Epistemic Beliefs: Relationship to Future Expectancies and Quality of Life in Cancer Patients

Genomic Tumour Testing (GTT) is an emerging site of “experimental care” in oncology [Cambrosio, Alberto, Peter Keating, Etienne Vignola-Gagné, Sylvain Besle, and Pascale Bourret. 2018a. “Extending Experimentation: Oncology’s Fading Boundary Bbetween Research and Care.” New Genetics and Society 37 (3): 207–226. doi: 10.1080/14636778.2018.1487281 ]. Few efforts to implement GTT have reached community oncology practices or patients living in rural communities within the US. Drawing on interdisciplinary research on a state-wide cancer genomics initiative in the rural US state of Maine, this paper explores the valuation practices within community oncologist and cancer stakeholders accounts of “doing good” within genomic science and care. We contribute to STS literatures on the bio-economy by highlighting the affective dimensions of strategies for managing economic and non-economic values. Clinician and stakeholders negotiated de-economizing and capitalizing modes of doing good as they built local genomic platforms “for Maine.” These situated modes of doing good and feeling good via cancer genomics shaped how they navigated the ethical ambiguities of US biomedical markets across the boundaries of research and care.

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“Doing Good” in U.S. Cancer Genomics? Valuation practices across the boundaries of research and care in rural community oncology

Darling

Kohut

Leeds

et al. 2022

New Genetics and Society

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Urban-Rural and Socioeconomic Differences in Patient Knowledge and Perceptions of Genomic Tumor Testing

DiBiase

Scharnetzki

Edelman

et al. 2023

JCO Precision Oncology

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PURPOSE Social determinants of health, such as rurality, income, and education, may widen health disparities by driving variation in patients' knowledge and perceptions of medical interventions. This effect may be greatest for medical technologies that are hard to understand and less accessible. This study explored whether knowledge and perceptions (expectations and attitudes) of patients with cancer toward large-panel genomic tumor testing (GTT), an emerging cancer technology, vary by patient rurality independent of other socioeconomic characteristics (education and income). METHODS Patients with cancer enrolled in a large precision oncology initiative completed surveys measuring rurality, sociodemographic characteristics, and knowledge and perceptions of GTT. We used multivariable linear models to examine differences in GTT knowledge, expectations, and attitudes by patient rurality, education, and income level. Models controlled for age, sex and clinical cancer stage and type. RESULTS Rural patients had significantly lower knowledge of GTT than urban patients using bivariate models ( P = .025). However, this association disappeared when adjusting for education and income level: patients with lower educational attainment and lower income had lower knowledge and higher expectations ( P ≤ .002), whereas patients with higher income had more positive attitudes ( P = .005). Urban patients had higher expectations of GTT compared with patients living in large rural areas ( P = .011). Rurality was not associated with attitudes. CONCLUSION Patients' education and income level are associated with knowledge, expectations, and attitudes toward GTT, whereas rurality is associated with patient expectations. These findings suggest that efforts to promote adoption of GTT should focus on improving knowledge and awareness among individuals with low education and income. These differences may lead to downstream disparities in GTT utilization, which should be explored in future research.

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Epistemic Beliefs: Relationship to Future Expectancies and Quality of Life in Cancer Patients

Cited by 2 publications

References 104 publications

“Doing Good” in U.S. Cancer Genomics? Valuation practices across the boundaries of research and care in rural community oncology

“Doing Good” in U.S. Cancer Genomics? Valuation practices across the boundaries of research and care in rural community oncology

Urban-Rural and Socioeconomic Differences in Patient Knowledge and Perceptions of Genomic Tumor Testing

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