Abstract P1-11-01: Patients' perspectives on using a genomic test for their breast cancer treatment decisions: Disparities in information exchange

Abstract

Abstract Research Objective Genomic tests predicting tumor recurrence risk may help inform treatment decisions and improve quality of care. Yet differences in information exchange and patient decision style about genomic tests may further exacerbate disparities in care, particularly if recommendations conflict with patients’ preferences or other prognostic information. This study looks at the information exchange between patients and physicians and patients’ preferences in decision-making in the context of receiving a genomic test for early-stage breast cancer. Study Design Retrospective study of women covered by a large national health insurer, who had received the most common, commercial genomic test for early-stage breast cancer prognosis. All eligible minority women (n=705) and a random sample of eligible white women (n=719) matched by age category, geography and diagnosis year, were invited to a mailed survey later linked to claims data. We used random-effects logistic regression models (cluster=state) to examine the association of patient self-reported race/ethnicity with 3 outcomes: 1) knowledge of being tested; 2) patient decision style (assessed with the Control Preference Scale and categorized as active (patient-based), shared, or passive (physician-based); 3) amount of information received on the test. Models were adjusted by patient age, education, income, family structure/support, year of testing, and plan type. Population Studied Privately insured women aged 64 years old or less, enrolled for at least 9 continuous months, with an insurance claim for the genomic test in 2009–2012. Principal Findings The 62% response rate yielded 896 respondents, including 108 Hispanics, 112 Black, 97 Asians, and 549 whites. 10% of the respondents were unaware that they had received the genomic test, with significant differences in this knowledge by race/ethnicity after controlling for age, education and income (OR= 3.8 for Hispanic and OR = 2.7 for Black women compared to White, both p < .010). Decision style was reported predominantly as active (47%) and shared (40%), and varied significantly with age, income, education and race. In particular, Blacks were more likely than Whites to report a passive rather than shared decision (OR = 1.6; p = .065). Black women were also more likely to rate the information received on the test’s clinical significance as insufficient (OR=2.1; p = .001). Conclusions While most women reported more active styles of decision-making, we found significant differences in information exchange that may lower the odds of a well-informed decision for minority patients. Variation in patient reports may reflect variation in understanding and retaining information about the genomic test, or in information delivery by physicians. Citation Format: Catherine Chanfreau-Coffinier, Ninez A Ponce, Patricia A Ganz, Michele Toscano, Joanne Armstrong, Jennifer S Haas. Patients' perspectives on using a genomic test for their breast cancer treatment decisions: Disparities in information exchange [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-01.