Disparities in uptake of BRCA1/2 genetic testing in a randomized trial of telephone counseling
Disparities in uptake of BRCA1/2 genetic testing in a randomized trial of telephone counseling
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DOI：
10.1038/gim.2014.125
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发表时间：
2015-06-01
影响因子：
8.8
通讯作者：
Schwartz, Marc D.
中科院分区：
文献类型：
--
作者：
Butrick, Morgan;Kelly, Scott;Schwartz, Marc D.
目的：随着遗传咨询和检测越来越全面地融入临床护理，替代性交付模式日益突出。本研究探讨遗传性乳腺癌/卵巢癌的遗传检测高危妇女在一项随机试验中的人与电话为基础的遗传consulting.Methods：方法包括多变量logistic回归和交互analyses.Results：669名参与者，600完成咨询和523收到测试结果的预测。如前所述，随机接受电话咨询的参与者接受测试的可能性显着降低。在意向治疗分析中，完成咨询和检测与以下因素相关：种族/民族（比值比（OR）= 1.96，95%置信区间（CI）：1.20-3.20），感知压力（OR = 0.89，95% CI：0.81-0.98）、知识（OR = 1.12，95% CI：1.02-1.23）和随机分组（OR = 1.48，95% CI：1.01-2.16）。此外，种族/民族缓和随机分组和测试之间的关联;少数民族妇女接受电话咨询是最不可能完成testing.Conclusion：证据的后勤和通信为基础的解释这种相互作用。由于电话遗传咨询服务的普及，总体上有所增加，但应考虑到这也可能导致高风险少数群体妇女的检测率降低。在通过电话提供服务时，应特别注意评估和解决潜在的障碍。
Purpose: As genetic counseling and testing become more fully integrated into clinical care, alternative delivery models are increasingly prominent. This study examines predictors of genetic testing for hereditary breast/ovarian cancer among high-risk women in a randomized trial of in-person versus telephone-based genetic counseling.Methods: Methods include multivariable logistic regression and interaction analyses.Results: Of the 669 participants, 600 completed counseling and 523 received test results. As previously reported, participants randomized to telephone counseling were significantly less likely to be tested. In intention-to-treat analyses, completion of counseling and testing was associated with: race/ethnicity (odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.20-3.20), perceived stress (OR = 0.89, 95% CI: 0.81-0.98), knowledge (OR = 1.12, 95% CI: 1.02-1.23), and randomization group (OR = 1.48, 95% CI: 1.01-2.16). Further, race/ ethnicity moderated the association between randomization group and testing; minority women receiving telephone counseling were least likely to complete testing.Conclusion: Evidence for logistical and communication-based explanations for this interaction is presented. The overall increased access made possible with telephone genetic counseling should be considered in light of the possibility that this may also lead to lower rates of testing among high-risk minority women. Additional care should be taken to assess and address potential barriers when services are delivered by telephone.