Methods: Family physicians (N=1,035) were surveyed to study, among other aims, their decisions to offer screening for genetic conditions and the influence of patient characteristics on these decisions. A randomly selected sample (N= 10,000) from the membership of the American Academy of Family Physicians was invited to participate in the web-based survey. 1035 physicians completed the 30 minute survey (response rate = 10%). Physicians were randomly assigned to view the vignette with a picture of either a “Black” or “White” patient. 978 physicians answered questions in response to the vignette of a female patient, age 36, considering pregnancy; her race, ethnicity or ancestry was not described in the vignette. Physicians indicated whether they would offer genetic screening and, if yes, for which genetic conditions. Finally, physicians were asked to select factors that influenced their decisions.

Results: Respondents who viewed the “Black” patient were more likely to offer any genetic screening than those who viewed the “White” patient (36% versus 26% p<.001). Testing for cystic fibrosis, a condition that is more prevalent among Whites in the United States, was offered more often by physicians presented with the “White” patient (46% vs. 25%, p<.0001). Screening for sickle cell disease, a condition more prevalent among Blacks in the United States, was offered more often by physicians presented with the “Black” patient (79% vs. 7%, p<.0001). Physicians who viewed the “Black” patient rated race and ethnicity as more important to their decisions than those who viewed the “White” patient (race: “Black” patient =76% vs. “White” patient=46% p<.0001; ethnicity: “Black” patient=43% “White” patient =31%, p<.05). There were no differences by patient race for consideration of age ancestry, family history, insurance coverage, and cost of screening.

Conclusion: Perceived patient race and ethnicity matters to physicians when making decisions to offer genetic screening. With increasing study of health disparities and racial and ethnic differences in genetic susceptibility to common diseases, greater understanding is needed as to how providers determine and consider patient race in decisions to offer genetic tests and services. Such knowledge will facilitate physician education about the use of race and ethnicity when incorporating genetics into clinical practice.