||1R01CA263501-01A1 Interpret this number
||Virginia Commonwealth University
||Racial Disparities in Cancer Genetic Counseling Encounters in the Naturalistic Clinical Setting
Despite 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 the 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. The overarching
goal of this proposed research is to compare and contrast the nature of genetic counseling encounters and
patient-centered outcomes between Black and White patients in the naturalistic clinical setting. 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
contribute to these racial healthcare disparities is racial bias. Drawing on findings from prior research, we
hypothesize that genetic counselor providers' greater implicit racial prejudice will be associated with poorer
patient-provider communication, while providers' explicit negative racial stereotypes will be associated with
less comprehensive clinical discussion of cancer risk and genetic testing for Black (vs. White) patients. These
disparities in encounters will be further associated with poorer patient-centered outcomes. We will test our
hypotheses by addressing four specific aims: Aim 1) to compare/contrast the nature of patient-provider
communication by patient race (Black or White); Aim 2) to compare/contrast the clinical discussion content by
patient race; Aim 3) to quantify the role of each type of counselor bias in patient-provider communication (Aim
1) and clinical discussion content (Aim 2); and Aim 4) to quantify the role of patient-provider communication/
clinical discussion content with patient-centered outcomes (trust, satisfaction, therapeutic alliance,
empowerment, genetic testing uptake). These aims will be achieved through an observational study with a
convergent mixed methods research design. We will analyze recorded cancer genetic counseling encounters
both qualitatively and quantitatively, linking those data to data from pre- and post-encounter surveys and
medical chart reviews. With COVID-19, many genetic counseling encounters have moved to telehealth, and
telehealth is expected to continue to thrive beyond the pandemic. The proposed study will embrace this
unique, transitional opportunity and addresses the overarching goal in the naturalistic clinical setting through
multiple modalities (in-person, telehealth). Findings from this multi-center study will highlight specific aspects of
cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are
directly associated with patient-centered outcomes. Patient-provider communication and clinical
recommendations are modifiable factors, and they are already being taught in genetic counseling training
programs; thus, the findings can have immediate impact on genetic counseling training and practice.
Implicit and explicit racial prejudice and stereotyping toward Black (vs. White) Americans: The prevalence and variation among genetic counselors in North America.
, Duffy C.
, Quillin J.
Journal of genetic counseling, 2023 Apr; 32(2), p. 397-410.