Relationship Between Patient-Provider Communication About Cannabis and Online Information-Seeking and Healthcare Outcomes Among Cancer Survivors

As medical cannabis gains wider legal and social acceptance in the U.S., understanding its perceived benefits, risks, and patterns of use among cancer survivors, as well as healthcare providers' perspectives, is critical for informing clinical care and improving patient-provider communication. We conducted parallel surveys of cancer survivors (n = 395) and cancer care providers (n = 62) to assess convergent and divergent attitudes, as well as perceived benefits and risks of cannabis. Among survivors, subgroup analyses by cannabis use status (cannabis users vs. never users) examined differences in healthcare utilization, satisfaction, quality of life, mental health, and risk behaviors (e.g., smoking and alcohol use). Overall, attitudes toward medical cannabis were similar across groups; however, providers (25%) were more aware of risks than survivors (8.4%; χ²=13.37, p< .01). Survivors (68.5%) were more comfortable discussing cannabis with providers than providers (46.7%) were with patients (χ²=35.20, p< .01), and providers held more negative views of recreational cannabis (t = 2.20, p=.03). Among survivors, cannabis users (vs. never users) reported higher social well-being but lower physical and emotional well-being, greater healthcare mistrust, and lower healthcare utilization (all ps< 0.05). Compared to non-cannabis using cancer survivors, cannabis-using survivors had higher rates of smoking, vaping, anxiety, and depression, with no differences observed in chronic pain, alcohol use, or sleep quality. These findings highlight gaps in risk awareness and communication between survivors and providers. Improving care will require open, nonjudgmental dialogue supported by clear clinical guidance, along with further research on the long-term and cancer-specific effects of cannabis use.

Background: An increasing number of states have legalized the use of cannabis and its derivatives. As a result, marijuana use is expected to increase among cancer survivors. Research shows that cancer survivors use cannabis to manage a myriad of cancer-related symptoms, including pain and nausea. Despite this, there is limited evidence on how cannabis use among cancer survivors impacts healthcare utilization, healthcare mistrust, and quality of life among cancer survivors. Environmental scanning is needed to inform clinical oncologic outcomes as well as the benefits and risks of cannabis use among cancer survivors. Objectives: To examine differences in healthcare utilization, healthcare mistrust, and quality of life between adult cancer survivors who have ever used cannabis and those who have never used it. Methods: We recruited adults with a history of cancer through Qualtrics online panels for an online survey across all the states with different levels of marijuana laws (e.g., decriminalized and/or medical use only, and fully illegal and/or CBD oil only). We assessed sociodemographic, behavioral, psychological, cancer-related, and treatment-related characteristics, as well as quality of life, healthcare utilization, healthcare mistrust, and cannabis use (e.g., types, duration of use, current/ever use). Results: Based on a total of 747 respondents, 395 were eligible and enrolled in the survey. Nearly one-fourth of participants were non-White (n=103, 26.1%), and 240 (60.8%) were female. Two hundred and forty participants indicated they had ever used cannabis (240/395, 60.8%). Of these, 35% (n=84) were current users of cannabis. Compared to individuals who never used cannabis, ever users had greater healthcare system mistrust (t(257)=2.58, p=.01), underutilized healthcare systems in the last 12 months (e.g., “..had a medical problem but never sought any medical attention about my condition” and “…did not come back for a follow-up appointment that my doctor gave me”) (t(248)=2.83, p=.005), and reported worse physical (t(260)= -3.32, p&amp;lt;.001) and emotional well-being (t(260)= -2.36, p=.02). There was no difference between these two groups (ever users vs. never users) for functional well-being (t(260)= 1.08, p=.28). Discussion: The present study provides empirical evidence on differences between cancer survivors who ever used and never used cannabis. Compared to never users, ever users of cannabis had greater mistrust of the healthcare system, underutilized healthcare, and reported lower physical and emotional well-being. Further studies are needed to examine how cannabis use impacts the long-term health and wellbeing of cancer survivors. Citation Format: Sunny Jung Kim, Ghader Dargahi Abbasabad, Viktor Clark, Susan Hong, Vanessa B. Sheppard. Healthcare underutilization, healthcare mistrust, and quality of life among cancer survivors who use cannabis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2241.

