Research on human genetic variation has for implications medication development. As the patterns and meaning of this variation are further illuminated, there is the potential for better-tailored treatments that minimize adverse events and maximize efficacy for an individual or group. Medications intended for a specific racial group have been approved or investigated in cardiology, oncology, neurology, and other areas of medicine.1
As technology improves, the medical advancements toward further personalized medicine are expected by some to be swift. However, as the promises of personalized medicines are many, research is also needed to understand behavioral reactions to personalized treatment options and develop approaches that facilitate the appropriate use of these technologies.
There has been exploratory investigation into patients’ receptivity to personalized medicine approaches.2–6
Focus group studies indicate a suspicion of race-based therapeutics, with the meaning of this approach differing for those in the racial majority versus minority.3,4
For example, one study (number of focus groups = 25; number of survey participants = 224) found high levels of public suspicion of race-based medicine, which varied by respondent race. Approximately 40%, 60%, and 90% of white, African American, and multiracial participants, respectively, reported “very suspicious” or “moderately suspicious” attitudes regarding the safety and effectiveness of a drug designed for African Americans only.3
Regarding genetically personalized medicine (GPM), participants generally express openness to DNA-based tailoring options that are expected to reduce side effects and increase efficacy. However, concerns include privacy, the potential for discrimination, and cost.4–6
Trust is often mentioned as a crucial dimension to the acceptance of unfamiliar tailoring approaches.3,4
Trust is an essential concept in medicine that stems from the vulnerability inherent in needing guidance from a physician to treat an illness.7
Trust can be defined as an “optimistic acceptance of a vulnerable situation in which the truster believes the trustee will care for the truster’s interests.”8
Trust is associated with many important health outcomes, including adherence.9,10
Physicians’ communication and behavior impact patients’ trust (e.g., elicitation of patient’s illness experience is associated with increased trust).11,12
In addition, there is some evidence that trust is lower among racial minorities,13
although the demographic composition (e.g., degree to which race and socioeconomic status are associated in the study sample) and specific context (e.g., history of race relations in a certain region) of a study setting can affect this relationship.14
Respect is a conceptually related, yet distinct, construct that refers to the recognition of the unconditional value of patients as persons and itself is independently associated with adherence.15
The theoretical framework for this study was informed by the model of relationship-centered care16
and the risk information seeking and processing theory.17
Relationship quality as a modifying factor in personalized medicine acceptance was a theme found in exploratory studies on the topic.3,4
This caused us to consider theories that reflect the moral dimensions and interpersonal influence in doctor-patient relationships. The model of relationship-centered care is one such model and emphasizes the personhood of both patient and physician.16
The perceived acknowledgment of this personhood may be diminished or illuminated with group or DNA-based tailoring approaches; perceived respect from the vignette physician was included in the measurements to capture this variation. The risk information seeking and processing theory further describes factors that influence the extent to which patients rely on physician advice in decision making.17
Along with the model of relationship-centered care, this theory further underscored the role for trust and also lead to the inclusion of belief in medication efficacy and intention to adhere.
With this theoretical underpinning as background, the broad objective of this study was to assess the association of conventional, race-based, or GPM approaches on participant’s responses regarding emotion, belief in medication efficacy, respect, trust, and adherence intention. We hypothesized that participants would have the most negative ratings of race-based medicine vignettes and the most positive ratings of conventional medicine vignettes. We also hypothesized that minorities would have more negative ratings of the race-based medicine vignettes based on the qualitative finding on this topic. Current and historical inequities were listed among reasons for more negative appraisals among minorities in the qualitative literature. This is among the first quantitative investigations on this topic to our knowledge.