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 four 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. (4) The use of normative methods to explore race, genomics, health equity and precision medicine.
For Aim 1, 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 2, 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 3, we conducted a national survey of general internal medicine physicians (2010-2012); 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. In our study of nurses from three separate studies using the Genetics and Genomics in Nursing Practice Survey, which includes the Racial Attributes in Clinical Evaluation (RACE) scale was used to measure explicit clinical use of race among nurses from across the United States. Multivariate regression analysis was used to examine associations between RACE score and individual-level characteristics and beliefs in 5,733 registered nurses. The analysis revealed significant relationships between RACE score and nurses' race and ethnicity, educational level, and views on the clinical importance of patient demographic characteristics. (Sellers et al. J Nursing Scholarship, 2016) For Aim 4, 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. We will also conduct this study among nurse practitioners.
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