BIOBEHAVIORAL RESEARCH IN PUBLIC HEALTH GENETICS

描述(由申请者提供)：这个短期研究职业发展奖旨在解决与公众就常见复杂疾病的遗传基础进行更多了解和参与的对话的需要。这项拟议的工作将促进对患者和专业人士对话风格的过程和内容的洞察，以及关于8种健康状况(糖尿病、骨质疏松症、心脏病、高胆固醇血症、高血压、肺癌、结肠癌和皮肤癌)的15个遗传标记物的基因测试结果的交流，并讨论其对家庭健康的影响。特定目标将用于患者与提供者交流的严格且经过充分验证的行为编码和分析系统(Roter交互分析系统)应用于关于这些“多路”基因测试结果的对话(目标1)；确定频繁使用的患者与提供者的沟通策略(例如，情感和信息交流)(目标2)；以及评估其对关键患者报告结果的影响(目标3)。行为编码具有很高的功能性和生态有效性。在这里，它将被用来识别医疗对话的前置刺激和控制结果。这项工作将通过申请人(肿瘤和儿科副教授Kenneth Tercyak)对接受多重基因测试的患者的提供者主导的教育会议的录音进行行为编码和分析来完成。在遗传性乳腺癌/卵巢癌遗传咨询/检测的成功研究生涯的基础上，他和这个项目的导师(健康、行为和社会、医学和护理教授Debra Roter和公共卫生遗传学社会和行为研究首席和高级研究员Colleen McBride)请求一年的保护时间，以加速转移和深化患者-提供者沟通和公共卫生遗传学的研究重点。要做到这一点，需要在行为相互作用理论、评估和分析方法、健康传播和常见复杂疾病的遗传学方面进行额外的课程作业、培训和指导。公共卫生影响：已知的基因在健康中作用的变化为人们预防疾病和过上更健康的生活创造了新的机会。随之而来的是以清晰、安全和有效的方式交流遗传风险信息的挑战。该奖项为专注于健康促进的临床行为科学家提供特殊培训，以实现从罕见疾病向更常见疾病的转变，并计划和实施干预措施，以了解患者和提供者之间的对话中更真实的需求和要求。使用新的研究工具和方法，这项工作将推进发现更明确的遗传健康沟通渠道。 公共卫生相关性：作为K18的一部分，我将在健康传播和遗传学的背景下接受基本行为和社会科学研究的额外培训，并将此培训应用于针对普遍健康状况的遗传教育和咨询的过程、分析和结果的试点调查。我将在两个高影响力的研究机构接受指导，他们是这一领域的思想领袖，并获得关键技能，这些技能可以应用于公共卫生遗传学的紧迫问题。

DESCRIPTION (provided by applicant): This short-term Research Career Development Award addresses the need for more informed and engaging dialogs with the public about the genetic basis of common complex diseases. The proposed work will foster insights into the process and content of patient and professional conversational styles and exchanges about genetic test results from a panel of 15 genetic markers for 8 health conditions (diabetes, osteoporosis, heart disease, hypercholesterolemia, high blood pressure, and lung, colon, and skin cancer), and discussion of its implications for family health. The Specific Aims apply a rigorous and well-validated behavioral coding and analytic system for patient-provider communication (the Roter Interaction Analysis System) to conversations about these 'multiplex' genetic test results (Aim 1); identify frequently used patient-provider communication strategies (e.g., emotional and informational communications) (Aim 2), and; assess their influence on key patient-reported outcomes (Aim 3). Behavioral coding is highly functional and ecologically valid. Here, it will be used to identify antecedent stimuli and controlling consequences of medical dialog. This work will be accomplished through the Applicant's (Kenneth Tercyak, Associate Professor of Oncology and Pediatrics) behavioral coding and analysis of audio-recordings of provider-led education sessions with patients who underwent multiplex genetic testing. Building off of a successful research career in genetic counseling/testing for hereditary breast/ovarian cancer, he and the Mentors for this project (Debra Roter, Professor of Health, Behavior, & Society, Medicine, and Nursing, and Colleen McBride, Chief and Senior Investigator of Social & Behavioral Research in Public Health Genetics) request 1 year of protected time to accelerate the shift and deepen the research focus in patient-provider communication and public health genetics. Doing so requires additional coursework, training, and mentoring in behavioral interaction theory, assessment, and analytic methods, health communication, and the genetics of common complex diseases. PUBLIC HEALTH IMPACT: Changes in what is known about the role of genes in heath creates new opportunities for people to prevent disease and lead healthier lives. With these opportunities come challenges in communicating genetic risk information in ways that are clear, safe, and effective. This award provides special training to a clinically- oriented behavioral scientist focusing on health promotion to achieve a shift away from rare diseases toward more common diseases, and to plan and implement interventions that are informed by more real-world needs and demands in conversations among patients and providers. Using new research tools and methodologies, the work will advance the discovery of clearer genetic health communication channels. PUBLIC HEALTH RELEVANCE: As part of this K18, I will take additional training in basic behavioral and social science research in the context of health communication and genetics, and apply this training to a pilot investigation of process, analysis, and outcomes of genetic education and counseling for prevalent health conditions. I will be mentored at 2 high impact research institutions that are thought leaders in this area, and gain critical skills that can be applied to pressing concerns in public health genetics.