Disparities in cancer genetic counseling encounters in the naturalistic clinical setting

Despite decades of effort to reduce gaps in cancer care, some patients, particularly those in vulnerable populations, continue to die at higher rates from cancer. Because prevention is the key to the cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing cancer disparities is high. However, the benefits of genetic counseling are not equitable across all people. The overarching goal of this proposed research is to compare and contrast the nature of genetic counseling encounters and patient-centered outcomes across different patient populations in the naturalistic clinical setting. When patients and healthcare providers do not come from the same social backgrounds, the patients tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is providers’ personal attitudes and beliefs. Drawing on findings from prior research, we hypothesize that genetic counselor providers’ attitudes that are activated spontaneously will be associated with the quality of patient-provider communication, while providers’ beliefs that are deliberately reported will be associated with the quality of clinical discussion of cancer risk and genetic testing depending on patients’ backgrounds. These disparities in encounters will be further associated with poorer patient-centered outcomes. We will test our hypotheses by addressing four specific aims: Aim 1) to compare/contrast the nature of patient-provider communication by patient characteristics; Aim 2) to compare/contrast the clinical discussion content by patient characteristics; Aim 3) to quantify the role of genetic counselors’ personal attitudes and beliefs in patient-provider communication (Aim 1) and clinical discussion content (Aim 2); and Aim 4) to quantify the role of patient-provider communication/clinical discussion content with patient-centered outcomes (trust, satisfaction, therapeutic alliance, empowerment, genetic testing uptake). These aims will be achieved through an observational study with a convergent mixed methods research design. We will analyze recorded cancer genetic counseling encounters both qualitatively and quantitatively, linking those data to data from pre- and post-encounter surveys and medical chart reviews. With COVID-19, many genetic counseling encounters have moved to telehealth, and telehealth is expected to continue to thrive beyond the pandemic. The proposed study will embrace this unique, transitional opportunity and addresses the overarching goal in the naturalistic clinical setting through multiple modalities (in-person, telehealth). Findings from this multi-center study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes. Patient-provider communication and clinical recommendations are modifiable factors, and they are already being taught in genetic counseling training programs; thus, the findings can have immediate impact on genetic counseling training and practice.