As precision medicine approaches are implemented, cancer treatment decisions have come to require comprehension of genetic tests and their role in risk stratification and treatment options. Acceptance and implementation of precision medicine requires patient understanding of numeracy, genetic literacy, health literacy, and medical trust. Implementing precision medicine in a US federally qualified community health center (FQCHC) setting has received little attention. Using a mixed-methods approach, we sought to identify patient-level factors influencing the understanding of cancer risk and precision medicine among FQCHC patients. We enrolled 26 English-speaking adults aged 40–79 years. Participants enrolled in focus groups and completed surveys to assess patient-level understanding of precision medicine, numeracy, and health literacy. The majority of participants were female (77%) and self-identified as African American (89%). Approximately one-third reported having a high school degree or less. While health literacy was generally high, 42% felt that genes or genetics had little impact on health and most (69%) reported little familiarity with precision medicine. Many participants reported that trust in their providers was extremely or very important when receiving genetic tests. Numeracy levels were moderate, with nearly half reporting some discomfort working with fractions and 38% finding numerical information only occasionally useful. Findings suggest that patients may lack familiarity with precision medicine concepts relevant for understanding cancer treatment decisions. Future educational efforts may help bridge the gap in patient understanding and facilitate equitable opportunities for precision medicine for all patients, including those seeking care from community health centers.
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The authors acknowledge and express gratitude for the Matthew Walker Comprehensive Health Center, Inc.—its patients, providers, and staff—for their support and assistance in carrying out this study.
This study was funded by a pilot grant from the Center of Excellence in Precision Medicine and Population Health (U54 MD010722) funded by the National Institute for Minority Health and Health Disparities. Jennifer Richmond is supported by grant number T32HS026122 from the Agency for Healthcare Research and Quality and a Loan Repayment Award from the National Cancer Institute (L60CA264691).
The study was approved by the Vanderbilt University Institutional Review Board, and all procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
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Stallings, S.C., Richmond, J., Canedo, J.R. et al. Assessing patient-level knowledge of precision medicine in a community health center setting. J Community Genet (2023). https://doi.org/10.1007/s12687-023-00632-4
- Precision medicine
- Patient knowledge
- Health equity
- Genetic testing