Nurses’ Use of Race in Clinical Decision Making

More than 4 million healthcare professionals in the United States are nurses, making them the front line of health provision (National Council of State Boards of Nursing, 2016). Driven by the Patient Protection and Affordable Care Act of 2010, the discipline of nursing has entered a new era of clinical practice. The profession has been called upon to increase the number of baccalaureate-prepared and doctorate-prepared nurses, appropriately inform and educate the next generation of nurses, and aid in closing the health disparities gap (Fairman, Rowe, Hassmiller, & Shalala, 2011; Hassmiller, 2010; Institute of Medicine, 2010; Levin & Bateman, 2012). The growing utilization of nurses as primary care providers highlights their important role in bringing a precision medicine approach to health care (Calzone, Jenkins, Nicol, et al., 2013; Cheek, Bashore, & Brazeau, 2015).Although precision medicine may allow a more accurate approach to patient care that moves beyond race, the complicated relationship between race and genetic ancestry continues to stir an ongoing debate around the clinical utility of race (Dankwa-Mullan, Bull, & Sy, 2015). Race is a fluid concept used to group people according to various factors, including ancestral background and social identity (Smedley & Smedley, 2012). Because race is a crude proxy for certain underlying genetic risk, it remains a commonly used indicator in disease prevention, screening, and treatment strategies.Differential Health Treatment and Outcomes by Race and EthnicityPersistent health disparities are apparent in the variation of disease incidence and mortality across racial and ethnic populations (Badve et al., 2011; Kaiser Family Foundation, 2015; U.S. Cancer Statistics Working Group, 2016). For example, complex diseases such as cardiovascular disease, type 2 diabetes, and prostate and colorectal cancer have disproportionally affected certain racial and ethnic minority populations (Centers for Disease Control and Prevention-National Center for Health Statistics, 2015). A debate has risen around whether race-based screening guidelines are needed to address these disparities and to what extent race has clinical utility, particularly as a proxy for genetic ancestry.One facet of the debate involves common practice and healthcare guidelines that specifically include the use of race as a proxy for ancestry, genetic risk, and response in diagnostic and treatment decisions. For example, a recently approved test for the Lp-PLA2 biological marker to predict risk for coronary heart disease is reported by the U.S. Food and Drug Administration (2014) to predict risk better in Black women. Additionally, there is a long history of using race in clinical decisions about the most effective type of drugs to administer (Ramamoorthy, Pacanowski, Bull, & Zhang, 2015). Given the current treatment guidelines and ongoing contention around the role of race in clinical practice, scientific discoveries that are beginning to illuminate the contributions of genomic variation and environmental factors to health outcomes for persons with complex chronic diseases hold the promise of guiding development of effective health interventions.Nurses' Clinical Use of RaceAs research continues to clarify the contribution of social and genetic factors to racial and ethnic differences in health, disease, intervention choices, and outcomes, it is necessary to understand how healthcare providers use (i.e., collect, perceive, and interpret) race in public health practice and clinical care. Research indicates that individual background characteristics, personal beliefs, and biases influence the clinical encounter, often to the disadvantage of minority patients (Lawrence, Rasinski, Yoon, & Curlin, 2014; McKinlay, Piccolo, & Marceau, 2013; Sabin, Nosek, Greenwald, & Rivara, 2009). Research also indicates that patients receive differential treatment by race and may respond differently to treatment based on genomic profile differences (Keenan et al. …