ORIGINAL PAPER Differences in Treatment-Based Beliefs and Coping Between African American and White Men with Prostate Cancer Colleen DiIorio • K. Steenland • M. Goodman • S. Butler • J. Liff • P. Roberts Published online: 24 November 2010 Ó Springer Science+Business Media, LLC 2010 Abstract The purpose of the study was to explore racial differences related to treatment-based beliefs (trust in physician, physician bias, access to care, and self-efficacy) and coping (religious coping and social support). The study was conducted in a 33-county area located in southwest Georgia (SWGA). Men living in SWGA and newly diag- nosed with prostate cancer were invited to participate in the study. Men were also required to be 75 years of age or younger at the beginning of the study and free of dementia. In collaboration with the Georgia Cancer Registry, poten- tially eligible participants were identified through pathol- ogy reports. Participants completed three interviews during a 12-month period post-diagnosis. The 320 participants in this analysis ranged in age from 44 to 75 years with a mean age of 63 years, and 42% were African American. After controlling for confounders, African American participants were more likely to report physician bias, financial prob- lems with access to care, and use of religious coping strategies. These results, based on a largely rural patient population, support those of other studies noting differ- ences in perception of care, access to care, and coping strategies between African American and white men with prostate cancer. Keywords African American Á Beliefs Á Coping Á Prostate cancer Á Rural Introduction Prostate cancer is the second most common cancer affecting men in the United States [1]. Most men are diagnosed with localized disease, which is associated with an excellent chance of survival; however, racial dif- ferences exist in both incidence and mortality [1]. Researchers have noted that the incidence of prostate cancer is highest among African American men who are likely to be diagnosed at a more advanced stage of the disease and are more likely to die from prostate cancer than white men [1]. Despite these differences, some researchers have noted that prostate cancer does not appear to be more aggressive in African American males [2], and when treated early, the outcomes for African American and white men are similar [3]. While further research will help determine the burden of prostate cancer among African American men, several investigators have begun to explore personal, institutional, and societal factors to help explain the differences in morbidity and mortality between African Americans and Whites. Beliefs about the health care system including mistrust of health care professionals, poor patient-physi- cian communication, and limited access to care can con- tribute to delays in seeking care and ineffective use of the health care system [2, 4–6]. System factors such as lack of continuity of care and seeing different physicians have been linked to fewer screenings for prostate cancer [7]. And societal factors, such as a history of discriminatory experiences and perceived racism in healthcare have been associated with medical mistrust, underutilization of health services, delays in seeking medical care, and poor adher- ence to medical recommendations [5, 8, 9]. Recent studies show that African Americans tend to report higher levels of mistrust of the health care system, rate experiences with C. DiIorio (&) Á K. Steenland Á M. Goodman Á S. Butler Á J. Liff Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA e-mail: cdiiori@sph.emory.edu P. Roberts Phoebe Putney Hospital, Albany, GA, USA 123 J Community Health (2011) 36:505–512 DOI 10.1007/s10900-010-9334-6