This project examines health professionals integration of genomic medicine in their clinical practice and understanding of the relationships among race, ethnicity, and human genetic variation. The project utilizes five broad approaches to address these issues: (1)The use qualitative methods to explore primary care physicians' knowledge of human genetic variation, beliefs about the relationships among race, genetics, and disease, and views about the future of genomic medicine (2) The development of new measures to assess health professionals knowledge of human genetic variation and use of race in clinical care; (3) The use quantitative and experimental methods to explore primary care physicians', nurse practitioners and nurses knowledge of human genetic variation; use of race in clinical care; beliefs about the relationships among race, genetics, and disease; and attitudes about the future of genomic medicine.
For Aim 1, we have completed 10 focus groups with self-identified black and white general internists. We report in Genetics in Medicine (Bonham et al., 2009; 11:279-286) that both black and white physicians believed that the race of a patient is medically relevant in clinical practice. Some physicians reported that it was important in providing insights into a patients' culture while others stated that it informs their screening decisions (e.g. prostate-specific antigen). Physicians offered conflicting views on the degree of relevance and the specific role of race in clinical decision-making. Our results found that both black and white physicians believe that race is medically relevant, including for therapy decisions, but both groups were reticent to make connections among race, genetics, and disease (Frank et al., JGIM, 2010). All physicians regardless of their own race believed that medical history, family history, and weight were important for making treatment decisions for the patient. However, black and white physicians reported differences in their views about the relevance of race (Snipes et al., BMC Health Services, 2011).
For Aim 2, we have developed a version of the Human Genetic Variation Beliefs and Knowledge Scale (HGVB) and a final version of the Bonham and Sellers Racial Assessment in Clinical Evaluation Scale (RACE Scale).
For Aim 3, we conducted a national survey where we evaluated the final HP GENE Survey with a random sample of 1738 general internists from across the U.S. This is the first survey of its kind to explore physicians understanding of race, genetics, and its use in clinical decision making. A total of 787 general internists completed the survey for a final response rate of 45%. Our confirmatory factor analyses show that the use of Bonham and Sellers Racial Assessment in Clinical Evaluation RACE Scale is an internally reliable measure (Cronbachs alpha = 0.86) of clinicians use of race in assessing genetic predispositions and clinical decision-making (Bonham et al. BMC Health Services Research, 2014). The Phase III survey provided quantitative data regarding the integration of new genomic tests in primary care practice. For example, 18% of the physicians surveyed had received at least one DTC genetic test report from a patient within the previous year. Physicians who received genetics training in residency (p-value < 0.05) as well as physicians who rated their own knowledge of genetics as excellent, very good, or good (p-value <0.01) were more likely to report having received such test results. We identified a positive association between physicians anxiety due to uncertainty in clinical practice and self-reported use of race in medical decision making (Cunningham et al., Medical Care, 2014).
For Aim 4, we conducted a national survey of nurses who are members of racial and ethnic nursing organizations, (Coleman et al., Journal of Nursing Scholarship, 2014) a national nursing organization (Calzone et al. Personalized Medicine, 2013) and national magnet hospitals to evaluate the nurses practice in genomics, and knowledge of human genetic variation and use of the Bonham and Sellers Racial Assessment in Clinical Evaluation RACE Scale.
For Aim 5, we are currently in the field to conduct the Personalized Medicine Decision-Making in a Virtual Clinical Setting Study a national study using a virtual clinical interaction experiment to assess primary care physicians (medical residents) knowledge of human genetic variation beliefs about the relationships among race, genetics, and disease and views and knowledge about the use of genotype-guided drug dosing for warfarin and sertraline.
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