Anticipating social and interpersonal influence of polygenic scores in future clinical settings

Clinical application of genomic risk information for complex disease is an important goal for genomic medicine. Its implementation will intersect with existing social, structural, and interpersonal dynamics in heretofore unexplored ways. Using immersive simulation technologies, it is possible to investigate potential influences of future applications like polygenic scores (PS), identifying areas where PS might exacerbate or attenuate biased behavior and attitudes towards historically marginalized patients. A series of studies investigates how the emergence of PS for common conditions could influence healthcare provider beliefs, behavior, and biases, and whether these influences vary depending upon the characteristics of the patient to whom the PS are applied. The first study engaged 81 medical students in simulated encounters with a virtual reality patient who presented as Black or White depending upon randomly assigned condition, and in some cases with PS for five diseases. Here, PS reports unintentionally affected many aspects of care recommendations, and differentially influenced bias-related beliefs and behavior depending upon the virtual patient’s apparent race. Use of an immersive setting enabled bias evaluation through implicit, interpersonal behavior in addition to self-report. To further understand PS influences, a larger, ongoing experiment immersing medical residents in telemedicine simulations evaluates the effects of PS of varying severity, integrated into the medical record on care decisions and interpersonal treatment of a virtual patient who varies in apparent race and also in body size. Pilot evaluations suggest feasibility of this new telemedicine simulation approach to support investigation of future genomic scenarios in a more scalable way. 

Author: Susan Persky, National Human Genome Research Institute, National Institutes of Health