African Americans consistently report higher levels of medical mistrust than their White counterparts. As a result, medical mistrust is considered to be a contributor to racial health disparities. Despite calls to address medical mistrust, few studies have explicitly examined it as a phenomenon of interest; those that have, tended to focus on personal experiences while neglecting vicarious experiences. The current study a) explicitly tests the effects of two types of news story content on reported levels of medical mistrust within an African American adult sample and b) examines two widely used medical mistrust measures. Participants (N = 410) were randomly assigned to view a news story based on a 2 (health care, non-health care) x 2 (racial discrimination, nonracial discrimination) experimental design. Results indicated that individually, both health care content and racial discrimination content increased race-based medical mistrust, but had no effect on general medical mistrust. However, when all four conditions were examined, exposure to health-related racial discrimination stories resulted in higher levels of race-based and general medical mistrust than non-health, nonracial discrimination stories. Findings are discussed in terms of the theoretical and practical implications for health communication scholars.

Racial and Ethnic Discrimination, Medical Mistrust, and Satisfaction with Birth Control Services among Young Adult Latinas.

Purpose: Lung cancer is the leading cause of cancer death in the U.S. Lung cancer screening significantly reduces lung cancer mortality, but national uptake is low (&amp;lt;6%). Black and low-income Americans have higher lung cancer mortality rates and lower lung cancer screening rates than White and high-income Americans, respectively. Lower lung cancer screening uptake among Black and low-income populations may widen existing disparities in lung cancer mortality. Prior studies have found higher levels of medical mistrust among Black and low-income populations, perhaps arising from structural racism and other inequities. Indeed, medical mistrust may reduce cancer screening intentions, but little is known about how health systems can promote lung screening uptake while earning patient trust. To address this gap, this study aimed to identify diverse patient perspectives on increasing equity in lung screening uptake and addressing medical mistrust. Methods: We conducted 20 semi-structured interviews and four focus groups (about four participants per group) with a diverse sample of lung cancer screening-eligible individuals throughout the U.S. (i.e., individuals aged 50-80 years with eligible smoking histories). Interviews and focus groups investigated participant awareness of lung screening, barriers to screening, the role of medical mistrust in screening uptake, and perspectives on equitable screening implementation. We used an iterative inductive/deductive content analysis approach to identify key themes from interview and focus group transcripts. Results: Interview participants (n=20) were 60 years of age on average and had a mean smoking pack-year history of 42.5 years. Half of interview participants identified as Black (50%), slightly more than half of participants had a household income of &amp;lt;$30,000 (55%), and most participants were female (60%). Focus group participants had similar demographics. Most participants were unaware of lung cancer screening but were eager to learn more. As a key barrier, participants discussed that their doctors had never mentioned lung screening, which confused and frustrated participants who had long-term relationships with primary care doctors. Prior negative healthcare experiences (e.g., misdiagnoses and having serious symptoms dismissed by healthcare providers) were also discussed as screening barriers as they engendered mistrust and hesitancy to seek future care. Several Black participants cited personal and vicarious experiences of racism in the healthcare system as key barriers contributing to mistrust and screening hesitancy. Lastly, participants raised several suggestions to promote equitable screening implementation, such as the need to meaningfully engage with communities to raise screening awareness and address cost issues. Conclusions: Lung cancer screening interventions may be more successful if concerted efforts are taken to understand and address medical mistrust. Future work is needed to address the reasons patients may mistrust healthcare providers and systems that deliver lung cancer screening. Citation Format: Jennifer Richmond, Jessica R. Fernandez, Kemberlee R. Bonnet, Maria A. Pena, Allana T. Forde, David G. Schlundt, Consuelo H. Wilkins, Melinda C. Aldrich. Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A116.

