Department of Medicine, Washington University School of Medicine, St Louis, MO.
Department of Psychiatry, Washington University School of Medicine, St Louis, MO.
J Clin Oncol. 2021 Dec 20;39(36):4020-4028. doi: 10.1200/JCO.21.01426. Epub 2021 Oct 18.
To determine if physicians' self-reported knowledge, attitudes, and practices regarding genetic counseling and testing (GCT) vary by patients' race.
We conducted a nationwide 49-item survey among breast oncology physicians in the United States. We queried respondents about their own demographics, clinical characteristics, knowledge, attitudes, practices, and perceived barriers in providing GCT to patients with breast cancer.
Our survey included responses from 277 physicians (females, 58.8%; medical oncologists, 75.1%; academic physicians, 61.7%; and Whites, 67.1%). Only 1.8% indicated that they were more likely to refer a White patient than refer an African American patient for GCT, and 66.9% believed that African American women with breast cancer have lower rates of GCT than White women. Regarding perceived barriers to GCT, 63.4% of respondents indicated that African American women face more barriers than White women do and 21% felt that African American women require more information and guidance during the GCT decision-making process than White women. Although 32% of respondents indicated that lack of trust was a barrier to GCT in all patients, 58.1% felt that this was a greater barrier for African American women ( < .0001). Only 13.9% believed that noncompliance with GCT is a barrier for all patients, whereas 30.6% believed that African American women are more likely than White women to be noncompliant ( < .0001).
We demonstrated that racial differences exist in oncology physicians' perceived barriers to GCT for patients with breast cancer. This nationwide survey will serve as a basis for understanding physicians' determinants of GCT for African American women and highlights the necessity of education and interventions to address bias among physicians. Awareness of such physician biases can enable further work to address inequities, ultimately leading to improved GCT equity for African American women with breast cancer.
确定医生在遗传咨询和检测（GCT）方面的自我报告知识、态度和实践是否因患者的种族而异。
我们在美国进行了一项全国性的 49 项调查，调查对象为乳腺癌肿瘤医师。我们询问了受访者自身的人口统计学特征、临床特征、知识、态度、实践以及在为乳腺癌患者提供 GCT 方面的感知障碍。
我们的调查包括 277 名医生的回复（女性，58.8%；肿瘤内科医师，75.1%；学术医师，61.7%；白人，67.1%）。只有 1.8%的医生表示，他们更倾向于推荐白人患者而不是非裔美国患者进行 GCT，66.9%的医生认为非裔美国乳腺癌患者接受 GCT 的比率低于白人患者。关于 GCT 的感知障碍，63.4%的受访者表示非裔美国女性比白人女性面临更多的障碍，21%的人认为非裔美国女性在 GCT 决策过程中需要更多的信息和指导。尽管 32%的受访者表示缺乏信任是所有患者接受 GCT 的障碍，但 58.1%的人认为这对非裔美国女性来说是一个更大的障碍（<.0001）。只有 13.9%的医生认为不遵守 GCT 是所有患者的障碍，而 30.6%的医生认为非裔美国女性比白人女性更有可能不遵守（<.0001）。
我们发现，在肿瘤医师对乳腺癌患者接受 GCT 的感知障碍方面存在种族差异。这项全国性调查将为了解医生对非裔美国女性 GCT 的决定因素提供基础，并强调了对医生进行教育和干预以解决偏见的必要性。认识到医生的这种偏见，可以进一步努力解决不平等问题，最终为非裔美国乳腺癌女性改善 GCT 公平性。
