Personalized Medicine Decision-Making in a Virtual Clinical Setting

Study Overview
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Brief Summary
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Background: -How people respond to drugs depends in part on their genes. For some drugs, doctors can use an individuals genetic background to help in dosing the drug. Researchers want to know how doctors incorporate personalized or genomic medicine into clinical practice. Objective: -To study how physicians make personalized treatment decisions Eligibility: -Healthy adult primary care physicians who are internal (or family) medicine residents. Design: Participants will complete a screening form. Participants will put on a headset, called a head-mounted display, showing a virtual reality environment. The environment will contain an exam room and the virtual patient. After interacting with the virtual patient, participants will complete a series of survey measures. Participation will last for about 60 minutes. The virtual patient interaction and follow-up questions will be audio taped.

Detailed Description
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This study will examine factors related to primary care physicians clinical decision-making. Using a virtual clinical interaction experiment, we aim to better understand physicians decision-making processes and to explore their communication behaviors toward patients in the clinical encounter. Physician participants will enter a virtual exam room where they will be asked to respond to a virtual patient, acting as her primary care physician in a follow-up visit to evaluate her for depression. Various aspects of physician communication in the virtual clinic and self-report measures related to decision-making will be analyzed.

Official Title
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Medical Decision-Making in a Virtual Clinical Setting

Conditions
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Deep Vein Thrombosis, Blood Clots

Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: All physicians will be healthy adult volunteers who are medical residents in the internal medicine specialty. EXCLUSION CRITERIA: persons with seizure or vestibular disorders; persons who are highly prone to motion sickness; those without normal or normal to corrected vision or hearing; all current and past employees and contractors of NHGRI; and persons who have received information about the study purpose or procedure from a past participant. NHGRI employees are excluded for this protocol because they are likely to have specialized genomic knowledge and may think differently about genomics in the clinical interaction.

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Physicians that interact with the black/High SES avatar patien<br>Medical residents will then be randomized to be exposed to a virtual patient with one of 4 race/SES profiles, this one being a female patient who is Upper-Middle Income and Black/African American. | |
| Physicians that interact with the black/Low SES avatar patient<br>Medical residents will then be randomized to be exposed to a virtual patient with one of 4 race/SES profiles, this one being a female patient who is low-Middle Income and Black/African American. | |
| Physicians that interact with the white race/high SES avatar<br>Medical residents will then be randomized to be exposed to a virtual patient with one of 4 race/SES profiles, this one being a female patient who is Upper-Middle Income White andCaucasian. | |
| Physicians that interact with the white race/low SES avatar p<br>Medical residents will then be randomized to be exposed to a virtual patient with one of 4 race/SES profiles, this one being a female patient who is low Income White and Caucasian. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To explore how physicians use genetic testing for anticoagulant (warfarin) dosage in patients of different racial/ethnic and SES backgrounds | To explore how physicians use genetic testing for anticoagulant (warfarin) dosage in patients of different racial /ethnic and SES backgrounds | Outcome measurements are assessed on the same date of the study visit. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physicians, Genomics, Internal Medicine, Warfarin, Natural History