Impact of Race and Decisional Conflict: Genetic Testing in Patients With PCa

Despite recommendations, genetic testing for advanced prostate cancer (PCa) is not widely used and may not be readily accepted by patients. This analysis investigated the attitudes and decisional conflicts surrounding genetic testing and the differences between White and non-White patients.

This prospective single-institution study included patients with N1 or M1 PCa who had not yet completed genetic testing. To assess attitudes toward genetic testing, including a validated assessment of decisional conflicts, patients were given a 24-question survey using a Likert scale of 0 (strongly agree) to 4 (strongly disagree).

Scores and subscores of decisional conflicts (range, 0-100; 100 = highest decisional conflicts) were calculated from subsets of survey responses, and self-identified race was obtained from the electronic medical record. Two-group comparisons between White and non-White patients and between individuals who completed genetic testing and those who did not were conducted.

Of 42 enrolled patients (21 White, 17 Black, 1 Asian, 3 declined), 52.4% completed genetic testing. Non-White patients demonstrated higher levels of worry regarding the privacy of test results (mean, 1.72 vs 2.95; P=.002), the potential misuse of test results for non-healthcare reasons (1.78 vs 3.00; P=.003), and the experimentation with unproven treatments (1.72 vs 2.67; P=.01) compared with White patients. Compared with White patients, non-White patients felt more external pressure in decision-making (0.67 vs 0.29; P=.04).

There were no significant differences in completion of testing, decisional conflicts, or any subscore between racial groups. Patients who completed the testing showed a higher likelihood of knowing the available options (0.73 vs 1.25; P=.05), understanding the benefits of each option (0.77 vs 1.30; P=.04), being informed about the risks and side effects of each option (0.95 vs 1.50; P=.05), being clear on which benefits mattered most to them (0.73 vs 1.37; P=.02), and being decisive about the best choice for themselves (0.73 vs 1.35; P=.02).

The decisional conflicts score was significantly elevated in patients who did not finish the testing (28.59 vs 18.11; P=.03), as were the uncertainty (31.25 vs 19.32; P=.02) and informed (31.25 vs 20.45; P=.03) subscores. There were no differences in values, clarity, support, or effective decision subscores.

The study revealed that non-White patients exhibited higher levels of apprehension regarding privacy, data misuse, and the utilization of unproven treatments. Furthermore, individuals who did not complete the testing process had more difficulty making informed decisions due to increased uncertainty about their knowledge.

These findings will serve as a valuable guide in implementing focused interventions aimed at enhancing knowledge, trust, and decision-making certainty regarding genetic testing among patients with advanced PCa.

Ongoing studies will evaluate the effectiveness of interventions in improving the testing completion rate within a single institution.

Source:

Purtell JP, Ralston A, Rose CM, et al. Race and decisional conflict about genetic testing in patients with advanced prostate cancer. Chicago, IL, & online: presented at 2024 ASCO Annual Meeting; June 2, 2024: abstract 5062.