Education and context matter when it comes to genetic testing among Latinx women (424)

Abstract

<b>Objectives:</b> Latinx women are known to have significantly lower genetic testing rates compared to non-Hispanic Whites. The focus of the current study was to assess attitudes and intentions toward genetic germline testing of Latinx patients in a comprehensive cancer center (CCC) clinic and community group settings. We evaluated demographics and other contextual variables, such as education level, medical knowledge, family size, social support, and insurance status as drivers for or against obtaining genetic testing. <b>Methods:</b> From February 2020 to September 2020, a survey was offered concurrently to Latinx female patients at a CCC gynecologic oncology practice and members of a Latinx community group unaffiliated with the CCC. The survey focused on demographic, financial, psychosocial, and acculturation factors and genetic testing attitudes and intentions for testing. Validated scales were utilized to conduct the survey, including the PHQ-9 and GAD-7 and the BASH acculturation scale. <b>Results:</b> Total 148 evaluable patient surveys were collected, with 50/50 split between the clinic and community settings. Sixty-one percent of respondents were born outside the United States, 42% of patients conducted the surveys in Spanish, and 58% in English. The mean patient age was 48 years, 68% of patients did not have cancer, 60% of patients were married or living with a partner, 29% had 0-1 children, whereas 25% had four or more children. Those with more children had higher religiosity (r_s = 0.29, <i>p</i> = 0.03) but it did not affect genetic testing intentions. Age by itself did not affect genetic testing intentions; however, if certain barriers were removed, including cost (r_s=. 52, p<.001); social support (r_s = 0.37, <i>p</i>= 0.007); provider characteristics, lack of information (r_s = 0.28, <i>p</i> = 0.002), younger women with lower acculturation were likely to consider testing. Among all women, those who had more schooling outside the US were more likely to consider testing (r_s = +0.32, <i>p</i> = 0.005). For women with lower acculturation and lower education in the US, knowing that they would pass on the gene was a deterrent to getting pregnant (r_s = -0.26. <i>p <</i> 0.03). Women were more likely to have testing intentions if there was a major life event (<i>p</i> = 0.048). For all women, if they thought that they would receive information about genetic testing from a trusted source, they were more open to genetic testing (r_s= +0.32, <i>p</i> = 0.005). <b>Conclusions:</b> Several factors motivated Latinx women recruited from both clinic and community settings to be more open to genetic testing. Higher educational levels in the US resulted in participants being more likely to consider testing. In this heterogeneous, uniquely low-income, low acculturated group of Latinas residing in Southern California, factors associated with willingness to undergo genetic testing differed by acculturation and included the presence of social support, insurance coverage, education, and medical knowledge. Subjects' total number of children did not impact decisions to proceed with genetic testing, although reproductive age and fewer children were predictive of testing.