Perceptions of provider's epistemic authority in response to variant of uncertain significance-related recommendations.
Perceptions of provider's epistemic authority in response to variant of uncertain significance-related recommendations.
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DOI：
10.1002/jgc4.1337
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发表时间：
2020-10-08
影响因子：
1.9
通讯作者：
Peterson SK
中科院分区：
文献类型：
--
作者：
Makhnoon S;Mork M;Arun B;Volk RJ;Peterson SK
在临床癌症基因检测中，患者经常会遇到不确定的遗传信息，如不确定意义的变异（VUS）。虽然医疗服务提供者促进患者对VUS相关经验风险及其医学影响的理解，但患者对风险的理解和感知往往不同，并且可能基于主观评价，例如他们对提供者认识权威（EA）的感知。本研究探讨了一个假设，即个人属性更大的EA遗传咨询师（GC）（相比胃肠道肿瘤学家）和供应商谁推荐更积极的VUS相关的建议（相比，不活跃）。在一项析因实验中，在Amazon Mechanical Turk上招募的652名成年参与者被随机分组，阅读结肠癌背景下10种不同类型的VUS相关场景之一（5种推荐类型x 2种提供者类型）。GC归因于比胃肠道肿瘤学家更高的EA（p=<0.001）。积极的建议（全面，检查，错误）归因于较低的EA（M=3.67，SD=0.79）相比，非积极的（备用，忽视）（M=3.89，SD=0.67）（p值=<0.001）。与四个正确的建议相比，错误的建议被认为是最低的EA（平均差异分别为-0.34，-0.45，-0.35，-0.44; p=0.002），当从分析中删除时，正确的积极和不积极建议之间没有差异（3.78 vs 3.89，p=0.095）。归因于GC的EA较高令人鼓舞，这可能是由于公众对遗传咨询行业的认识提高所致。由于各种正确但不完整的VUS相关建议形式，EA缺乏差异，这表明个人可能不知道并因此完全依赖于提供者来处理VUS等复杂的医疗主题。沟通与VUS相关的不确定性需要谨慎和进一步研究，以阐明最佳实践和结果。
Uncertain genetic information such as variants of uncertain significance (VUS) are often encountered by patients in clinical cancer genetic testing. Although healthcare providers facilitate patient’s understanding of VUS-associated empirical risk and its medical implications, patients’ understanding and perceptions of risk often differ and may be based on subjective evaluations such as their perception of provider’s epistemic authority (EA). This study examines the hypothesis that individuals attribute greater EA to genetic counselors (GCs) (compared to gastrointestinal oncologists) and to providers who recommend more active VUS-related recommendations (compared to inactive). In a factorial experiment, 652 adult participants recruited on Amazon Mechanical Turk were block randomized to read one of 10 different types of VUS-related scenarios in the context of colon cancer (5 recommendation types x 2 provider types). GCs were attributed higher EA than gastrointestinal oncologists (p=<0.001). Active recommendations (comprehensive, check back, wrong) were attributed lower EA (M=3.67, SD=0.79) compared to the inactive (stand by, disregard) (M=3.89, SD=0.67) (p-value=<0.001). The wrong recommendation was attributed lowest EA compared to the four correct recommendations (mean difference= −0.34, −0.45, −0.35, −0.44 respectively; p=0.002), which when dropped from the analysis, showed no difference between the correct active and inactive recommendations (3.78 vs 3.89, p=0.095). The higher EA attributed to GCs is encouraging and possibly explained by increased public awareness of the genetic counseling profession. The lack of difference in EA attributed to various correct, yet incomplete forms of VUS-related recommendation indicates that individuals may be unaware of and thus completely rely on providers for complex medical topics like VUS. Communicating VUS-related uncertainty warrants caution and further research to elucidate best practices and outcomes.
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