The culture of faith and hope: patients' justifications for their high estimations of expected therapeutic benefit when enrolling in early phase oncology trials.

Background: Patients' estimates of their chances of therapeutic benefit from participation in early phase trials greatly exceed historical data. Ethicists worry that this therapeutic misestimation undermines the validity of informed consent.

Methods: The authors interviewed 45 patients enrolled in phase 1 or 2 oncology trials about their expectations of therapeutic benefit and their reasons for those expectations.

What keeps you up at night? Genetics professionals' distressing experiences in patient care.

Purpose: To explore specific patient care experiences that genetics professionals associate with distress and the emotions engendered by those experiences.

Methods: We conducted semistructured telephone interviews with clinical geneticists, genetic counselors, and genetic nurses that focused on a single distressing experience.

Results: Fourteen clinical geneticists, 25 genetic counselors, and 14 nurses were interviewed.

The role and impact of personal faith and religion among genetic service providers.

This paper describes the impact of genetic service providers' personal faith and religious values on their experiences interacting with colleagues and patients. We surveyed 480 clinical geneticists (MDs), genetic counselors (GCs), and genetic nurses randomly selected from their professional associations, and then interviewed a sample of survey respondents. Outcomes included religiosity, coping with distress through spiritual beliefs, and personal value conflicts (PVCs).

Development of a revised Health Care System Distrust scale.

Context: Growing evidence suggests that most forms of distrust are multidimensional, including domains of technical competence and value congruence. Prior measures of health care system distrust have not reflected this multidimensional structure and may be limiting research into the role of health care system distrust in health and health care in the US.

Objective: To develop a revised a scale of health care system distrust.

Differences in the patterns of health care system distrust between blacks and whites.

Context: Although health care-related distrust may contribute to racial disparities in health and health care in the US, current evidence about racial differences in distrust is often conflicting, largely limited to measures of physician trust, and rarely linked to multidimensional trust or distrust.

Objective: To test the hypothesis that racial differences in health care system distrust are more closely linked to values distrust than to competence distrust.

Design: Cross-sectional telephone survey.

Interest in breast cancer chemoprevention among older women.

Objectives: The study aim is to describe interest in breast cancer chemoprevention among older women without a history of breast cancer and to determine whether aging-related factors such as diminished life expectancy, increasing comorbidity and medication burden attenuate chemoprevention interest.

Design: Cross-sectional survey.

Setting: University of Pennsylvania Health System.

Prescription of tamoxifen for breast cancer prevention by primary care physicians.

Background: Although tamoxifen citrate has been approved for primary reduction of breast cancer risk since 1998, little is known about the prescription of tamoxifen by primary care physicians.

Methods: To investigate the determinants of prescription of tamoxifen for breast cancer prevention by primary care physicians, we mailed a national survey to 350 primary care physicians, including specialties of family practice, obstetrics and gynecology, and general internal medicine, regarding past prescription of tamoxifen, intention to prescribe tamoxifen in hypothetical scenarios, and potential predisposing and enabling factors.

Results: Ninety-six physicians (27.

Value for the future and breast cancer-preventive health behavior.

Background: Time preference, or the extent to which people discount future benefits in favor of immediate benefits, might represent an important determinant of preventive health behavior, but the little research thus far on this association has yielded mixed results. This study examined the association between future time preference and use of genetic counseling for BRCA1/2 testing and how this association may differ from the relationship between future time preference and mammography screening and self-breast examination.

Experimental Design: A health system-based case-control study with a nested cross-sectional survey.

Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer.

Context: Given the current context of racial disparities in health and health care and the historical context of eugenics, racial disparities in the use of genetic susceptibility testing have been widely anticipated. However, to our knowledge there are no published studies examining the magnitude and determinants of racial differences in the use of genetic susceptibility testing.

Objectives: To investigate the relationship between race and the use of BRCA1/2 counseling among women with a family history of breast or ovarian cancer and to determine the contribution of socioeconomic characteristics, cancer risk perception and worry, attitudes about genetic testing, and interactions with primary care physicians to racial differences in utilization.

Differential willingness to undergo smallpox vaccination among African-American and white individuals.

Objective: To examine potential disparities in willingness to be vaccinated against smallpox among different U.S. racial/ethnic groups.