title: The influence of health care policies and health care system distrust on willingness to undergo genetic testing.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. karmstro@mail.med.upenn.edu
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
authors.forename: Mary
authors.initials: M
authors.lastname: Putt
authors.forename: Chanita Hughes
authors.initials: CH
authors.lastname: Halbert
authors.forename: David
authors.initials: D
authors.lastname: Grande
authors.forename: Jerome Sanford
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Kaijun
authors.initials: K
authors.lastname: Liao
authors.forename: Noora
authors.initials: N
authors.lastname: Marcus
authors.forename: Mirar Bristol
authors.initials: MB
authors.lastname: Demeter
authors.forename: Judy
authors.initials: J
authors.lastname: Shea
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D001294:Attitude to Health; D003695:Delivery of Health Care; D030881:Disclosure; D005260:Female; D005820:Genetic Testing; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D044469:Racial Groups / Q000523:psychology*; D012959:Socioeconomic Factors; D035502:Trust; D014481:United States; D044465:White People / Q000523:psychology; D055815:Young Adult