Abstract
Oncologists’ perceptions of tumor genomic profiling and barriers to communicating secondary hereditary risks to African American patients
APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)
Tumor Genomic Profiling (TGP) is used to identify genetic targets for precision cancer treatments. TGP may also identify secondary hereditary cancer risks, necessitating complex decision support during informed consent. Oncologists are poorly trained in the communication of this information, particularly for patients with low health literacy, poor knowledge of genetics, and high medical mistrust. African American (AA) patients are especially vulnerable, making them an important intervention target.
Methods
We conducted semi-structured interviews with oncologists to assess perceived barriers in AA patients related to communication of secondary hereditary findings detected by TGP. Interviews were reviewed and coded for themes/subthemes.
Results
Nine oncologists from 4 cancer centers in Philadelphia participated: 6 females; 3 Caucasian, 3 Asian, 3 AA. Oncologists rated their knowledge in genomics on par with colleagues, and better than community oncologists. Most felt skilled to explain risks/benefits of TGP for treatment, but 5 felt inadequately informed to discuss hereditary risks. Four felt no special considerations based on race/ancestry should be made when discussing TGP. Conversely, 5 identified medical mistrust, suspicion, exploitation and discrimination as aspects that should be considered. Seven anticipated low literacy and emotional risk in AA as unique to receiving hereditary risk information. Eight agreed physicians need education in genetics and how to convey hereditary results.
Conclusion
Oncologists recognize unique needs and barriers for AAs related to communication of secondary genetic information, but many feel uncertain about how/whether to address these and their skillset to do so. Training is necessary to ensure informed decision making.
Assessment of individual and community needs for health education Communication and informatics Diversity and culture