Table 2 Select quotes from semi-structured interviews (n = 10)

Discrimination concerns

 ONC7

I think doctors need to take these [into] consideration when talking to underserved [patients], not only in terms of race, but also socio-economic status as well, because many times people who have poor socio-economic status they think they get lesser care and when you offer these things that they don’t understand they might see it as a way to discriminate against them. So, explaining to them, “This is a standard thing and I offer it to everyone, and it is how I may help you.”

Medical mistrust

 ONC3

I think emotional risk probably is pretty high because of the mistrust. [Patients] go to [their] wife/husband and say they [doctors] want to do genetic testing on me and they [family] would say “don’t do it”, because this is the way [they do things] to not treat you, this is the way of finding something that will harm you, instead of help you.”

 ONC8

My biggest push back from AA patients more than other races, is that they don’t like the idea of experimental types of care. Some patients if you mention [the] words “clinical trial” they’re really not…aligned with the term “clinical trial”. They consider it as something experimental, ‘it doesn’t benefit me’, and ‘I’m not a guinea pig’ — these are the kind of [remarks] I’ve heard a lot

Poor awareness/understanding of genetics

 ONC8

I’ve noticed it being a biggest difference when I’m talking about things like tumor profiling; sometimes it’s [due to] a bigger educational gap, so you really have [to make] that dedicated effort to explain what TGP is, very clearly

 ONC5

To middle- aged and older people it’s hard to sell genomic profiling. They just don’t want to understand. They say, “I’ll do whatever you need, where do I sign?” “It’s just too much, I don’t understand what are you saying.” “Do what you have to do.”

Uniform vs patient-tailored approach to TGP communication

 ONC4

I think you should approach people the same way, and yet every patient needs something different from you. And there are maybe specific things to address but….[pause]. I think that these tests are not well understood by patients across the board. I don’t think it’s necessarily specifically racial differences that I have seen

 ONC6

I think in general I present options and information the same way. I think AAs sometimes, depending on educational level [need more explanation], but anybody … with low health literacy or lower SES [needs this too], and so you need to able to explain it clearly, issues like cost maybe more often. I treat prostate cancer, and certainly … AAs maybe [have] higher risk of mutations, but I’m not sure I will present it somehow differently

 ONC10

A generic approach at discussion works for many but not for all [patients]. Obviously, we want to take into consideration cultural sensitivities, cultural appreciation, racial and socio- economic boundaries. I think as a clinician one has to be sensitive… in general