Primary care physician use of patient race and polygenic risk scores in medical decision-making.

PURPOSE: The use of patient race in medicine is controversial for its potential either to exacerbate or address health disparities. Polygenic risk scores (PRS) have emerged as a tool for risk stratification models used in preventive medicine. We examined whether PRS results impact primary care physician (PCP) medical decision-making and whether that impact varies by patient race.

METHODS: Using an online survey with a randomized experimental design among PCPs in a national database, we ascertained decision-making around atherosclerotic cardiovascular disease prevention and prostate cancer screening for case scenario patients who were clinically identical except for randomized reported race.

RESULTS: Across 369 PCPs (email open rate 10.8%, partial completion rate 93.7%), recommendations varied with PRS results in expected directions (low-risk results, no available PRS results, and high-risk results). Still, physicians randomized to scenarios with Black patients were more likely to recommend statin therapy than those randomized to scenarios with White patients (OR 1.74, 95% CI 1.16, 2.59, p=0.007), despite otherwise identical clinical profiles and independent of PRS results. Similarly, physicians were more likely to recommend prostate cancer screening for Black patients compared with White patients (OR 1.58, 95% CI 1.06, 2.35, p=0.025), despite otherwise identical clinical and genetic profiles.

CONCLUSION: Despite advances in precision risk stratification, physicians will likely continue to use patient race implicitly or explicitly in medical decision-making.