Objectives:The contribution of medical mistrust to healthcare utilization delays has been gaining increasing attention. However, few studies have examined these associations among subgroups of Black men (African Americans, Caribbean, and African immigrants) in relation to prostate cancer (PCa). This study addresses this gap by assessing how medical mistrust affects PCa screening behavior and to further understand perceptions of medical mistrust among subgroups of Black men.Methods:This research employs a mixed-methods approach comprising two distinct phases. In Phase 1, a cross-sectional examination was conducted to evaluate the influence of medical mistrust toward healthcare organizations on prostate cancer screening among 498 Black men. In Phase 2, a qualitative investigation was undertaken to delve into the nuances of medical mistrust through six focus groups (n=51) and ten key informant interviews (n=10). Logistic regression and grounded theory methods were employed for data analysis.Results:Quantitative findings unveiled disparities in mistrust among subgroups, with Caribbean immigrants exhibiting higher levels of medical mistrust. Nevertheless, individuals with a family history of PCa showed elevated likelihoods of undergoing screening, despite mistrust. Qualitative results revealed 1) differences in reasons for medical mistrust among Black subgroups, 2) cultural perceptions which influence medical mistrust and medical care seeking, 3) lack of education in relation to PCa that contributes to medical mistrust, 4) negative past experiences and poor provider communication contribute, and 5) when PCa directly affected one’s life, either personally or within the family, there was a recognized importance placed on monitoring one’s risk despite mistrust.Conclusion:While medical mistrust may not significantly deter healthcare utilization among individuals with a family history or diagnosis of PCa, it underscores the variability of medical mistrust and its underlying reasons among different Black subgroups.

BackgroundMedical mistrust is salient among African American women, given historic and contemporary racism within medical settings. Mistrust may influence satisfaction among navigated women by affecting women's preferences and perceptions of their healthcare self-efficacy and their providers' roles in follow-up of abnormal teset results.ObjectivesTo a) examine if general medical mistrust and healthcare self-efficacy predict satisfaction with mammography services; and b) test the mediating effects of health-related self-efficacy.DesignThe current study is a part of a randomized controlled patient navigation trial for medically underserved women who had received a physician referral to obtain a mammogram in three community hospitals in Chicago, IL. After consent, 671 African American women with no history of cancer completed questionnaires concerning medical mistrust and received navigation services. After their mammography appointment, women completed healthcare self-efficacy and patient satisfaction questionnaires.ResultsWomen with lower medical mistrust and greater perceived self-efficacy reported greater satisfaction with care. Medical mistrust was directly and indirectly related to patient satisfaction through self-efficacy.ConclusionsPreliminary findings suggest future programs designed to increase healthcare self-efficacy may improve patient satisfaction among African American women with high levels of medical mistrust. Our findings add to a growing body of literature indicating the importance of self-efficacy and active participation in healthcare, especially among the underserved.

Medical mistrust is thought to affect health care-based decisions and has been linked to poor health outcomes. The effects of medical mistrust among men with prostate cancer are unknown. Thus, the goal of the current study is to examine the association between medical mistrust and quality of life (QOL) among black and white men with prostate cancer. A total of 877 men (415 black, 462 white) with prostate cancer between the ages of 40 to 81 years who entered the North Carolina Central Cancer Registry during the years 2007 and 2008 were retrospectively recruited. The dependent variable was overall QOL measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The primary independent variable was medical mistrust. Multivariate regression analysis was used to assess the association between medical mistrust and overall QOL. Compared with white men, black men reported a higher level of medical mistrust (black = 2.7, white = 2.4; P < .001) and lower QOL (black = 134.4, white = 139.5; P < 0.001). After controlling for demographical and clinical variables, higher levels of medical mistrust were associated with a reduction in overall QOL among men with prostate cancer (beta = -7.73; standard error = 1.54) CONCLUSIONS: Higher levels of medical mistrust are associated with reduced overall QOL among black and white men with prostate cancer. Interventions targeted to reduce medical mistrust may be effective in increasing the overall QOL of men with prostate cancer.

