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McDowell K, Wetherill L, Pollock B, Halverson C, Ivanovich J. Exploring Genetic Counselors' Experiences with Indigenous Patient Populations. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02194-8. [PMID: 39382618 DOI: 10.1007/s40615-024-02194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 09/22/2024] [Accepted: 09/24/2024] [Indexed: 10/10/2024]
Abstract
This study investigates the preparedness of genetic counselors in addressing the potentially unique elements and considerations of Indigenous patients in the United States and Canada. Considering the healthcare disparities Indigenous populations face, particularly in specialty care, this study aims to assess the preparedness of genetic counselors in addressing the unique needs and cultural considerations of Indigenous patients. An online survey was utilized, and a subset of participants was selected to be interviewed. Results reveal genetic counselors felt less competent with Indigenous patients compared to non-Indigenous patients, especially in specific aspects of genetic counseling such as responding to cultural issues or identifying resources. Factors such as increased years of experience and more exposure to Indigenous populations during graduate training correlated with higher self-rated competency. Despite a patient population that is on average 7% Indigenous by self-report, genetic counselors lacked exposure to Indigenous encounters in graduate programs and professional training. These findings underscore the importance of enhancing genetic counseling education and exposure to Indigenous training opportunities such as voluntary events or Indigenous guest speakers to improve cultural competency and address healthcare disparities for Indigenous communities.
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Affiliation(s)
- Kimberly McDowell
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street IB130, Indianapolis, IN, 46202, USA
- Department of Maternal Fetal Health, Southcentral Foundation, Anchorage, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street IB130, Indianapolis, IN, 46202, USA
| | - Bethany Pollock
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street IB130, Indianapolis, IN, 46202, USA
- Indiana University Health Physicians, Indianapolis, USA
| | - Colin Halverson
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, USA
| | - Jennifer Ivanovich
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street IB130, Indianapolis, IN, 46202, USA.
- Indiana University Health Physicians, Indianapolis, USA.
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Quillin JM, Shin Y, Shin D, Carmany E, Duffy C, Hagiwara N. An exploration of cultural competency training and genetic counselors' racial biases. J Genet Couns 2024; 33:709-715. [PMID: 37615202 PMCID: PMC10891290 DOI: 10.1002/jgc4.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
Research shows genetic counselors generally have pro-White implicit biases-both prejudice and stereotyping. Cultural competency training aims to foster equitable beliefs, behaviors, and attitudes in cross-cultural genetic counseling sessions, including those that are racially discordant (genetic counselors and patients are from different racial backgrounds). Therefore, cultural competency training has the potential to mitigate bias and reduce disparities. Here, we report the prevalence of cultural competency training among genetic counselors and associations between recency of training and counselors' racial biases. We conducted an online survey of genetic counselors and trainees in fall 2021. The survey assessed four types of bias (implicit/explicit prejudice and implicit/explicit stereotyping), time since last cultural competency training, time since last communication skills training, and frequency of clinic sessions with Black patients. Multiple linear regressions modeled associations between cultural competency training and different types of bias, adjusting for communication skills training, frequency of encounters with Black patients, and counselor race (White vs. non-White). Two hundred fifteen participants (107 genetic counselors and 108 trainees) responded, and 205 reported whether they had prior cultural competency training. Of these, 187 (91%) reported ever having cultural competency training, most (53%) of participants who had training had it within 6 months prior to survey completion. We found no clear pattern of associations between cultural competency training and racial biases (implicit or explicit) in adjusted analyses. Participants who had cultural competency training four or more years prior demonstrated less negative implicit stereotyping toward Black individuals compared with those having more recent training; but no statistically significant effect was found for participants who reported never having cultural competency training, compared with those having training more recently than 4 years prior. Overall, our findings do not support that cultural competency training is negatively associated with, or mitigates, Black/White racial prejudices and stereotypes against Black patients. These findings suggest more effective interventions are needed to reduce racial biases.
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Affiliation(s)
- John M. Quillin
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA
| | - Yongyun Shin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
| | - Dongho Shin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
| | - Erin Carmany
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
| | - Conor Duffy
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
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Antony M, Putnam E, Peltzer C, Levy A. A Scoping Review of Medical Mistrust Among Racial, Ethnic, and Gender Minorities With Breast and Ovarian Cancer. Cureus 2024; 16:e62410. [PMID: 39011181 PMCID: PMC11248488 DOI: 10.7759/cureus.62410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
An overarching theme in clinical literature suggests an inherent mistrust among populations of color within the healthcare system and the importance of healthcare professionals to bridge this gap in care. This is especially true when addressing cancer care in underserved populations due to mistrust in providers, diagnostic tools, and treatments. Ovarian cancer is difficult to diagnose early in all populations; however, women of color who have an intrinsic mistrust of the medical community will delay or refuse screenings or treatments that could be greatly beneficial. Similarly, although breast cancer rates are high in women of color, many are reluctant to utilize genetic screenings or counseling services due to bad experiences with healthcare, both personally and within their community. Moreover, transgender patients are at a unique disadvantage, as they face barriers to accessing culturally competent care while also being at a higher risk for developing cancer. The objective of this study was to conduct a scoping review of the literature in order to synthesize knowledge about the climate of mistrust between medical providers and racial, ethnic, and gender minorities with breast cancer and ovarian cancer. It is imperative for healthcare workers to acknowledge medical mistrust and strive to reduce internalized bias, increase their availability to patients, and ensure patients feel heard, respected, and well cared for during visits. Improving care by physicians can enhance trust between underserved communities and healthcare workers, encouraging all people to actively seek proper medical care and cancer screening, potentially resulting in a reduction of mortality and morbidity rates.
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Affiliation(s)
- Manisha Antony
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Emma Putnam
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Cadynce Peltzer
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Arkene Levy
- Medical Education (Pharmacology), Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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Saylor KW, Klein WM, Calancie L, Lewis KL, Biesecker LG, Turbitt E, Roberts MC. Genetic Testing and Other Healthcare Use by Black and White Individuals in a Genomic Sequencing Study. Public Health Genomics 2023; 26:90-102. [PMID: 37544304 PMCID: PMC10614486 DOI: 10.1159/000533356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Early adopters play a critical role in the diffusion of medical innovations by spreading awareness, increasing acceptability, and driving demand. Understanding the role of race in the context of other characteristics of potential early adopters can shed light on disparities seen in the early implementation of genomic medicine. We aimed to understand the association between self-identified race and individual experience with genetic testing outside of the research context. METHODS We assessed factors associated with the odds of having ever received genetic testing prior to enrollment in a genomic sequencing study among 674 self-identified white and 407 self-identified African, African American, or Afro-Caribbean ("Black") individuals. RESULTS Controlling for individual determinants of healthcare use (demographics, personality traits, knowledge and attitudes, and health status), identifying as Black was associated with lower odds of prior genetic testing (OR = 0.43, 95% CI [0.27-0.68], p < 0.001). In contrast, self-identified race was not associated with the use of non-genetic clinical screening tests (e.g., echocardiogram, colonoscopy). Black and white individuals were similar on self-reported personality traits tied to early adoption but differed by sociodemographic and resource facilitators of early adoption. CONCLUSION Persistent racial disparities among early adopters may represent especially-entrenched disparities in access to and knowledge of genomic technologies in clinical settings.
