Understanding the Relationships between Race, Ethnicity, Ancestry and Genomics

这个项目考察了卫生专业人员在临床实践中对基因组医学的整合，以及对种族、民族和人类遗传变异之间关系的理解。该项目利用四种广泛的方法来解决这些问题：(1)使用定性的方法来探索初级保健医生对人类遗传变异的知识，对种族、遗传学和疾病之间关系的信念，以及对基因组医学未来的看法(2)开发新的测量方法来评估卫生专业人员对人类遗传变异的知识和在临床护理中使用种族；(3)使用定量和实验方法来探索初级保健医生、执业护士和护士对人类遗传变异的知识；在临床护理中对种族的使用；对种族、遗传学和疾病之间关系的信念；以及对基因组医学未来的态度。(四)运用规范方法探索种族、基因组、健康公平、精准医学。 对于目标1，我们开发了一个版本的人类遗传变异信念和知识量表(HGVB)和一个最终版本的Bonham和Sellers临床评估种族评估量表(RACE量表)。 对于目标2，我们进行了一项全国性调查，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。这是第一次探索医生对种族、遗传学及其在临床决策中的使用的此类调查。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，在临床评估中使用Bonham和Sellers种族评估“种族量表”是临床医生在评估遗传易感性和临床决策时使用种族的内部可靠测量(CronbachsAlpha=0.86)(Bonham等人)。BMC卫生服务研究，2014)。第三阶段调查提供了有关在初级保健实践中整合新的基因组测试的定量数据。例如，18%的受访医生在前一年内从患者那里收到过至少一份DTC基因检测报告。接受住院医师遗传学培训的医生(P-Value&lt；0.05)以及将自己的遗传学知识评为优秀、非常好或良好(P-Value&lt；0.01)的医生更有可能报告收到这样的测试结果。我们发现，由于临床实践中的不确定性而导致的医生焦虑与自我报告的在医疗决策中使用种族之间存在正相关(Cunningham等人，医疗保健，2014)。 对于目标3，我们对普通内科医生(2010-2012年)、种族和民族护理组织成员的护士(Coleman等人，《护理奖学金杂志》，2014)和国家护理组织(Calzone等人)进行了一项全国性调查。个人化医学，2013)和国家磁石医院，以评估护士在基因组学方面的实践，人类遗传变异的知识，以及在临床评估中使用Bonham和Sellers种族评估的“种族量表”。在我们对来自三个独立研究的护士的研究中，我们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，以衡量来自美国各地的护士对种族的明确临床使用。对5733名注册护士进行了多元回归分析，以检验种族得分与个体特征和信念之间的关系。分析显示，种族得分与护士的种族、种族、教育水平以及对患者人口统计特征的临床重要性的看法之间存在显著的关系。(Sellers等人)J护理奖学金，2016)我们在2019年发表了一项对护士从业者的研究结果，我们发现最终的多变量模型，NPs的平均种族得分比医生的得分高1.60分(P=.03)。Abdallah Ke，et al.种族和疾病，2019年) 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从业者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.