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Principal Investigator: Nao Hagiwara
Organization: VIRGINIA COMMONWEALTH UNIVERSITY
Fiscal Year: 2024
Award: $100,000
Funding agency: National Cancer Institute
Project Summary / Abstract
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 contributes 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.
Terms: <Address><African American><Afro American><Afroamerican><Baseline Surveys><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Breast Cancer><COVID-19><CV-19><Cancer Control><Cancer Control Science><Cancers><Caring><Clinical><Clinical assessments><Code><Coding System><Cognitive Discrimination><Communication><Communities><Coronavirus Infectious Disease 2019><Counseling><Counselor><Data><Discrimination><Disparities><Disparity><Educational process of instructing><Empirical Research><Familiar Malignant Neoplasm><Frequencies><Gender Identity><General Population><General Public><Genetic Counseling><Genetic testing for cancer risk><Goals><Guidelines><Healthcare><Hereditary Cancer><Hereditary Malignant Neoplasm><Individual><Instruction><Interview><Investigators><LGBTQ><Lesbian Gay Bi-sexual Transgender Queer><Lesbian Gay Bisexual Transgender Queer><Link><Malignant Breast Neoplasm><Malignant Neoplasms><Malignant Tumor><Malignant Tumor of the Prostate><Malignant neoplasm of prostate><Malignant prostatic tumor><Medical><Minority><Modality><Multi-center studies><Multicenter Studies><Nature><Observation research><Observation study><Observational Study><Observational research><Outcome><Parents><Patient Care><Patient Care Delivery><Patient Self-Report><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Perception><Personal Satisfaction><Persons><Play><Prejudice><Prevalence><Prevention><Professional counselor><Prostate CA><Prostate Cancer><Prostate malignancy><Prostatic Cancer><Provider><Publications><Race><Races><Racial Group><Recommendation><Reporting><Research><Research Design><Research Methodology><Research Methods><Research Personnel><Researchers><Risk Management><Role><Sampling><Scientific Publication><Self-Report><Sex Orientation><Sexual Orientation><Stereotyping><Study Type><Survey Instrument><Surveys><Teaching><Testing><Therapeutic><Training><Training Programs><Trust><Video Recording><Videorecording><black patient><cancer disparity><cancer genetics><cancer health disparity><cancer risk><cancer-related health disparity><care for patients><care of patients><caring for patients><clinical care><clinical decision-making><clinical encounter><clinical risk><clinician factors><clinician-level factors><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><cost effective><disparities in race><disparity due to race><disparity in cancer><disparity in care><disparity in healthcare><empowerment><experience><familial cancer><gene testing><gene-based testing><genetic counselor><genetic predictors><genetic testing><health care><health care disparity><health care inequality><health care inequity><healthcare disparity><healthcare inequality><healthcare inequity><improved><inequality due to race><inequity due to race><malignancy><malignant breast tumor><microaggression><minority patient><neoplasm/cancer><non-heterosexual><nonheterosexual><pandemic><pandemic disease><parent><patient oriented outcomes><patient population><patient response><patient specific response><patient-clinician communication><patient-doctor communication><patient-provider communication><patients from minority><patients of minority><physician factors><physician-level factors><prevent><preventing><programs><provider factors><provider-level factors><race based disparity><race based inequality><race based inequity><race bias><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial bias><racial disparity><racial inequality><racial inequity><racial origin><racial population><racial prejudice><racial subgroup><racially unequal><research and methods><responsive patient><satisfaction><secondary analysis><sex><social role><study design><telehealth><testing uptake><trans*><transgender><video recording system><well-being><wellbeing>