My work investigates the impact of the diffusion of genomic information into clinical and public health contexts. I am particularly interested in health disparities, and thus studying genomic communication relevant to diseases or populations that are stigmatized and/or underserved. I examine these issues both in simulated clinical contexts, and online through social media platforms. I currently have several recently completed studies that contribute to these aims. In the clinical context, my colleagues and I mounted a study to assess the benefits and/or risks of a physician introducing obesity genomics information into clinical weight-management encounters (Weight Management Interaction Study; NHGRI protocol # 11-HG-0238). We are interested in how this information will influence patients' health-related attitudes, beliefs, behavior, and patient perceptions of stigmatization. The project also aims to determine whether a physician's patient-centered versus doctor-centered approach to a health care encounter could mitigate or amplify the potential negative and positive consequences of genomic information provision. This study is being conducted in an immersive virtual reality-based clinical simulation in the Immersive Virtual Environment Testing Unit. During this reporting year, we have conducted additional analyses for another planned manuscript. In continuing to examine and inform provision of obesity-related genomic information in clinical encounters, colleagues and I have conducted a study that assesses the impact of patient emotion and racial group on these processes. Emotions such as fear and anger arise in these clinical encounters from sources like receipt of risk information and perceptions of interpersonal treatment. Theoretically, the experience of emotion is expected to influence patient interpretation and reaction to genomic information provided by a physician. In addition, this may interact with participant racial group, given the potential synergistic effects of combining emotion with heightened vigilance for bias as is found among some individuals of historically disadvantaged groups. We have designed a two-pronged approach using both an internet-based and an immersive virtual reality-based simulation experiment to address these processes; a paper generated from this work was accepted for publication during this reporting year. Another study in preparation examines the influence of the provider's apparent weight on potential patients' reaction to the weight-related genomic information she provides. This is an experiment that was planned during this reporting year, for which data will soon be collected. Looking at encounters where genomic information relevant to body weight is discussed from the provider's perspective, during this reporting year we have engaged in coding of a consultation between a medical student and virtual patient exploring verbal behavior relevant to weight stigma and bias. A manuscript from this process is in preparation. In addition to my experimental research related to communication about genomic information in the clinic, I also investigate issues around dissemination of genomic information in online and public health-related contexts. I have fielded a survey assessing individuals' interest in and information seeking behaviors with respect to weight management and genomic information. One paper is published from this project, and two are in preparation. An additional study in this vein assesses genetic understanding and stigma in the context of diabetes. Data for this study have been collected and coding has been completed. One paper is under review and two more are in preparation.
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