Participant | Special considerations related to genetics and use of TGP in AA cancer patients due to concerns about discrimination, high mistrust, and poor understanding |
---|---|
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 |