Genetic testing in a gynaecological oncology care in developing countries—knowledge, attitudes and perception of Nepalese clinicians

Abstract

BackgroundGenetic testing for an inherited susceptibility to cancer is an emerging technology in medical practice. Little information is currently available about physicians’ attitudes towards these tests in developing countries.MethodsWe conducted an email survey of Nepalese physicians practicing in academic and non-academic settings in Nepal, regarding knowledge, attitudes and perception towards genetic testing for gynaecologic cancer.ResultsResponses were received from 251 of 387 practitioners (65%). Only 46% of all respondents felt prepared to answer patients’ questions about genetic testing for gynaecologic cancer, despite 80% reporting that patients had asked questions about genetic testing, and 55% being asked more than 5 times in the past year. 42% reported more than 10 of their patients having had genetic testing for cancer, the majority for BRCA1/2. Access (40%), cost (37%) and lack of physicians’ information (24%) were cited as the main barriers to testing. The most commonly identified concerns regarding genetic testing were the potential for increased patient anxiety, misinterpretation of results by patients, and maintaining confidentiality of results (64%, 47% and 38% of respondents respectively).ConclusionThis study shows the gap among the health care providers in developing countries and the available modern scientific tools and skills in regard to the benefits of genetic testing for gynaecological cancers in a developing nation. These findings indicate the need for the introduction of further genetic counselling education and support into gynaecological care in Nepal.Electronic supplementary materialThe online version of this article (doi:10.1186/s40661-016-0034-5) contains supplementary material, which is available to authorized users.

Hereditary gynaecologic cancers in Nepal: a proposed model of care to serve high risk populations in developing countries

“…Although there have been recent advances in the availability of genetic testing in many developing countries, there is disparity in skills and knowledge among the health care providers regarding the availability of modern scientific tools, and recognition of the benefits of genetic testing for gynaecological cancers. As such, there is a great need for the introduction of further genetic counselling education and hereditary cancer services for gynaecological care in Nepal [ 35 ]. However, multiple barriers need to be overcome.…”

“…The information applies to a relatively small number of patients in any practice, and the evidence base changes rapidly, making it difficult for all but the most specialized providers to stay up-to date. In our previous study [ 35 ] it was found that approximately 46% of all clinicians felt prepared to answer patient’s questions about genetic testing for gynaecologic cancer. However, while 94% of gynaecologic oncologists felt prepared, only 47% of gynaecologists and 26% of other clinicians did so, despite 86% of gynaecologists and 71% of other clinicians reporting that patients had asked questions about genetic testing [ 35 ].…”

“…In our previous study [ 35 ] it was found that approximately 46% of all clinicians felt prepared to answer patient’s questions about genetic testing for gynaecologic cancer. However, while 94% of gynaecologic oncologists felt prepared, only 47% of gynaecologists and 26% of other clinicians did so, despite 86% of gynaecologists and 71% of other clinicians reporting that patients had asked questions about genetic testing [ 35 ]. An educational program could be devised, based on the emerging practice of “mainstreaming”, i.e.…”

“…The second arm involved gathering information from Nepalese gynaecologists and other health care professionals regarding their experience and attitudes to genetic testing [ 35 ]. Further, we conducted a focus group discussion among the senior gynaecologists practising in Nepal for more than a decade.…”