Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Community Health. 2017 Oct;42(5):1044-1061. doi: 10.1007/s10900-017-0339-2.
Despite well-documented benefits of colorectal cancer (CRC) screening, African Americans are less likely to be screened and have higher CRC incidence and mortality than Whites. Emerging evidence suggests medical mistrust may influence CRC screening disparities among African Americans. The goal of this systematic review was to summarize evidence investigating associations between medical mistrust and CRC screening among African Americans, and variations in these associations by gender, CRC screening type, and level of mistrust. MEDLINE, CINAHL, Web of Science, PsycINFO, Google Scholar, Cochrane Database, and EMBASE were searched for English-language articles published from January 2000 to November 2016. 27 articles were included for this review (15 quantitative, 11 qualitative and 1 mixed methods study). The majority of quantitative studies linked higher mistrust scores with lower rates of CRC screening among African Americans. Most studies examined mistrust at the physician level, but few quantitative studies analyzed mistrust at an organizational level (i.e. healthcare systems, insurance, etc.). Quantitative differences in mistrust and CRC screening by gender were mixed, but qualitative studies highlighted fear of experimentation and intrusiveness of screening methods as unique themes among African American men. Limitations include heterogeneity in mistrust and CRC measures, and possible publication bias. Future studies should address methodological challenges found in this review, such as limited use of validated and reliable mistrust measures, examination of CRC screening outcomes beyond beliefs and intent, and a more thorough analysis of gender roles in the cancer screening process.
尽管结直肠癌（CRC）筛查的益处有充分的记录，但非裔美国人接受筛查的可能性较低，CRC 的发病率和死亡率高于白人。新出现的证据表明，医疗不信任可能会影响非裔美国人的 CRC 筛查差异。本系统评价的目的是总结调查非裔美国人医疗不信任与 CRC 筛查之间关联的证据，以及这些关联在性别、CRC 筛查类型和不信任程度方面的差异。从 2000 年 1 月到 2016 年 11 月，我们在 MEDLINE、CINAHL、Web of Science、PsycINFO、Google Scholar、Cochrane 数据库和 EMBASE 中搜索了英语文章。本综述共纳入 27 篇文章（15 篇定量研究、11 篇定性研究和 1 篇混合方法研究）。大多数定量研究表明，较高的不信任评分与非裔美国人较低的 CRC 筛查率相关。大多数研究都在医生层面上研究了不信任，但很少有定量研究在组织层面（即医疗保健系统、保险等）分析了不信任。性别方面的不信任和 CRC 筛查的定量差异不一，但定性研究强调了非裔美国男性对筛查方法的实验和侵入性恐惧是独特的主题。研究的局限性包括不信任和 CRC 措施的异质性，以及可能存在的发表偏倚。未来的研究应解决本综述中发现的方法学挑战，例如不信任和 CRC 措施的使用有限、超越信念和意图的 CRC 筛查结果的检查，以及更全面地分析性别角色在癌症筛查过程中的作用。
