Measuring Physicians?? Tolerance for Ambiguity and its Relationship to Their Reported Practices Regarding Genetic Testing

Geller, Gail; Tambor, Ellen; Chase, Gary A.; Holtzman, Neil A.

doi:10.1097/00005650-199311000-00002

Cited by 168 publications

(171 citation statements)

References 21 publications

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“…Diagnostic uncertainty 8 and levels of tolerance for uncertainty 9,10 have been linked to variations in physicians' diagnoses, testing patterns, and treatment choices.…”

Section: Data From the Population Based National Health Andmentioning

confidence: 99%

Implicit Bias Among Physicians

Dawson

Arkes

2008

J GEN INTERN MED

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T o the Editor: Green and colleagues 1 claim to have provided evidence that unconscious (implicit) race bias among physicians is causally associated with fewer recommendations for appropriate thrombolytic treatment for African-American male patients who present with symptoms suggestive of acute coronary syndromes. We attempt to demonstrate why this claim is not substantiated.From a sample of 776 internal medicine and ED residents, Green and colleagues obtained data from 220 who were unaware of the purpose of the study or who were not otherwise excluded. They were shown a vignette about a 50-year-old man with a history of hypertension and smoking who presented to the ED with chest pain. With the vignette the face of a white or black man of approximately age 50 was randomly paired. The vignette was written to be consistent with the presentation of myocardial infarction, in particular containing an EKG reading that was "suggestive of anterior myocardial infarction." The subject was told he/she did not have access to a cardiac catheterization lab and that the patient had no absolute contraindications to thrombolysis.Subjects were asked to a) assess the likelihood that the patient's pain was due to CAD using a five-point scale where 1=very unlikely (< 20%), 5=very likely (>80%); b) state "yes" or "no" to "would you recommend thrombolysis" for this patient; c) state the strength of that recommendation on a five-point scale from 1=would definitely recommend to 5=would definitely NOT recommend; and d) give their opinion about the effectiveness of thrombolysis for acute MI on a five-point scale from 1=very ineffective to 5=very effective.Subjects then completed three implicit association tests (IATs) to "measure bias that may not be consciously recognized." The "IAT measures the time it takes subjects to match members of social groups (e.g., blacks and whites) to particular attributes (e.g., good, bad, cooperative, stubborn)." A difference in reaction times to associate good or bad concepts with black or white faces is the measure of "implicit bias."We obtained opinions from content experts to develop plausibility arguments and consulted published literature to critique the methods and results of Green et al. Nine attending-level general internists plus two disparities researchers (one nephrologist, one pulmonary-critical care physician) reviewed the study scenario [A] without a patient face [B] and were blinded to the published study and its results.

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“…Diagnostic uncertainty 8 and levels of tolerance for uncertainty 9,10 have been linked to variations in physicians' diagnoses, testing patterns, and treatment choices.…”

Section: Data From the Population Based National Health Andmentioning

confidence: 99%

Implicit Bias Among Physicians

Dawson

Arkes

2008

J GEN INTERN MED

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“…Potential variables in all three specialties (GPs, GYNs, and PEDs) were gender, age, years of experience, year of graduation, genetics in the medical curriculum, having attended these required lessons, having taken an elective course in genetics during medical school, faculty membership, involvement in fellow education, opinion on the importance of diagnosing hereditary disorders, discussion of hereditary background with patients, frequency of seeing patients with a "hereditary disease," provision of genetic counseling in own practice, personal or family experience with genetic counseling, source of information generally used to keep up to date, referral for genetic counseling, and innovativeness (willingness to offer predictive genetic tests when this is not common practice). 12 Specific variables were practice characteristics and involvement in obstetrics for the GPs, working in a university or general hospital for the GYNs and PEDs, and membership in the Section on Congenital and Inherited Disorders (SCID) of the Pediatric Association of The Netherlands for the PEDs. …”

Section: Survey Instrumentmentioning

confidence: 99%

Deficiency of knowledge of genetics and genetic tests among general practitioners, gynecologists, and pediatricians: A global problem

