Racial disparities in cancer genetic counseling encounters: study protocol for investigating patient-genetic counselor communication in the naturalistic clinical setting using a convergent mixed methods design

BMC Cancer

Study Protocol

Erin P. Carmany¹  Yongyun Shin²  Susan Eggly³  Nadia Harika⁴  John Quillin⁴  Shawn C. T. Jones⁵  Nao Hagiwara⁶ 

[1]Center for Molecular Medicine and Genetics, Wayne State University, 3127 Scott Hall, 540 E. Canfield Ave, 48201, Detroit, MI, USA

[2]Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, One Capitol Square 718, 23298, Richmond, VA, USA

[3]Department of Oncology, Wayne State University, Karmanos Cancer Institute, 4100 John R, 48201, Detroit, MI, USA

[4]Department of Pediatrics, Virginia Commonwealth University, B-011 Box 980270, 1008 East Clay Street, 23219, Richmond, VA, USA

[5]Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, 23284, Richmond, VA, USA

[6]Department of Public Health Sciences, University of Virginia, 200 Jeanette Lancaster Way, 22903, Charlottesville, VA, USA

关键词: Cancer genetic counseling;    Implicit bias;    Explicit bias;    Prejudice;    Stereotyping;    Racial healthcare disparities;    Patient-provider communication;    Clinical discussion;    Black/African American;   

DOI  :  10.1186/s12885-023-11486-x

 received in 2023-09-15, accepted in 2023-10-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDespite decades of effort to reduce racial cancer disparities, Black people continue to die at higher rates from cancer than any other U.S. racial group. Because prevention is a key to the cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing racial cancer disparities is high. However, the benefits of genetic counseling are not equitable across race. Only 2% of genetic counselors self-identify as Black/African American, so most genetic counseling encounters with Black patients are racially discordant. Patients in racially discordant medical interactions tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is racial bias. Drawing on findings from prior research, we hypothesize that genetic counselor providers’ implicit racial prejudice will be associated negatively with the quality of patient-provider communication, while providers’ explicit negative racial stereotypes will be associated negatively with the comprehensiveness of clinical discussions of cancer risk and genetic testing for Black (vs. White) patients.MethodsUsing a convergent mixed methods research design, we will collect data from at least 15 genetic counseling providers, from two different institutions, and their 220 patients (approximately equal number of Black and White patients per provider) whose appointments are for a hereditary cancer condition. The data sources will include two provider surveys, two patient surveys, video- and/or audio-recordings of genetic counseling encounters, and medical chart reviews. The recorded cancer genetic counseling in-person and telehealth encounters will be analyzed both qualitatively and quantitatively to assess the quality of patient-provider communication and the comprehensiveness of clinical discussion. Those data will be linked to pre- and post-encounter survey data and data from medical chart reviews to test our hypotheses.DiscussionFindings from this multi-site study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes (e.g., satisfaction, trust, genetic testing completion). Patient-provider communication and clinical recommendations are modifiable factors that can be integrated into current genetic counseling training curricula and thus can have immediate impact on genetic counseling training and practice.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023