Physicians' knowledge, beliefs, and use of race and human genetic variation: new measures and insights.

Vence L Bonham,Sam Woolford,Sherrill L Sellers

doi:10.1186/1472-6963-14-456

Abstract

BackgroundUnderstanding physician perspectives on the intersection of race and genomics in clinical decision making is critical as personalized medicine and genomics become more integrated in health care services. There is a paucity of literature in the United States of America (USA) and globally regarding how health care providers understand and use information about race, ethnicity and genetic variation in their clinical decision making. This paper describes the development of three scales related to addressing this gap in the literature: the Bonham and Sellers Genetic Variation Knowledge Assessment Index--GKAI, Health Professionals Beliefs about Race—HPBR, and Racial Attributes in Clinical Evaluation—RACE scales.MethodsA cross-sectional, web survey of a national random sample of general internists in the USA (N = 787) was conducted. Confirmatory factor analysis was used to assess the construct validity of the scales. Scale items were developed through focus groups, cognitive interviews, expert advisory panels, and exploratory factor analysis of pilot data.ResultsGKAI was measured as a count of correct answers (Mean = 3.28 SD = 1.17). HPBR yielded two domains: beliefs about race as a biological phenomenon (HPBR-BD, alpha = .69, 4 items) and beliefs about the clinical value of race and genetic variation for understanding risk for disease (HPBR-CD alpha = .61, 3 items). RACE yielded one factor (alpha = .86, 7 items).ConclusionsGKAI is a timely knowledge scale that can be used to assess health professional knowledge of race and human genetic variation. HPBR is a promising new tool for assessing health professionals’ beliefs about the role of race and its relationship with human genetic variation in clinical practice. RACE offers a valid and reliable tool for assessing explicit use of racial attributes in clinical decision making.

Highlights

Understanding physician perspectives on the intersection of race and genomics in clinical decision making is critical as personalized medicine and genomics become more integrated in health care services
New scientific knowledge of human genetic variation is facilitating an understanding of why susceptibility to common diseases varies among individuals and populations often described by race and ethnicity [9]
We developed the Genetic Variation Knowledge Assessment Index (GKAI) to assess physicians’ scientific knowledge of genetic variation, the Health Professionals Beliefs about Race (HPBR) scale to measure health professionals’ beliefs about genetic difference, and the Racial Attributes in Clinical Evaluation (RACE) scale to investigate health professionals’ use of race in clinical practice.a

Summary

Introduction

Understanding physician perspectives on the intersection of race and genomics in clinical decision making is critical as personalized medicine and genomics become more integrated in health care services. There is a paucity of literature in the United States of America (USA) and globally regarding how health care providers understand and use information about race, ethnicity and genetic variation in their clinical decision making. Some researchers argue that racial and ethnic categories can serve as useful variables to investigate the genetic component of disease and patients' responses to treatment, while others contest the utility of race for understanding genetic variation [14,16]. Many are concerned that if physicians rely on race as a proxy for genetic risk, this could exacerbate racial and ethnic healthcare disparities in the USA and may even lead to poorer quality of care for all patients [13,19,20]

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