Journal of Community Genetics
Volume 9, Issue 3, 2018, Pages 263-276

Cancer genetic counseling communication with low-income Chinese immigrants (Article)

Cheng J.K.Y. , Guerra C. , Pasick R.J. , Schillinger D. , Luce J. , Joseph G.*
  • a Department of Anthropology, History & Social Medicine, University of California, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
  • b Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States, Department of General Internal Medicine, University of California, San Francisco, CA, United States
  • c Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States, Department of General Internal Medicine, University of California, San Francisco, CA, United States
  • d Department of Medicine, University of California, San Francisco, CA, United States
  • e Department of Medicine, University of California, San Francisco, CA, United States
  • f Department of Anthropology, History & Social Medicine, University of California, San Francisco, CA, United States, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States

Abstract

As genetics and genomics become part of mainstream medicine, these advances have the potential to either reduce or exacerbate health disparities. Relatively, little research has explored the quality of genetic counseling communication experienced by limited English proficiency patients, especially Chinese Americans. We observed and audio recorded genetic counseling appointments (n = 40) of low-income, limited English-proficient Chinese patients (n = 25) and conducted post-visit interviews (n = 17) using stimulated recall to examine patient understanding of the communication. Standard techniques based in grounded theory, including iterative data review and multiple coders, were used to analyze observation fieldnotes and interview transcripts and to identify these themes: (1) strong beliefs in environmental causes of cancer and skepticism about genetic causes, (2) willingness to undergo genetic testing despite skepticism of hereditary cause of cancer, (3) misunderstanding of key information needed to make informed decisions about testing and screening/prevention options, (4) variable quality of medical interpretation, and (5) selective family communication about cancer and genetic counseling and testing. Together, these themes describe substantial gaps in communication and identify the need for genetic counseling techniques and skills that enable counselors to communicate more effectively across language, literacy, and culture. Understanding the mechanisms of inheritance and the implications of genetic test results can be challenging for anyone, and it is exceptionally daunting for those who have limited English proficiency and/or low literacy. For Chinese immigrant patients to reap the full benefits of genetic counseling and testing, effective communication is essential. Research on interventions to improve communication is needed to ensure that disparities do not widen as genomic medicine reaches a more diverse population. © 2017, Springer-Verlag GmbH Germany, part of Springer Nature.

Author Keywords

Genetic counseling Precision medicine health disparities communication Health literacy Hereditary cancer Genomic medicine Limited English proficiency

Index Keywords

medical record review immigrant comprehension Chinese lowest income group interpersonal communication human language ability health belief priority journal audio recording Aged cancer prevention cancer screening interview clinical observation male genetic screening environmental factor female family interaction clinical article cultural factor Article carcinogenesis adult grounded theory heredity genetic counseling medical decision making recall health literacy cancer genetics
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85035802896&doi=10.1007%2fs12687-017-0350-4&partnerID=40&md5=d37eb51f9391c381702826eb7c9a83ff
DOI: 10.1007/s12687-017-0350-4
ISSN: 1868310X
Cited by: 3
Original Language: English