10562 Background: Germline GT and tumor genomics are relevant to the care of nearly every cancer pt. These tests inform treatment planning by NGS-based tumor genomic profiling (TGP) and hereditary risk assessment. Socioeconomic and race-based disparities in GT are well-known, but the impact of growing MM, fueled by political polarization and social unrest due to overt and institutional racism, has been less studied. In previous research of African American (AA) cancer pts, we identified a consistent association of high levels of MM with negative attitudes toward GT. To inform development of an intervention to support informed decisions about GT in cancer pts, we further characterized the relationship of MM to GT attitudes. Methods: Pts from two Fox Chase Cancer Center (FCCC) sites were recruited (6/2022-12/2022) to complete a cross-sectional survey (n=105, Burholme campus; n=95, Temple University Hospital). A stratified purposive sampling method was employed. Data on pt demographics and disease factors were collected. MM was queried with two validated measures: LaVeist MM Index (MMI: range 0-10, measures healthcare/institution MM) and Thompson Group Based MM Scale (GBMMS: range 1-5, measures race/ethnicity specific MM; suspicion, discrimination, and lack of support subscales). Attitudes toward GT (GTpros=6 items/GTcons=11 items) were measured w/a validated scale (Morren: range 0-10) plus 4 items developed by our team. The study was approved by the FCCC IRB 22-8003. Results: Median age of pts was 62 yrs (range 25-91); 62% were female, 47% AA, 15% Hispanic, 42% married, 47% ≤high school grad, 52% had household income ≤$50K/yr. Mean GBMMS was 2.11 (SD 0.80) and mean MMI was 4.63 (SD 1.54). Mean of GTpros was 8.77 (SD 1.68); GTcons 4.16 (SD 2.32). MM was associated with race/ethnicity by GBMMS (p&lt;0.001) and MMI (p&lt;0.04), as were GBMMS subscales (suspicion, discrimination, lack of support, all p&lt;0.001). Race/ethnicity was not associated w/GTpros (p=0.59) but was w/GTcons (p&lt;0.001). In univariate models both GTpros and GTcons were associated with GBMMS (p=0.005 and p&lt;0.001, respectively) and MMI (p=0.002 and p&lt;0.001, respectively). In a multivariable model examining GTcons, GBMMS score remained significant (p&lt;0.001) even when controlling for race (p&lt;0.01) and an interaction btw race*mistrust. A similar model showed MMI score also remained significant (p=0.04) when controlling for race and interaction effects. Only the GBMMS suspicion subscale remained significant (p&lt;0.02) in a model with both race and an interaction term. Conclusions: MM is markedly more common among racial/ethnic minority cancer pts, but the relationship btw MM and GT attitudes is only partially rooted in race/ethnicity. Oncologists considering germline GT or tumor genomics for pts, and efforts to support informed decision-making, must consider the pervasiveness of MM.

Black/African American (BAA) men have the lowest life expectancy among other major demographic groups in the United States, with BAA male mortality rates 40% higher than their White male counterparts. Despite known benefits of preventive health care utilization, BAA men are 43% more likely to use the emergency department for usual care. Many intersecting factors like medical mistrust and religion have been identified as common barriers BAA men face in health care utilization with few studies exploring factors that impact their current preventive health care utilization. In addition, BAA men's perceptions of health and ability to identify or seek help have always been disproportionately lower than other racial groups despite higher rates of preventable diseases. Using the tenets of the Andersen Healthcare Utilization Model, this cross-sectional study of 176 BAA men explores BAA men's current preventive health care practices while examining the intersection of predisposing, enabling, and need factors on BAA men's preventive health care utilization. While it is well known that higher income levels and higher education positively influence health care utilization, the intersection of religious affiliation and higher levels of medical mistrust was associated with BAA men's decreased engagement with health care as religion posed as a buffer to health care utilization. This study demonstrated that BAA men's perception of health differed by sexual orientation, educational status, and income. However, across all groups the participants' perspective of their health was not in alignment with their current health outcomes. Future studies should evaluate the impact of masculine norms as potential enabling factors on BAA men's preventive health care utilization.

