Psychosocial and Cultural Determinants of Interest and Uptake of Skin Cancer Genetic Testing in Diverse Primary Care

Abstract

<b><i>Background:</i></b> Translational research in genomics has limited reach and requires efforts to broaden access and utility in diverse populations. Skin cancer is common and rates are rising, including among Hispanics. Germline variants in the melanocortin-1 receptor (<i>MC1R</i>) gene are common in the population and confer moderate risk for melanoma and basal cell cancers across skin types. Feedback about <i>MC1R</i> risk status may promote skin cancer risk awareness and risk reduction. <b><i>Aims:</i></b> We examined the level of interest in pursuing <i>MC1R</i> testing, and patterns of interest across skin cancer perceived threat and control attitudes, cultural beliefs (family influence on health, health system distrust, cancer fatalism, skin cancer misconceptions), and health literacy. <b><i>Methods:</i></b> We used a study website to inform primary care patients in Albuquerque, NM about the benefits and drawbacks of <i>MC1R</i> testing. Website logon, request of a saliva test kit, and return of the test kit (yes vs. no) were primary assessments of study interest and uptake. <b><i>Results:</i></b> Of 499 participants provided with a test offer, 33% requested and returned the test. Lower family influence on participants’ health was an important factor both overall and within ethnicity subgroups, and may indicate that primary care patients interested in skin cancer genetic testing see themselves as proactive health seekers, independent from family encouragement. Lower self-efficacy for skin cancer prevention was also an important characteristic of those who tested. <b><i>Conclusion:</i></b> As evidence for common genetic markers for skin cancer accumulates, these findings suggest characteristics of those most likely to pursue genetic testing for skin cancer risk.

Behavioral and Psychological Outcomes Associated with Skin Cancer Genetic Testing in Albuquerque Primary Care

“…This may include large portions of the general population who tan and/or do not use adequate sun protection [76]. In the current study, patients with low risk perceptions were significantly more likely to refuse study participation than those with higher risk perception [54], which may have decreased the ability to detect an overall impact of the genetic testing feedback. It is an important element of study rigor that we were able to well-characterize these study refusers.…”

“…Further, those with higher perceived skin cancer risk and those with greater interest in learning about genes were more likely to participate. Participants who answered "don't know" to absolute perceived skin cancer risk were less likely to participate in the study than patients who gave another scale response; these psychosocial factors remained significant predictors of study participation after adjustment for ethnicity and education [54].…”

“…Second, were there significant moderators of the relationship between the receipt of higher vs. average genetic risk findings and the 3 month outcomes (i.e., overall sun protection, skin cancer screening, cancer worry)? Potential moderators included participant health literacy, perceived importance of genetic information, cancer risk perceptions, demographics, and skin cancer risk factors, all of which may influence behavioral and psychosocial outcomes associated with skin cancer genetic testing [48][49][50][51][52][53][54][55].…”

How Do Subjective Health Literacy Measures Work in Young Adults? Specifying “Online” or “Paper-Based” Forms Impacts Results

“…Comprehension was assessed by providing a short passage about genetics and skin cancer risk, which was created for a young adult population. We chose this topic since it is likely unfamiliar to young adults 22,23 so we could better assess knowledge learned from the passage. Five items were included to assess comprehension, with true, false, or unsure response options.…”

Dismissing “Don’t Know” Responses to Perceived Risk Survey Items Threatens the Validity of Theoretical and Empirical Behavior-Change Research

“…Likewise, individuals who, between 1993 and 2000, indicated that they did not know their risk of having HIV were less likely to obtain an HIV test than those who provided a scale response (Kiviniemi et al, 2018). In addition, DK responding (compared with a scaled response) to items assessing perceived risk of skin cancer was associated with lower likelihood of enrolling in a research study that provided information about the risk of skin cancer (Hay et al, 2019). Furthermore, participants who indicated that they were uncertain about their perceived risk had lower odds of eating a healthy diet or engaging in physical activity in the past 12 months, regardless of the level of perceived risk they indicated (Orom et al, 2020).…”