Baars

Henneman

Kate

2005

Genetics in Medicine

200

152

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Purpose: The objective of this study was to assess knowledge of genetics and awareness of genetic tests among Dutch general practitioners (GPs), gynecologists (GYNs), and pediatricians (PEDs), as well as factors influencing their knowledge and awareness. Methods: An anonymous questionnaire inquiry was used, validated with a sample of 52 clinical geneticists (CGs). The study was carried out in primary care (general practice) and secondary care (general and university hospitals) in The Netherlands. A random sample of 200 GPs, 300 GYNs, and 265 PEDs received a questionnaire. In addition, all registered CGs (58) received a questionnaire for validation. In total, 122 GPs, 187 GYNs, 164 PEDs, and 52 CGs returned a completed questionnaire. The main outcome measures were differences in knowledge scores between physicians working in different disciplines and factors influencing these scores. Results: Knowledge scores of GPs (mean 64% correct answers, 61%-66% [95% confidence interval]), GYNs (mean 75% correct answers, 73%-76% [95% confidence interval]), and PEDs (mean 81% correct answers, 79%-82% [95% confidence interval]) were lower than those in the CG validation group (mean 95% correct answers, 94%-96% [95% confidence interval]). The 5th percentile of GPs, GYNs, and PEDs was at approximately 40%, 52% and 62% correct answers, respectively. There was a specific lack of knowledge about DNA testing. In addition to specialty, important factors positively associated with the knowledge scores of nongeneticists are more recent graduation, having taken an elective course in genetics, and providing genetic counseling in their own practice. Conclusion:The overall knowledge levels of genetics in many nongeneticist health care providers show clear deficiencies. This is in line with reports from other countries, showing that these deficiencies are a global problem.Genet Med 2005:7(9):605-610.

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“…12 Other research has indicated that an individual's ability to tolerate ambiguity can determine responses to a situation that is not clearly defined or is still open to interpretation. 13 We reasoned that for most individuals from the general public, low or nonexistent family history of breast cancer would make the results of genetic mutation testing confounding and ambiguous. Therefore, variance in tolerance for this ambiguity might help to determine an individual's interest in obtaining testing.…”

Section: Abstract: Genetic Testing Risk Information Breast Cancer mentioning

confidence: 99%

“…We further hypothesized that this effect would be affected by an individual's baseline tolerance level for ambiguous situations. 13 Finally, we hypothesized that the effects of counseling would be affected by changes in beliefs about genetic testing, specifically beliefs targeted by counseling such as possible stigmatization due to testing and access issues around testing. …”

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confidence: 99%

Effects of risk counseling on interest in breast cancer genetic testing for lower risk women

Bowen

Burke

Yasui

et al. 2002

Genetics in Medicine

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Purpose: A randomized trial was conducted to test the effects of two counseling methods (genetic counseling and group counseling) against a control no-intervention condition on interest in genetic testing in lower risk women.Methods: After completing baseline surveys, women (N ϭ 357) were randomized to one of three conditions: to receive individual genetic risk counseling, to receive a group psychosocial group counseling, or to serve as a control group. Participants completed follow-up questionnaires 6 months after randomization. Results: All participants had some familial history of breast cancer, but none had a family history indicative of autosomal dominant genetic mutation. At baseline over three fourths of the sample judged themselves to be appropriate candidates for testing.By the end of the survey, two thirds (70%) of the women in the counseling group still judged themselves to be appropriate candidates for testing. Findings were similar for interest in genetic testing. Changes in beliefs about genetic testing (e.g., beliefs about potential stigma associated with testing) altered the effects of counseling. Conclusion:These results indicate that counseling can change interest in genetic testing only slightly and that changing women's beliefs about the properties of testing might be one mechanism of doing so. Genet Key Words: genetic testing, risk information, breast cancer risk counselingGenetic mutation testing to determine breast cancer risk is a relatively recent clinical option. Mutations in the BRCA1 and BRCA2 genes were discovered in 1995 to confer a relatively high risk of breast cancer in women with a strong family history of breast cancer. 1,2 This type of genetic testing was offered to the public through physicians beginning in 1997. The low prevalence of the mutation in the general population combined with the difficulty in interpreting test results to any family except a high-risk family has caused most policy-making bodies to limit clinical testing to individuals with breast cancer and their family members in families with strong genetic histories. [3][4][5][6] The extent to which genetic mutation testing is currently being used and will be used clinically in the near future is unknown. Several surveys of women from diverse samples indicate high interest, ranging from 55 to 80% of the respondents interested in obtaining testing. [7][8][9][10] This high level of interest is astounding, as most women from the general public are not seen as appropriate medical candidates for breast cancer genetic testing. The few studies that have assessed actual use of the test indicate much lower uptake, as low as 10 to 20% in clinical studies. 11 The reasons for this high interest and the potential methods of reducing it to more medically realistic levels are the topic of this article.Contact with a counselor trained in assisting with risk-understanding could assist women in choosing their personal options for genetic mutation testing. We conducted a randomized trial to test the effects of two counseling type...

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Measuring Physicians?? Tolerance for Ambiguity and its Relationship to Their Reported Practices Regarding Genetic Testing

Cited by 168 publications

References 21 publications

Implicit Bias Among Physicians

Implicit Bias Among Physicians

Deficiency of knowledge of genetics and genetic tests among general practitioners, gynecologists, and pediatricians: A global problem

Effects of risk counseling on interest in breast cancer genetic testing for lower risk women

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