Carole H. Browner
Departments of Psychiatry & Biobehavioral Sciences and
Browner’s current work looks at communication about genetics and genetic testing during clinical encounters between
neurologists, movement disorder patients, and their family. Recent rapid developments in genetic medicine have created
the expectation that genetic assessments will soon become integral to routine health care. Yet although such practices
stand to have far-ranging clinical implications, little empirical attention has been devoted to understanding the processes
or consequences of incorporating genetic testing into routine diagnosis and management procedures.
We are studying some of the factors that shape neurologists’ views about and use of genetic information in their clinical
practice, and the consequences of their doing so. Our specific aims are: 1) To examine how genetic information
associated with adult-onset movement disorders is communicated during routine clinical care. 2) To determine how
physicians, patients with symptoms of adult-onset movement disorders, and their families conceptualize and use this
information. 3) To explore the degree to which variation in practice setting acts to constrain or promote neurologists’ offers
of genetic testing to such patients and their families.
The practice of neurology is an ideal setting in which to explore the processes by which genetic information is
incorporated into clinical routines. While standard genetic tests to diagnose specific neurological diseases are becoming
increasingly available, it is not yet known when and how these tests are offered to particular patients. In addition, the
nature and consequences of this genetic knowledge introduces unique concerns into the standard clinical relationship
between neurologists, patients, and families (i.e., psychological distress of learning about a hereditary disease, fears of
occupational and/or insurance discrimination, and disclosure of familial risk). Our focus is on why, how, when, and by
whom these issues are communicated during medical interactions, and how specific genetic information affects patients’
and family members’ understandings about and management of symptoms.