Background: The use of medical cannabis represents an opportunity to improve access to equitable cancer treatment among minoritized populations who frequently face barriers to traditional palliative care options or mental health treatments. Poor mental health among cancer survivors is of concern as it reduces adherence to cancer survivorship treatment and can reduce overall survival. The COVID-19 pandemic has highlighted the importance of access to palliative care due to the increase of mental health symptoms among cancer survivors. Despite the potential benefits of medicinal cannabis, data describing the use of cannabis to manage mental health symptoms among cancer survivors is limited, particularly in the context of the COVID-19 pandemic. Objective: Our objective was to examine the prevalence of mental health symptoms and the behavioral impacts of the COVID-19 pandemic on cancer survivors who endorse cannabis use. Methods: Our participants included adults (≥18 years) who self-reported medicinal cannabis use and responded to our internet-based questionnaire (03/21/2020-03/24/2021). Overall, we received 3,594 responses. For this study, data included 158 participants including 79 cancer survivors (2.2%) along with age-matched medicinal cannabis users without a history of cancer (N = 79). Descriptive statistics were used to compare demographic characteristics, prevalence of generalized anxiety (GAD-7), and depression (CES-D-10), changes in behavior during the COVID-19 pandemic, and self-reported coping mechanisms by cancer survivorship status. Results: Overall, 61% and 48% of cancer survivors self-reported to use medicinal cannabis to manage their anxiety and depression, respectively. Additionally, 54% of cancer survivors reported cannabis use to manage their chronic pain. Probable clinical depression (CES-D-10 score ≥ 10) and anxiety (GAD-7 score ≥ 10) were identified in 50.7% and 38.9% of cancer survivors, respectively. Cancer survivors were more likely to report that their anxiety symptoms made it very or extremely difficult to work, take care of things at home, or get along with other people (23.0% vs. 11.8%, p = 0.015) than adults without a history of cancer. Pandemic-related coping mechanisms frequently reported by cancer survivors with anxiety or depression included more sleep (47.5%), practicing meditation/mindfulness (47.5%), physical activity (47.5%), talking to family and friends (42.5%), overeating or stress-eating (25.0%), and using more cannabis (25.0%). Cancer survivors with anxiety and depression reported to be more likely to fear giving COVID-19 to someone else (47.5% vs. 23.1%, p=0.023) and to fear being diagnosed with COVID-19 (77.5% vs. 38.5%, p&amp;lt;0.001) compared to cancer survivors without mental health conditions. Conclusion: Given the prevalence of anxiety and depression symptoms reported among cancer survivors and their use of cannabis, further research is recommended to evaluate its use as palliative care to improve mental health and quality of life among cancer survivors. Citation Format: Diane L. Rodriguez, Denise C. Vidot, Marlene Camacho-Rivera, Jessica Y. Islam. Mental health symptoms during the COVID-19 pandemic among cancer survivors who endorse cannabis: Results from the COVID-19 cannabis health study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-125.

18 Background: Cancer survivors experience unique challenges in receiving needed health care services. There is little information on individual-level factors affecting satisfaction with health care services among survivors. Methods: This study used satisfaction ratings provided by cancer survivors in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare Survey linked to data from NCI’s SEER Program (SEER-CAHPS). CAHPS data on self-reported general and mental health status and five composite measures of satisfaction with health care interactions (customer service, doctor communications, getting care quickly, getting needed care, and getting prescription drugs) were linked to patient sociodemographic and cancer characteristics from SEER. Medicare beneficiaries diagnosed with cancer in SEER regions 1997-2011 participating in CAHPS Medicare Survey &gt; 1 year after cancer diagnosis were included. The study included individuals alive &gt; 1 year following CAHPS completion, at least age 66, and diagnosed with non-metastatic breast, colorectal, lung, or prostate cancer. Analyses were performed separately by cancer type. Results: Among 23,969 cancer survivors with linked SEER-CAHPS data, higher general health was associated with higher satisfaction for all survivors except those diagnosed with lung cancer; higher mental health predicted higher satisfaction only among lung and prostate cancer survivors. Higher education predicted lower satisfaction among breast cancer survivors. Non-white survivors generally had lower satisfaction, although results were mixed. Among breast and prostate cancer survivors, fee-for-services Medicare (vs. Medicare advantage) was associated with lower customer service satisfaction but higher satisfaction with getting prescription drugs. Breast cancer patients diagnosed with stage 3 disease reported greater satisfaction than did those diagnosed at stage 1. Conclusions: Factors associated with health care satisfaction ratings for cancer survivors showed substantial variations by cancer types. Programs to improve survivorship care and outcomes need to be tailored to survivors’ clinical and sociodemographic characteristics.

