities of color in the first year of the COVID-19 pandemic

RationaleThe disproportionate impact of COVID-19 on communities of color has raised questions about the unique experiences within these communities not only in terms of becoming infected with COVID-19 but also mitigating its spread. The utility of contact tracing for managing community spread and supporting economic reopening is contingent upon, in part, compliance with contact tracer requests. ObjectiveWe investigated how trust in and knowledge of contact tracers influence intentions to comply with tracing requests and whether or not these relationships and associated antecedent factors differ between communities of color. MethodData were collected from a U.S. sample of 533 survey respondents from Fall (2020) to Spring 2021. Multi-group SEM tested quantitative study hypotheses separately for Black, AAPI, Latinx, and White sub-samples. Qualitative data were collected via open-ended questions to inform the roles of trust and knowledge in contact tracing compliance. ResultsTrust in contact tracers was associated with increased intentions to comply with tracing requests and significantly mediated the positive relationship between trust in healthcare professionals and government health officials with compliance intentions. Yet, the indirect effects of trust in government health officials on compliance intentions were significantly weaker for the Black, Latinx, and AAPI samples compared to Whites, suggesting this strategy for increasing compliance may not be as effective among communities of color. Health literacy and contact tracing knowledge played a more limited role in predicting compliance intentions directly or indirectly, and one that was inconsistent across racial groups. Qualitative results reinforce the importance of trust relative to knowledge for increasing tracing compliance intentions. ConclusionsBuilding trust in contact tracers, more so than increasing knowledge, may be key to encouraging contact tracing compliance. Differences among communities of color and between these communities and Whites inform the policy recommendations provided for improving contact tracing success.