Purpose Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment. Patients and Methods Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients’ perceptions of the quality of the physicians’ communication and were used to assess patients’ previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale. Results Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P =.80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P =.02). Black patients, compared with white patients, judged the physicians’ communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients’ perceptions of physicians’ communication were statistically significant (P = .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P = .05) predictors. Conclusion Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients’ lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication.