Impact of medical mistrust (MM) on perceptions of tumor genomic profiling (TGP) among African American (AA) cancer patients: Application of perceptual mapping (PM).

Authors

Michael Hall

Michael J. Hall

Fox Chase Cancer Center, Philadelphia, PA

Michael J. Hall , Paul D'Avanzo , Yana Chertock , Jesse A Brajuha , Sarah Bauerle Bass

Organizations

Fox Chase Cancer Center, Philadelphia, PA, Temple University College of Public Health, Philadelphia, PA, Temple University, Philadelphia, PA

Research Funding

Other
American Cancer Society

Background: TGP is widely used to identify targetable mutations for precision cancer treatment and clinical trials. Many patients have poor understanding of TGP and are unaware of possible secondary hereditary risks. Lack of clarity regarding the relevance of informed consent and genetic counseling further magnify risks for patients. AA patients have lower genetic knowledge and health literacy and higher MM than Caucasian patients, making them especially vulnerable in the clinical setting. Perceptions of TGP in AA cancer patients have not been well-characterized. Methods: 120 AA pts from 1 suburban and 1 urban site (Fox Chase Cancer Center[FCCC] and Temple University Hospital[TUH]) were surveyed. A k-means cluster analysis using a modified MM scale was conducted; chi-square analysis assessed demographic differences. Perceptual mapping (PM)/multidimensional scaling and vector modeling was used to create 3-dimensional maps to study how TGP barriers/facilitators differed by MM group and how message strategies for communicating about TGP may also differ. Results: Data from 112 analyzable patients from FCCC (55%) and TUH (45%) were parsed into less MM (MM-L, n = 42, 37.5%) and more MM (MM-H, n = 70, 72.5%) clusters. MM-L and MM-H clusters were demographically indistinct with no significant associations by sex (p = 0.49), education (p = 0.3), income (p = 0.65), or location (p = 0.43); only age was significant (older = higher MM, p = 0.006). Patients in the MM-H cluster reported higher concerns about TGP, including cost (p < 0.001), insurance discrimination (p < 0.001), privacy breaches (p = 0.001), test performance/accuracy (p = 0.001), secondary gain by providers (p < 0.001) and provider ability to explain results (p = 0.04). Perceptual mapping identified both shared and contrasting barriers between MM clusters (Table). Conclusions: More than 2/3 of AA patients comprised a MM-H cluster. Communication strategies should focus on concerns about family and how to discuss TGP with an oncologist. PM can identify distinct and shared information needs of vulnerable populations undergoing TGP.

Less mistrust (MM-L)Shared perceptionsMore mistrust (MM-H)
TGP concernsResults are not accurate
Genetic info may be used against me (i.e. insurance) because of my race
What TGP will find Results used for gain without me knowing
Genetic info won't be private
Minorities more likely to be discriminated against
Oncologist can't explain results so I understand
TGP being done to get more money from me and insurance
TGP benefitsBenefits outweigh risks
Can benefit society
Can improve QoLCan improve treatment options
Can help treat cancer
TGP and familyWould ask my family advice about TGPResults could benefit familyFamily will judge me for genetic testing
Beliefs about providerTrust of own oncologist
Comfort talking to oncologist

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Prevention, Risk Reduction, and Hereditary Cancer

Track

Prevention, Risk Reduction, and Genetics

Sub Track

Germline Genetic Testing

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e22527)

DOI

10.1200/JCO.2021.39.15_suppl.e22527

Abstract #

e22527

Abstract Disclosures