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We conducted semi\u2010structured, qualitative interviews with 50 high\u2010risk women to understand how financial constraints affect use of genetic counseling, genetic testing, and further risk\u2010management decisions. Inductive analyses revealed three categories of health\u2010related financial constraint: (a) lack of insurance, (b) underinsurance, and (c) other financial constraints (e.g., medical debt, raising children, managing comorbidities). Various breast cancer risk\u2010management actions were limited by these financial constraints, including genetic counseling, genetic testing, enhanced screening, and prophylactic surgeries. Women's narratives also identified complex relationships between financial constraint and perceptions of healthcare providers and insurance companies, particularly as related to bias, price transparency, and potential genetic discrimination. Results from this study have implications for further research and expansion of genetic counseling services delivery to more economically and racially diverse women.<\/jats:p>","DOI":"10.1002\/jgc4.1413","type":"journal-article","created":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T06:23:25Z","timestamp":1616394205000},"page":"1452-1467","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Financial constraints on genetic counseling and further risk\u2010management decisions among U.S. women at elevated breast cancer risk"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6949-4932","authenticated-orcid":false,"given":"Rachel J.","family":"Meadows","sequence":"first","affiliation":[{"name":"Division of Epidemiology College of Public Health The Ohio State University Columbus OH USA"},{"name":"Center for Outcomes Research JPS Health Network Fort Worth TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasleem J.","family":"Padamsee","sequence":"additional","affiliation":[{"name":"Division of Health Services Management and Policy College of Public Health and Comprehensive Cancer Center The Ohio State University Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,21]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"AHRQ(Agency for Healthcare Research and Quality). 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