BIOBEHAVIORAL RESEARCH IN PUBLIC HEALTH GENETICS

描述（由申请人提供）：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知情和参与对话的需求。拟议的工作将促进对患者和专业对话方式的过程和内容的深入了解，以及对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种遗传标记的基因检测结果的交流，以及对其对家庭健康的影响的讨论。具体目标应用一个严格的和经过良好验证的行为编码和分析系统，用于患者-提供者沟通（Roter互动分析系统），以讨论这些“多重”基因测试结果（目标1）；确定经常使用的患者-提供者沟通策略（例如，情绪和信息沟通）（目标2）；评估其对患者报告的关键结果的影响（目标3）。行为编码具有高度功能性和生态有效性。在这里，它将被用来识别先行刺激和控制后果的医疗对话。这项工作将通过申请人（肿瘤学和儿科副教授Kenneth Tercyak）的行为编码和对接受多重基因检测的患者进行提供者主导的教育课程录音的分析来完成。基于在遗传性乳腺癌/卵巢癌遗传咨询/测试方面的成功研究生涯，他和该项目的导师（健康、行为与社会、医学和护理学教授Debra Roter和公共卫生遗传学社会与行为研究首席和高级研究员Colleen McBride）要求获得1年的保护时间，以加速转变并深化患者-提供者沟通和公共卫生遗传学的研究重点。这样做需要在行为互动理论、评估和分析方法、健康沟通和常见复杂疾病的遗传学方面进行额外的课程学习、培训和指导。公共卫生影响：对基因在健康中的作用所知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。这些机遇带来了以清晰、安全和有效的方式传达遗传风险信息的挑战。该奖项为注重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常见病的转变，并根据患者和提供者之间的对话中更多的现实需求和要求来计划和实施干预措施。利用新的研究工具和方法，这项工作将促进发现更清晰的遗传健康交流渠道。

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.