Understanding the Relationships between Race, Ethnicity, Ancestry and Genomics

该项目研究了卫生专业人员在临床实践中整合基因组医学，并了解种族，民族和人类遗传变异之间的关系。该项目采用四种方法来解决这些问题：（1）使用定性方法来探讨初级保健医生对人类遗传变异的知识，对种族，遗传和疾病之间关系的信念，以及对基因组医学未来的看法。（2）开发新的措施来评估卫生专业人员对人类遗传变异的知识和临床护理中种族的使用。（3）采用定量和实验方法探讨初级保健医生、执业护士和护士对人类遗传变异的认识;种族在临床护理中的使用;对种族、遗传和疾病之间关系的信念;以及对基因组医学未来的态度。(4)使用规范方法探索种族，基因组学，健康公平和精准医学。 对于目标1，我们开发了人类遗传变异信念和知识量表（HGVB）的一个版本和临床评价量表（RACE量表）中的博纳姆和塞勒斯种族评估的最终版本。 对于目标2，我们进行了一项全国性调查，在该调查中，我们对来自美国各地的1738名普通内科医生进行了随机抽样，对最终的HP基因调查进行了评估。这是同类调查中第一次探索医生对种族、遗传学及其在临床决策中的应用的理解。共有787名普通内科医生完成了调查，最终回复率为45%。我们的验证性因素分析表明，临床评价中使用博纳姆和塞勒斯种族评估“种族量表”是临床医生使用种族评估遗传易感性和临床决策的内部可靠指标（Cronbachs α = 0.86）（博纳姆等人，BMC Health Services Research，2014）。第三阶段调查提供了关于在初级保健实践中整合新的基因组检测的定量数据。例如，18%的受访医生在过去一年内至少收到过一份DTC基因检测报告。在住院医师中接受过遗传学培训的医生（p值< 0.05）以及将自己的遗传学知识评定为优秀、非常好或良好（p值<0.01）的医生更有可能报告收到了这样的测试结果。我们确定了由于临床实践中的不确定性而引起的医生焦虑与自我报告的在医疗决策中使用种族之间的正相关（Cunningham等人，医疗保健，2014年）。 对于目标3，我们对普通内科医生进行了一项全国性调查（2010-2012年）;护士是种族和民族护理组织的成员，（科尔曼等人，Journal of Nursing Scholarship，2014）、国家护理组织（Calzone et al. Personalized Medicine，2013）和国家磁铁医院，以评估护士在基因组学方面的实践、人类遗传变异的知识以及博纳姆和塞勒斯种族评估在临床评估“种族量表”中的使用。在我们对来自三项独立研究的护士进行的研究中，使用了遗传学和基因组学在护理实践中的调查，其中包括临床评估中的种族属性（RACE）量表，用于测量来自美国各地的护士中种族的明确临床使用。多元回归分析被用来检查种族评分和个人层面的特征和信念之间的关联5,733注册护士。分析显示，种族评分和护士的种族和民族，教育水平，并对患者的人口统计学特征的临床重要性的看法之间的显着关系。（Sellers et al. J Nursing Scholarship，2016）我们在2019年发表了一项针对护士从业者的研究结果，我们发现最终的多变量模型，NP的平均RACE评分比医生的评分高1.60分（P=.03）。（Abdallah KE.，等.种族和疾病，2019） 对于目标4，我们目前正在使用定性和定量研究方法分析从虚拟临床交互实验中收集的数据。我们主要调查1）医生偏见和2）比较遗传知识，在临床环境中使用种族，以及初级保健医生和护士执业学生之间的隐性偏见。

This project examines health professionals integration of genomic medicine in their clinical practice and understanding of the relationships among race, ethnicity, and human genetic variation. The project utilizes four broad approaches to address these issues: (1)The use qualitative methods to explore primary care physicians' knowledge of human genetic variation, beliefs about the relationships among race, genetics, and disease, and views about the future of genomic medicine (2) The development of new measures to assess health professionals knowledge of human genetic variation and use of race in clinical care; (3) The use quantitative and experimental methods to explore primary care physicians', nurse practitioners and nurses knowledge of human genetic variation; use of race in clinical care; beliefs about the relationships among race, genetics, and disease; and attitudes about the future of genomic medicine. (4) The use of normative methods to explore race, genomics, health equity and precision medicine. For Aim 1, we have developed a version of the Human Genetic Variation Beliefs and Knowledge Scale (HGVB) and a final version of the Bonham and Sellers Racial Assessment in Clinical Evaluation Scale (RACE Scale). For Aim 2, we conducted a national survey where we evaluated the final HP GENE Survey with a random sample of 1738 general internists from across the U.S. This is the first survey of its kind to explore physicians understanding of race, genetics, and its use in clinical decision making. A total of 787 general internists completed the survey for a final response rate of 45%. Our confirmatory factor analyses show that the use of Bonham and Sellers Racial Assessment in Clinical Evaluation "RACE Scale" is an internally reliable measure (Cronbachs alpha = 0.86) of clinicians use of race in assessing genetic predispositions and clinical decision-making (Bonham et al. BMC Health Services Research, 2014). The Phase III survey provided quantitative data regarding the integration of new genomic tests in primary care practice. For example, 18% of the physicians surveyed had received at least one DTC genetic test report from a patient within the previous year. Physicians who received genetics training in residency (p-value < 0.05) as well as physicians who rated their own knowledge of genetics as excellent, very good, or good (p-value <0.01) were more likely to report having received such test results. We identified a positive association between physicians anxiety due to uncertainty in clinical practice and self-reported use of race in medical decision making (Cunningham et al., Medical Care, 2014). For Aim 3, we conducted a national survey of general internal medicine physicians (2010-2012); nurses who are members of racial and ethnic nursing organizations, (Coleman et al., Journal of Nursing Scholarship, 2014) a national nursing organization (Calzone et al. Personalized Medicine, 2013) and national magnet hospitals to evaluate the nurses practice in genomics, and knowledge of human genetic variation and use of the Bonham and Sellers Racial Assessment in Clinical Evaluation "RACE Scale". In our study of nurses from three separate studies using the Genetics and Genomics in Nursing Practice Survey, which includes the Racial Attributes in Clinical Evaluation (RACE) scale was used to measure explicit clinical use of race among nurses from across the United States. Multivariate regression analysis was used to examine associations between RACE score and individual-level characteristics and beliefs in 5,733 registered nurses. The analysis revealed significant relationships between RACE score and nurses' race and ethnicity, educational level, and views on the clinical importance of patient demographic characteristics. (Sellers et al. J Nursing Scholarship, 2016) We published in 2019 findings from a study of nurse practitioners, we found that final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians' score (P=.03). (Abdallah KE., et al. Ethnicity and Disease, 2019) For Aim 4, we are currently analyzing data collected from the virtual clinical interaction experiment using both qualitative and quantitative research methods. We are primarily investigating 1) physician bias and 2) comparing genetic knowledge, use of race in a clinical setting, and implicit bias between primary care physicians and nurse practitioner students.