67 Spirituality and Medical Trust Among Breast Cancer Outpatients in an Urban Safety-Net Setting

Background

Medical mistrust can undermine patient engagement across the breast cancer continuum, influencing communication, treatment adherence, and survivorship care. Spirituality is commonly used for coping in cancer and may shape care perceptions, yet its relationship with medical trust, particularly across race and socioeconomic status, remains unclear. In this survey study, we aimed to evaluate the relationship between spirituality and medical trust in an urban safety-net breast oncology population and assess whether this relationship differed by age, race, and income.

Methods

A cross-sectional survey was administered to 100 English- and Spanish-speaking patients with breast cancer at Boston Medical Center. Ninety-eight had complete responses. Spirituality was measured using the Santa Clara Strength of Faith Questionnaire, and medical trust was assessed via the Trust in Physician Scale, assessing perceived honesty, communication, fairness, and confidence in appropriate care. Sociodemographic and clinical characteristics were self-reported. The association between spirituality and trust was assessed using a linear regression model with stratified models by age, race, and income to understand how the spirituality-trust association differed across groups.

Results

Ninety-eight patients were analyzed. Mean age was 64.5 years (SD, 11.45). The cohort included equal numbers of Black (n = 39) and White (n = 39) participants. Approximately 50 patients reported annual income as less than $40,000, and 35 reported greater than $40,000. Most had early-stage disease (stage I, 56.1%; stage II, 32.7%). Mean trust score was 4.51/5 (SD, 0.67), and mean spirituality score was 3.58/5 (SD, 0.69).

Spirituality was positively associated with trust overall. Among patients younger than 65 years, the association was borderline, whereas for those older than 65 years, the association was not meaningful. Associations were only significant among Black participants and those with income less than $40,000, as compared with White participants and those with income greater than $40,000 (Table).

Conclusion

In this safety-net breast oncology cohort, higher spirituality was associated with higher medical trust. While trust was high overall, the spirituality-trust association was most pronounced among Black and lower-income patients, suggesting that spirituality may be one psychosocial factor linked to trust for patients facing structural vulnerability, consistent with prior literature on spirituality and coping in marginalized cancer populations. Given evidence that mistrust can hinder engagement across the breast cancer care continuum, these findings support prospective studies to test whether spiritually sensitive, culturally responsive supportive care can strengthen trust and related care experiences.