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Comment & Response
March 4, 2021

Redefining Attribution From Patient to Health System—How the Notion of “Mistrust” Places Blame on Black Patients—Reply

Author Affiliations
  • 1Vanderbilt University Medical Center, Nashville, Tennessee
  • 2Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
JAMA Oncol. 2021;7(5):780-781. doi:10.1001/jamaoncol.2020.8494

In Reply Our study1 found that Black men with prostate cancer indicated less willingness to discuss clinical trials with their physicians than White men and that this racial difference was statistically mediated by greater medical mistrust among Black men in our sample. Borno and colleagues suggest that focusing on medical mistrust blames patients, rather than systemic racism, for disparate health outcomes, reinforcing a deficit-based approach to disparities research. We share their concern. However, we propose that our findings are consistent with a focus on system-level causes and solutions to disparate clinical trial participation.

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