Medical Mistrust Influences Black Women's Level of Engagement in BRCA1/2 Genetic Counseling and Testing
Medical Mistrust Influences Black Women's Level of Engagement in BRCA1/2 Genetic Counseling and Testing
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DOI：
10.1016/s0027-9684(15)30081-x
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发表时间：
2013-03-01
影响因子：
3.3
通讯作者：
Tercyak, Kenneth P.
中科院分区：
文献类型：
--
作者：
Sheppard, Vanessa B.;Mays, Darren;Tercyak, Kenneth P.
临床证据支持BRCA 1/2遗传咨询和检测对管理遗传性乳腺癌和卵巢癌风险的价值;然而，BRCA 1/2遗传咨询和检测在黑人妇女中未得到充分利用，使用率低的原因仍然难以捉摸。我们研究了社会文化因素（医学上的不信任，对遗传歧视的担忧）对遗传咨询和检测参与的潜在影响，样本为100名携带BRCA 1/2突变风险增加的黑人妇女。合格的参与者分为3组之一：（1）至少有1名一级亲属患有乳腺癌和/或卵巢癌的健康女性，（2）年龄小于或等于50岁的诊断为乳腺癌的女性，和（3）年龄大于或等于50岁时诊断患有乳腺癌和/或卵巢癌的女性，其有1个一级亲属或2个二级亲属，有乳腺癌和/或卵巢癌的直系亲属。参与者从临床和社区环境中招募，并完成了半结构化面试。使用双变量检验和多变量回归分析检查研究变量关系。正如预期的那样，这个样本中的遗传咨询和检测参与率很低（28%）。在考虑了社会气候因素和自我效能（B = 0.37，p < .001）后，对医学不信任程度高的妇女对遗传咨询和检测的参与程度较低（B =-0.26，p < .01）。需要社区一级和个人的干预措施，以提高利用遗传咨询和检测服务不足的妇女。沿着患者和提供者之间建立信任，这些战略应增强妇女的个人信心。在未来的研究中，应进一步研究医疗不信任对少数群体实现个性化医疗益处的影响。
Clinical evidence supports the value of BRCA1/2 genetic, counseling and testing for managing hereditary breast and ovarian cancer risk; however, BRCA1/2 genetic counseling, and testing are underutilized among black women, and reasons for low use remain elusive. We examined the potential nfluence Of sociocultural factors (medical mistrust, concerns about genetic discrimination) on genetic counseling and testing engagement in a sample of 100 black women at increased risk for Carrying a BRCA1/2 mutation. Eligible participants fell into 1 of 3 groups: (1) healthy women with at least 1 first-degree relative affected by breast and/or ovarian cancer, (2) women diagnosed with breast cancer at age less than Or equal, to 50 years, and (3) women diagnosed with breast and/or ovarian cancer at age greater than or equal to 50 years with either 1 first-degree relative or 2 second-degree relatives With breast and/or ovarian cancer. Participants were recruited from clinical and community settings and completed a semistructured interview. Study variable relationships were examined using bivariate tests and multivariate regression analysis. As expected, genetic counseling and testing engagement among this sample was low (28%). After accounting for socioclemographic factors and self-efficacy (B = 0.37, p < .001), women with higher medical mistrust had lower genetic counseling and testing engage ment (B = -0.26, p < .01). Community-level and individual interventions are needed to improve utilization of genetic counseling and testing among underserved women. Along with trust building between patients and providers, strategies should enhance women's personal confidence. The impact of medical mistrust on the realization of the benefits of personalized medicine in minority populations should be further examined in future studies.