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

描述(由申请者提供)：遗传知识正日益成为了解和解决人类健康和疾病的核心。为了促进医学知识转化为有效的实践，重要的是了解目前临床医生和患者是如何理解遗传知识的，并将其应用于他们的日常医疗接触中。基因信息已经从抽象的实验室研究领域转化为临床实践和日常生活的实际背景。与此同时，人们对了解和缓解影响美国某些种族/民族人口的不平等疾病负担非常感兴趣。研究表明，健康差距在很大程度上是由非遗传因素造成的，如社会经济地位、种族歧视、医疗保险不足以及不平等地暴露在环境危害中。尽管如此，许多人认为，基因研究是解释和解决种族/民族健康差距的关键。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，这些都还没有得到仔细的研究。利用开放式访谈和参与者观察的定性研究技术，拟议的研究将探索一组初级保健临床医生和他们的患者如何理解和解释两种对种族/少数族裔有不同影响的突出慢性疾病的遗传和非遗传基础：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。比较定性分析将被用来产生这些临床医生和他们的患者解释和应用遗传信息的具体方式。这项研究将以对初级保健临床医生的全国调查结束，旨在测试定性结果的概括性，并检查分析中出现的任何假设。我们的具体目标是：1)了解为少数族裔人口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)在临床医生对这些对少数民族人群有不同影响的常见慢性病的病因和治疗的理解中，了解遗传因素与非遗传因素的性质。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)产生关于如何有效地向临床医生和患者介绍新兴遗传学科学的知识，以促进对遗传知识的适当解释和应用，同时避免可能的误解和种族/民族定型观念。公共卫生相关性：随着遗传学日益成为医疗保健的核心，显然有必要更好地理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疾病的遗传知识尤其重要，因为这些疾病对少数族裔人口造成了不成比例的影响。这个项目将有助于临床医生和患者在日常临床接触中使用遗传学概念，这将有助于更好地理解新兴遗传学知识如何有效地向临床医生和患者展示，同时避免可能的误解和种族/民族成见。

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.