Trust, Mistrust, Distrust and the Patient-Provider Relationship in Cancer: A Systematic Review.
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BACKGROUND: Ensuring that cancer patients have trust in their healthcare provider is important for effective cancer care. However, it has not yet been documented in a systematic review how trust is associated with the larger patient-provider relationship among cancer patients. Additionally, while trust, mistrust, and distrust are often discussed interchangeably, they represent distinct concepts for patient behavior and outcomes. Therefore, this systematic review examined how trust, mistrust, and distrust affect the patient-provider relationship among cancer patients in the United States. METHODS: A systematic search of three databases (PubMed, Scopus, and PsycInfo) was conducted through February 2025. Studies were limited to those that examined current cancer patients in the U.S. and evaluate the impact of trust, mistrust, or distrust on patient-provider relationship. The studies were screened using Rayyan and Covidence. A narrative synthesis approach was used to integrate findings. RESULTS: A total of forty-four studies were included. Many studies assessed patient trust, and trust was associated with perceptions of provider competence and willingness for provider-led decision making. Mistrust and distrust were less frequently studied but were more consistently reported to reduce adherence to medical treatments. A gap in the literature was identified, as no studies exclusively examined pediatric cancer patients, and no studies primarily consisted of individuals identifying as Hispanic, Asian, Native American, or other underrepresented racial and ethnic groups. CONCLUSION: Trust, mistrust, and distrust each uniquely shape cancer patients' relationships with healthcare providers. While trust improves perceptions of providers, it does not always lead to increased engagement or adherence to medical advice. Conversely, mistrust and distrust appear to be more strongly associated with adherence. More research is needed across a wide range of populations and provider types to guide interventions in oncology care.