The Influence of Health Care Policies and Health Care System Distrust on Willingness to Undergo Genetic Testing

Bibliographic Data

ID9101708
AuthorsKatrina Armstrong (0000-0001-5781-5970, University of Pennsylvania, corresponding author), Mary Putt (Cancer Research And Biostatistics, corresponding author), Chanita Hughes Halbert (0000-0002-0103-6916, Abramson Cancer Center), David Grande (0000-0002-6717-6735, corresponding author), Jerome Sanford Schwartz, Kaijun Liao (corresponding author), Noora Marcus (0000-0002-9232-5333, corresponding author), Mirar Bristol Demeter (corresponding author), Judy A Shea (0000-0002-7334-4192, corresponding author), JUDY SHEA
Year2012
Volume50
Issue5
Pages381-387
Publication date2012-05-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e31824d748b
PMID22473221
PMCIDPMC3360826
OpenAlexW2040346664
LanguageEN
Citations received6
References cited35

PURPOSE: As the potential role of genetic testing in disease prevention and management grows, so does concern about differences in uptake of genetic testing across social and racial groups. Characteristics of how genetic tests are delivered may influence willingness to undergo testing and, if they affect population subgroups differently, alter disparities in testing. METHODS: Conjoint analysis study of the effect of 3 characteristics of genetic test delivery (ie, attributes) on willingness to undergo genetic testing for cancer risk. Data were collected using a random digit dialing survey of 128 African American and 209 white individuals living in the United States. Measures included conjoint scenarios, the Revised Health Care System Distrust Scale (including the values and competence subscales), health insurance coverage, and sociodemographic characteristics. The 3 attributes studied were disclosure of test results to the health insurer, provision of the test by a specialist or primary care doctor, and race-specific or race-neutral marketing. RESULTS: In adjusted analyses, disclosure of test results to insurers, having to get the test from a specialist, and race-specific marketing were all inversely associated with willingness to undergo the genetic test, with the greatest effect for the disclosure attribute. Racial differences in willingness to undergo testing were not statistically significant (P=0.07) and the effect of the attributes on willingness to undergo testing did not vary by patient race. However, the decrease in willingness to undergo testing with insurance disclosure was greater among individuals with high values distrust (P=0.03), and the decrease in willingness to undergo testing from specialist access was smaller among individuals with high competence distrust (P=0.03). CONCLUSIONS: Several potentially modifiable characteristics of how genetic tests are delivered are associated with willingness to undergo testing. The effect of 2 of these characteristics vary according to the level of health care system distrust, suggesting that policy decisions about delivery of genetic testing may influence differences in uptake across patient subgroups defined by levels of distrust rather than by race

Affect (linguistics) · Distrust · Economics · Environmental health · Family medicine · Genetic testing · Health care · Population · Random digit dialing · Test (biology) · Willingness to pay · BRCA gene mutations in cancer · Ethics in Clinical Research · Global Cancer Incidence and Screening · Medicine · Psychology · Gerontology