Clinicians' Concepts of Racial/Ethnic Differences in the Management of Chronic Il

描述（由申请人提供）：遗传知识对理解和解决人类健康和疾病的方式越来越重要。为了将医学知识转化为有效的实践，了解临床医生和患者目前如何理解遗传知识，并将其应用于日常医疗接触是很重要的。遗传信息已经从实验室研究的抽象世界转化为临床实践和日常生活的实际背景。与此同时，人们对理解和减轻影响美国某些种族/民族人口的不平等疾病负担非常感兴趣。研究表明，健康差异在很大程度上可归因于非遗传因素，如社会经济地位、种族歧视、医疗保险不足和环境危害的不平等暴露。尽管如此，许多人认为基因研究是解释和解决种族/民族健康差异的关键。临床医生如何将遗传知识转化为临床实践，他们如何整合遗传和非遗传疾病的理解，以及患者如何反过来理解这些信息尚未得到仔细研究。采用开放式访谈和参与性观察的定性研究技术，本研究将探讨一组初级保健临床医生及其患者如何理解和解释两种主要慢性疾病的遗传和非遗传基础，这两种疾病对种族/少数民族有不同的影响：糖尿病和心血管疾病。这项研究将检查他们对这些疾病的易感性和管理的理解。比较定性分析将用于产生具体的方式，遗传信息是解释和应用这些临床医生和他们的病人。该研究将以一项全国初级保健临床医生调查结束，旨在测试定性研究结果的普遍性，并检验分析中出现的任何假设。我们的具体目标是：1)了解为少数民族人群服务的临床医生如何解释和应用种族/民族差异的遗传概念。2)了解遗传和非遗传因素在临床医生对这些常见慢性疾病的病因和管理的理解中的本质，这些疾病对少数民族人群的影响是不同的。3)了解患者对这些概念的理解，以及对自身风险、健康状况和治疗责任的理解。4)产生新兴遗传学科学如何有效地呈现给临床医生和患者的知识，促进遗传知识的适当解释和应用，同时避免可能的误解和种族/民族刻板印象。公共卫生相关性：随着遗传学在医疗保健中越来越重要，显然需要更好地了解临床医生如何将遗传知识转化为他们的实践，以及患者如何反过来理解遗传信息。这对于确保适当解释和应用有关对种族/少数民族人口造成不成比例影响的疾病的遗传知识尤其重要。该项目将为临床医生和患者在日常临床接触中使用遗传学概念提供有价值的见解，这将更好地理解如何将新兴的遗传学知识有效地呈现给临床医生和患者，同时避免可能的误解和种族/民族刻板印象。

DESCRIPTION (provided by applicant): Genetic knowledge is becoming increasingly central to the way human health and disease are understood and addressed. In order to advance the translation of medical knowledge into effective practice, it is important to know how genetic knowledge is presently understood by clinicians and patients, and applied in their routine medical encounters. Genetic information is already being translated from the abstracted world of laboratory research to the practical context of clinical practice and everyday life. At the same time, there is great interest in understanding and alleviating the unequal burden of disease affecting certain racial/ethnic populations in the U.S. Research has shown that health disparities are largely attributable to non-genetic factors such as socio-economic status, racial discrimination, inadequate health insurance, and unequal exposure to environmental hazards. Still, many believe that genetic research holds a key to explaining and addressing racial/ethnic health disparities. How clinicians translate genetic knowledge into clinical practice, how they integrate genetic and non-genetic illness understandings, and how patients in turn understand this information has not as yet been carefully studied. Using qualitative research techniques of open-ended interviewing and participant observation, the proposed study will explore how a group of primary care clinicians and their patients understand and interpret the genetic and non-genetic basis of two prominent chronic illnesses which differentially impact racial/ethnic minorities: diabetes and cardiovascular disease. The study will examine their understandings of susceptibility and management of these diseases. Comparative qualitative analysis will be used to generate specific profiles of ways that genetic information is interpreted and applied by these clinicians and their patients. The study will conclude with a national survey of primary care clinicians, designed to test the generalizability of the qualitative findings, and examine any hypotheses emerging from the analysis. Our specific aims are to: 1) Understand how genetic concepts of racial/ethnic difference are interpreted and applied by clinicians serving minority populations. 2) Understand the nature of genetic versus non-genetic factors in clinicians' understandings of the causes and management of these common chronic illnesses, which differentially impact minority populations. 3) Understand patients' interpretations of these concepts and of their own risk, health status and treatment responsibility. 4) Generate knowledge of how emerging genetics science can effectively be presented to clinicians and patients, to promote appropriate interpretation and application of genetic knowledge while avoiding possible misinterpretation and racial/ethnic stereotyping. PUBLIC HEALTH RELEVANCE: As genetics becomes increasingly central to medical care, there is a clear need for better understanding of how clinicians translate genetic knowledge into their practice, and how patients in turn understand genetic information. This is especially important in assuring appropriate interpretation and application of genetic knowledge concerning diseases that disproportionately affect racial/ethnic minority populations. This project will be contribute valuable insight into clinician and patient use of genetics concepts in everyday clinical encounters, which will yield better understanding of how emerging genetics knowledge can effectively be presented to clinicians and patients, while avoiding possible misinterpretation and racial/ethnic stereotyping.