Racial/ethnic minorities and those of lower socioeconomic status suffer disproportionate rates of cancer incidence and mortality. They are also less likely to engage in preventive screening practices. The potential impact for improved screening rates is great. Screening for breast and colon cancer, two of the top five cancer sites, has been shown to reduce mortality. Results are more controversial for the effect on prostate cancer mortality, another of the top five cancer sites in men. Among reported reasons for lower screening practices are mistrust of the healthcare system, fear of the procedures or results, lack of or inadequate insurance coverage, and fatalistic beliefs. Racial/ethnic minorities are typically thought to exhibit higher levels of medical mistrust than their Caucasian counterparts. The purpose of this analysis was to examine associations between medical mistrust and specific cancer screening behaviors – breast, colon, and prostate cancer screening – in a low-income urban and predominately racial minority adult population. As part of a longitudinal survey study to assess colon cancer screening practices, participants were recruited from federally qualified health centers in an urban Midwest city. Eligibility included age ≥40 and being a patient at a federally qualified health center. Interviewer-administered surveys were used to collect baseline data on self-reported cancer screening practices, health history, insurance status, and demographics. Medical mistrust was assessed using the Group Based Medical Mistrust Scale. The study population included 144 individuals and was 61% male, with an average age of 51 years (±6.73 SD). Participants were predominately African American (87.5%), uninsured (52%), and low income, with 42.4% earning a monthly income &amp;lt; $400. Only 15% were married or in a marriage-like relationship, and just under half reported good/excellent overall health. Preliminary results indicate that there were no significant differences in medical mistrust by gender, having a healthcare home (defined as one particular doctor's office individuals visit when sick), or by ever having been screened for colon, breast, or prostate cancer. Bivariate analysis found that having a healthcare home was significantly associated with having had a mammography (p=0.02), CRC screening (p=0.012), and prostate cancer screening (p &amp;lt; 0.001). Mistrust levels did not vary by healthcare home status. Medical mistrust may be a less important determinant in nonadherence of low-income, racial/ethnic minority adults to screening guidelines than previously thought. As medical mistrust levels did not differ by gender or healthcare home status, it may be that focusing efforts on connecting low-income individuals with regular sources of care in which they will experience a greater continuity in care has the potential to increase cancer screening and preventive behaviors. This may provide avenues for interventions focused on eliminating disparities in cancer screening rates among minorities and those of lower socioeconomic status. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B104.

Tumor genomic profiling (TGP) examines genes and somatic mutations specific to a patient's tumor to identify targets for cancer treatments but can also uncover secondary hereditary (germline) mutations. Most patients are unprepared to make complex decisions related to this information. Black/African American (AA) cancer patients are especially at risk because of lower health literacy, higher levels of medical mistrust, and lower awareness and knowledge of genetic testing. But little is known about their TGP attitudes or preferences. Five in-person focus groups were conducted with Black/AA cancer patients (N = 33) from an NCI-designated cancer center and an affiliated oncology unit in an urban safety-net hospital located in Philadelphia. Focus groups explored participants' understanding of TGP, cultural beliefs about genetics, medical mistrust, and how these perceptions informed decision-making. Participants were mostly female (81.8%), and one-third had some college education; mean age was 57 with a SD of 11.35. Of patients, 33.3% reported never having heard of TGP, and 48.5% were not aware of having had TGP as part of their cancer treatment. Qualitative analysis was guided by the principles of applied thematic analysis and yielded five themes: (1) mistrust of medical institutions spurring independent health-information seeking; (2) genetic testing results as both empowering and overwhelming; (3) how provider-patient communication can obviate medical mistrust; (4) how unsupportive patient-family communication undermines interest in secondary-hereditary risk communication; and (5) importance of developing centralized patient support systems outside of treatment decisions. Results improve understanding of how Black/AA patients perceive of TGP and how interventions can be developed to assist with making informed decisions about secondary hereditary results.

Patient and counselor satisfaction with structured contraceptive counseling by health center staff in federally qualified health centers