Racial Differences in BRCA1/2 Testing: Patients or Providers?

BRCA1/2 检测中的种族差异：患者还是提供者？

基本信息

批准号：
8471069
负责人：
PETER W. GROENEVELD
金额：
$ 41.86万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8471069
关键词：
Address Adjuvant Adjuvant Chemotherapy Adjuvant Therapy Adoption Area Attitude Awareness BRCA1 gene BRCA2 gene Cancer Control Cancer Patient Cancer-Predisposing Gene Caring Case-Control Studies Certification Characteristics Clinical Cohort Studies Complex Development Ensure Family Family history of Genetic Genetic Predisposition to Disease Genetic Research Genetic screening method Genomics Health Policy Health Status Health system Healthcare Healthcare Systems Hospitals Individual Insurance Coverage Intervention Lead Link Literature Logistic Regressions Malignant Neoplasms Malignant neoplasm of ovary Minority Modeling Mutation Myocardial Infarction Outcome Patients Performance Physicians Population Predisposition Prevalence Primary Health Care Probability Provider Race Radiation Recommendation Recording of previous events Relative (related person)Research Resources Risk Risk Reduction Sampling Second Primary Cancers Socioeconomic Status Sorting - Cell Movement Source System Techniques Technology Testing Time Translating Variant Woman Work breast lumpectomy cancer genetics cancer risk chemotherapy clinical care clinical practice early onset evidence base health care delivery health care service utilization high risk hormone therapy improved innovation innovative technologies insight malignant breast neoplasm medical specialties mortality population based prospective public health relevance racial difference uptake

项目摘要

DESCRIPTION (provided by applicant): Genetic tests for cancer susceptibility have the potential to reduce cancer mortality by targeting intensive cancer risk reduction interventions to high risk individuals. Testing for mutations in the breast cancer susceptibility genes, BRCA1and BRCA2, is one of the earliest examples of cancer genetic susceptibility testing to become incorporated into clinical practice and be linked to multiple evidence based options for cancer risk reduction. Although recommendations for consideration of BRCA1/2 testing among high risk groups have existed for nearly ten years, evidence suggests that testing uptake has been limited and that substantial racial disparities in testing utilization may exist. Understanding the underlying causes of these disparities is critical for the development of strategies to ensure that advances in genomics are translated into equitable improvements in clinical care. The determinants of utilization of genetic testing are complex and encompass patient, provider and system factors. Although racial disparities in health care have traditionally been traced to differences in patient characteristics or physician bias, a growing body of literature indicates that differences in providers across patient racial groups are an important and often fundamental of health care disparities. Whether the sorting of patients of different races across different providers is an important determinant of racial differences in the use of genetic or genomic technologies is currently not known. In this proposal, we outline a population based, prospective cohort study that will determine the rates of BRCA1/2 testing among Black and White women with early onset breast cancer and investigate the relative contribution of individual patient characteristics ("within provider effects") vs. provider characteristics ("between provider effects") to racial differences in utilization. We will use both multi-level models to examine the contribution of specific patient and provider characteristics and conditional logistic regression and decompositional techniques to determine the relative proportion of the racial difference in testing explained at the patient vs. the provider level. Building on our prior work in this area, we will test specific hypotheses about the contribution of health care related distrust and insurance coverage at the patient level and specific hypotheses about the contribution of attitudes towards innovation and access to resources at the provider level. We will compare these results to the contribution of the same factors to other known racial disparities in breast cancer management, asking whether the patient and provider characteristics that lead to disparities in BRCA1/2 testing also lead to disparities in use of adjuvant therapy and whether a provider's performance on one outcome also predicts their performance on the other outcomes.

描述（由申请人提供）：癌症易感性的基因检测有可能通过针对高风险个体的强化癌症风险降低干预措施来降低癌症死亡率。测试乳腺癌易感性基因BRCA1和BRCA2中的突变是癌症遗传易感性测试的最早实例之一，可以纳入临床实践，并与多种基于证据的降低癌症风险选择有关。尽管已经存在近十年的高风险群体中考虑了BRCA1/2测试的建议，但有证据表明，测试摄取的摄入量是有限的，并且可能存在实质性的种族差异。了解这些差异的根本原因对于制定策略至关重要，以确保基因组学的进步被转化为临床护理方面的公平改善。基因检测利用的决定因素是复杂的，并且包括患者，提供者和系统因素。尽管传统上，医疗保健中的种族差异已被追溯到患者特征或医师偏见的差异，但越来越多的文献表明，跨患者种族群体提供者的差异是医疗保健差异的重要且通常是基本的。目前尚不清楚不同提供者的不同种族患者的分类是否是种族差异的重要决定因素。在该提案中，我们概述了一项基于人群的前瞻性队列研究，该研究将确定患有早期发作乳腺癌的黑人和白人妇女中BRCA1/2测试的速率，并研究了个体患者特征（“提供者效应”）与提供者特征（提供者之间的特征（提供者之间）对种族差异的相对贡献）。我们将使用两种多层模型来研究特定患者和提供者特征以及条件逻辑回归和分解技术的贡献，以确定在患者与提供者水平上解释的种族差异相对比例。在我们在该领域的先前工作的基础上，我们将检验有关患者一级与医疗保健相关的不信任和保险范围的贡献的具体假设，以及有关态度在提供商层面上对创新和获取资源访问的贡献的具体假设。我们将将这些结果与相同因素对乳腺癌管理中其他已知的种族差异的贡献进行比较，询问导致BRCA1/2测试差异的患者和提供者特征是否还会导致使用辅助治疗方面的差异，以及提供者在某种结果上的表现是否还可以预测其他结果的表现。

项目成果

期刊论文数量（7）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Age at diagnosis may trump family history in driving BRCA testing in a population of breast cancer patients.

DOI：
10.1158/1055-9965.epi-13-0426
发表时间：
2013-10
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
影响因子：
0
作者：
Vig HS;McCarthy AM;Liao K;Demeter MB;Fredericks T;Armstrong K
通讯作者：
Armstrong K

Medical oncologists' willingness to participate in bundled payment programs.

DOI：
10.1186/s12913-018-3202-y
发表时间：
2018-05-31
期刊：
BMC health services research
影响因子：
2.8
作者：
Murciano-Goroff YR;McCarthy AM;Bristol MN;Domchek SM;Groeneveld PW;Motanya UN;Armstrong K
通讯作者：
Armstrong K