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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)：癌症易感性的基因测试有可能通过针对高危个体的密集癌症风险降低干预措施来降低癌症死亡率。乳腺癌易感基因BRCA1和BRCA2的突变检测是癌症遗传易感性测试进入临床实践的最早例子之一，并与降低癌症风险的多种循证选择相联系。尽管在高危人群中考虑BRCA1/2检测的建议已经存在了近十年，但有证据表明，检测的接受程度有限，检测利用方面可能存在很大的种族差异。了解这些差异的根本原因对于制定战略至关重要，以确保基因组学的进步转化为临床护理的公平改善。利用基因检测的决定因素是复杂的，包括患者、提供者和系统因素。尽管卫生保健方面的种族差异传统上被追溯到患者特征或医生偏见的差异，但越来越多的文献表明，不同患者种族群体之间提供者的差异是卫生保健差异的一个重要且往往是根本的因素。目前尚不清楚不同提供者对不同种族的患者进行分类是否是使用遗传或基因组技术时种族差异的重要决定因素。在这项建议中，我们概述了一项基于人群的前瞻性队列研究，该研究将确定在患有早发性乳腺癌的黑人和白人女性中进行BRCA1/2测试的比率，并调查个体患者特征(“提供者内部效应”)与提供者特征(“提供者之间效应”)对利用方面的种族差异的相对贡献。我们将使用多水平模型来检验特定患者和提供者特征的贡献，并使用条件Logistic回归和分解技术来确定在患者和提供者层面上解释的测试中种族差异的相对比例。在我们以前在这一领域的工作的基础上，我们将测试关于患者层面上与医疗保健相关的不信任和保险覆盖面的贡献的具体假设，以及关于提供者层面上对创新和获得资源的态度的贡献的具体假设。我们将把这些结果与乳腺癌治疗中其他已知种族差异的相同因素的贡献进行比较，询问导致BRCA1/2测试差异的患者和提供者的特征是否也导致辅助治疗的使用差异，以及提供者在一个结果上的表现是否也预测他们在其他结果上的表现。

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