Exploring the role of acculturation in promoting genetic testing in the Latinx community (417)

Abstract

<b>Objectives:</b> Rates of genetic testing in Latinx women have historically been low. To understand the reason, we evaluated factors contributing to Hispanic/Latinx women's decision to seek out and undergo germline genetic testing. We assessed whether acculturation levels in community members and current patients of a comprehensive cancer center (CCC) gynecologic oncology practice were associated with attitudes toward genetic testing. We hypothesized that mental health, acculturation, and comfort with providers would influence decisions leading to genetic testing in both groups of women. <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 a cancer care center. The survey focused on demographic, financial, psychosocial, and acculturation factors. Validated scales were utilized, including the PHQ-9, GAD-7, and the BASH acculturation scale. <b>Results:</b> Of the 148 surveys collected, half were collected in the clinic and half in community settings; 42% were completed in Spanish and 58% in English. Most participants (54%) were of reproductive age (<50 years old), 22% attended no school in the US, 50% had some college/ vocational education, 16.5% had a BA or more in the US, and 66% had low levels of acculturation. Moreover, 29% of the women were unemployed or did not earn an income, 10% were uninsured, 50% had government-subsidized insurance, and 40% had private insurance. Most (68%) did not carry a diagnosis of cancer. Women with higher acculturation had the higher testing intention (r_s=.54, <i>p</i>=0.001). Older women were more likely to have a cancer diagnosis but less likely to get genetic testing; however, those who had exposure to a cancer diagnosis (self and close to them) were more likely to get tested if they had lower acculturation (r_s=37, <i>p</i>=0.03). There was no correlation between mental health (depression or anxiety) and genetic testing in the overall group. However, women above reproductive age with higher anxiety had higher testing intentions (r_s=.21, <i>p</i>=0.048). Women under 50 with lower acculturation were more likely to have genetic testing intentions if they had a female physician (<i>p</i>=0.02), a Hispanic/Latinx physician (<i>p</i><0.001), or a Spanish-speaking physician (<i>p</i><0.001). <b>Conclusions:</b> Age and acculturation determined if participants were more open to testing, with patterns complicated by exposure to cancer. But for those with lower acculturation, the person to share this information with them mattered (female, Latino, Spanish speaking). Given this sensitive subject, it was important that the women felt comfortable talking/connecting to their providers and trusting the information given. Diversifying the physician pool to reflect the patient population could potentially improve genetic testing rates in the Latinx population. This is especially important in areas with high Latinx populations and high immigration.