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Affiliation(s)
- Katherine W. Saylor
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William M.P. Klein
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Larissa Calancie
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Katie L. Lewis
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leslie G. Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Megan C. Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Hagiwara N, Duffy C, Quillin J. Implicit and explicit racial prejudice and stereotyping toward Black (vs. White) Americans: The prevalence and variation among genetic counselors in North America. J Genet Couns 2023; 32:397-410. [PMID: 36341692 PMCID: PMC10168592 DOI: 10.1002/jgc4.1648] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
Research has shown that patient experiences and outcomes of genetic counseling are not equitable across racial categories, disadvantaging Black patients relative to White patients. One major factor contributing to such racial disparities might be genetic counselor racial bias. The present study examined the prevalence of and variation in racial bias toward Black (vs. White) Americans among genetic counselors in North America. This study extends the current literature of racial disparities in experiences and outcomes of genetic counseling by distinguishing prejudice (negative feelings or attitudes) and stereotyping (beliefs) at the implicit and explicit levels as well as by including both certified genetic counselors and genetic counseling trainees. Two-hundred and fifteen genetic counselors (107 genetic counselors Board-certified by the American Board of Genetic Counseling, 108 genetic counseling trainees from Accreditation Council for Genetic Counseling accredited programs) completed four measures in a random order: the Race Implicit Association Test (IAT, for implicit prejudice), feeling thermometer (for explicit prejudice), the Medical Cooperativeness IAT (for implicit stereotyping), and a self-report measure of explicit stereotypes (for explicit stereotyping). On average, genetic counselors (both certified genetic counselors and genetic counseling trainees) were slightly to moderately in favor of White Americans over Black Americans at the implicit level. They were also slightly more likely to associate "medically cooperative" stereotypes with White Americans more than Black Americans implicitly. In contrast, genetic counselors, on average, did not display either explicit prejudice or explicit negative stereotyping, which may reflect social desirability concerns among genetic counselors. However, genetic counselors as a group strongly endorsed stereotypes related to mistrust (mistrustful of the healthcare system, skeptical of genetic testing, mistrustful of genetic counselors) to be more true for Black (vs. White) Americans. Finally, our study revealed relatively large variability in each type of bias across genetic counselors. Future research should examine how such variability in each type of bias is associated with patient experiences and outcomes of genetic counseling.
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Affiliation(s)
- Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Conor Duffy
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John Quillin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Delk P, Bowling I, Schroeder C, Wilson TE, Wesson M, Wetherill L. An investigation of preceptors' perceptions of behavioral elements of “professionalism” among genetic counseling students. J Genet Couns 2022; 32:325-341. [PMID: 36184900 DOI: 10.1002/jgc4.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
Professionalism in health care is a loosely defined but increasingly studied concept. In genetic counseling, "professional development" expectations for entry-level genetic counselors are described in the "Practice-Based Competencies for Genetic Counselors," but the teaching and evaluation of "professionalism" among genetic counseling students is relatively unexplored. This study investigated program leaders' and clinical supervisors' perceptions of professionalism demonstrated by genetic counseling graduate students to learn about their associated strengths and lapses. Members of program leadership and clinical supervisors at Accreditation Council for Genetic Counseling (ACGC) accredited genetic counseling graduate programs in the United States and Canada were surveyed regarding their observations of genetic counseling students for the years 2017-2019 regarding four domains of professional behavior: integrity, accountability/conscientiousness, teamwork, and patient care, with the Merriam-Webster definition of each behavior provided for each domain. Participants also provided open-text descriptions. Descriptive results showed that the 263 participants found all facets of these professional behaviors to be essential. Patient care had the highest importance and was the domain with the most strengths observed among genetic counseling students. Lapses in professional behavior were identified for self-awareness, time management, and thoroughness. Free responses noted that suggestions or strategies for education about professional behavior from ACGC may improve the professional behavior of genetic counseling students and in turn, genetic counselors. Participants voiced the importance of consideration of diverse professional and cultural backgrounds in setting the expectations for professional behavior among genetic counseling students and genetic counselors so that "professionalism" in genetic counseling is not defined through a White lens. Further investigation into challenges that genetic counseling students face regarding professional behavior during their graduate training and strategies for education about these behaviors will aid in the growth and improvement of the training of genetic counselors. Given the sensitive nature of this topic, portions of this discussion may be triggering for some readers.
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Affiliation(s)
- Paula Delk
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Isabella Bowling
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Courtney Schroeder
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Theodore E. Wilson
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Melissa Wesson
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
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