Knowledge, Attitude and Perceptions about Cancer Genetic Testing in Clinical Practice in Karachi, Pakistan

doi:10.21203/rs.3.rs-2127849/v1

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Research Article

Knowledge, Attitude and Perceptions about Cancer Genetic Testing in Clinical Practice in Karachi, Pakistan

https://doi.org/10.21203/rs.3.rs-2127849/v1

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published 05 May, 2023

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Health care professionals (HCP) play an important role in the practical application of genetic screening tests but often feel inadequately prepared for cancer genetic testing (CGT) in clinical care. As the complexity of gene related malignancies increases, it demands HCPs’ preparedness to cater to patients’ needs. Therefore, our study aimed to assess the knowledge, attitude, and practices of HCPs in Pakistan regarding the application of cancer genetics. A cross-sectional survey was conducted from April 2022 to June 2022 amongst HCPs at a private and a governmental institution in Karachi, Pakistan. Non-probability random convenience sampling was used to select the population. A total of 210 HCPs, 56.7% (119) were included in this study. Most respondents from both hospitals deemed their knowledge inadequate, with only 2% (2) and 1.8% (2) being extremely knowledgeable, respectively. 68.6% (144) HCPs displayed a positive attitude towards CGT, with 55.2% (116) participants perceiving CGT in a positive light. As compared to the private sector, significantly more HCPs in the public sector dedicated ≥ 5 hours/week for CME (P = 0.006), and were better prepared to counsel patients (P = 0.021) and interpret results concerning CGT (P = 0.020). Additionally, screening tests for specific cancer types were popularly considered a worthwhile avenue of investment to improve the current state of CGT in our healthcare system [47.6% (N=100)]. Our results thus call upon the need for additional training concerning CGT. Understanding specific gaps in knowledge may further help enhance post-graduate training programs and eventually lead to effective incorporation of CGT into our healthcare setting.

genetic counseling

genetic testing

knowledge

attitudes

health literacy

Cancer is the second leading global cause of death (1). According to the World Health Organization’s (WHO) report in 2020, cancer accounted for nearly 20 million deaths, with leading incidence from breast cancer (2.26 million cases), and lung cancer as the leading cause of death (1.80 million deaths) (2). In Pakistan, the estimated incidence of cancer is 0.17 million, with mortality at 0.12 million (3). According to the WHO, abstaining from risk factors and following preventative strategies can reduce cancer burden by 30–50%. Furthermore, early detection and treatment of a developing neoplasm can lead to an increased reduction in the number of cancer-related deaths (1).

The etiology of cancer is multifactorial, influenced by genetic, environmental, medical and lifestyle factors. Inherited genetic mutations play a major role in 5–10% of all cancers, with greater than 50 hereditary syndromes associated with gene mutations that lead to neoplasm development (4). With advancing genetic databases and detailed genetic testing methods in development for clinical application, examining these mutations that predispose at-risk patients is now possible. Through genetic testing, patients with hereditary cancer syndromes can be provided with individualized management options, leading to better prognoses and an improved Quality of Life (QoL) (5–7).

Therefore, sufficient knowledge amongst HealthCare Professionals (HCPs) in clinical practice regarding Cancer Genetic Testing (CGT) is essential. HCPs play an important role in the practical application of genetic screening tests, interpretation of their results, counselling patients, and preventative/ corrective interventions. A review by Becker et al demonstrated that appropriate use of genetic testing for breast and colon cancer was efficacious and cost-effective (8). However, various reports conducted worldwide suggest that HCPs do not have proper knowledge regarding CGT in clinical care, with many physicians feeling inadequate in training regarding cancer genetics (9–11). A cross-sectional study from Switzerland revealed primary care physicians lacked relevant knowledge to manage patients with a family history of cancer and there was no program to facilitate the physicians for genetic testing and prevention guidelines (12). This highly suggests a need for increasing the genomic literacy of HCPs for better patient outcomes.

As the complexity of gene related malignancies increases, it demands commensurate growth and preparedness of HCPs to cater to patients’ needs. No evident survey to date has been conducted in Pakistan to assess the utilization of currently available CGTs and counseling strategies amongst HCPs. The aim of our study is to assess the knowledge, attitude, and perception of regional HCPs regarding the application of cancer genetics, such as routine genetic screening tests and counseling in clinical practice. The results of this study may validate the need for proper training of Pakistani HCPs regarding genomic knowledge in management of cancer.

We conducted this descriptive cross-sectional study in Karachi, Pakistan from April 2022 to June 2022, at two tertiary care-hospitals: The Jinnah Postgraduate Medical Centre (JPMC, public sector) and Liaquat National Hospital (private sector). The study was approved for being conducted by the Institutional Review Board of JPMC (Supplementary Information File) and a self-designed questionnaire was developed through a detailed review of existing literature (13–15) and pre-tested on 10 HCPs. The final questionnaire consisted of 43 items, with sections on Socio-Demographics, Knowledge & Training, Attitude and Perceptions towards CGT. HCPs were individually approached for informed consent to participate in this study. Participants either filled the questionnaire in-person immediately or were emailed an anonymous form and requested for it to be returned at the earliest possible convenience. Email reminders were sent to fill the form at 2-week intervals, up to 3 months. Anonymity was maintained amongst participants, with no personal information or identifiers recorded, and consent forms collected separately.

We selected our population through non-probability random convenience sampling. Our sample size was calculated through openepi.com to be 384, with a Confidence Interval (CI) of 95%. A broad study population was considered, from all disciplines and specialties of Medicine. Study subjects not currently involved in clinical activities were excluded from the final analysis, to ensure that responses were only included from HCPs involved in clinical practice. Interns/House Officers were also excluded, as they would require greater clinical experience before being expected to prescribe CGT for patients.

Statistical analysis was conducted using SPSS V25.0 (Armonk, NY), with Continuous Data reported as Means ± Standard Deviation (S.D.) and Categorical variables as gross numbers and percentages (n; %). Statistical significance between Public and Private Sectors was compared using the independent sample t-test for continuous variables and Chi-squared test for categorical variables. A P-value of < 0.05 was considered significant for all analyses.

A total of 384 HCPs were approached to participate in this study, of which 210 agreed to participate. Ten participant responses were not included in the subsequent final analysis, since they weren’t involved in any clinical activity (overall response rate= 54.7%). Furthermore, we excluded specific specialty from our analysis due to a wide disparity and missing data.

Our study included participants from both the private (N=100, 47.6%) and public sectors (N=110, 52.4%), representing an approximately equal proportion of males and females with a sex ratio of 1.18, along with the mean age of respondents 36.2 ± 10.2 years. More than half the respondents (N=114, 54.3%) belonged to the field of medicine, with 37.6% (N=79) in surgery, and the remainder 8.1% (N=17) in other professional clinical areas. 36.7% (N=77) of HCPS had been in practice for more than 10 years, 20.0% (N=42) for 5-10 years, and 43.3% (N=91) for less than 5 years. There were 32.9% (N=69) participants who reported a personal or family history of cancer.

Knowledge and Training:

Table 1 outlines and compares the knowledge and training of participants from public and private hospitals regarding CGT.

Significantly more physicians in the public sector (N=46, 41.8%) dedicated ≥ 5 hours/week for CME, as opposed to 24 (24.0%) doctors in the private sector (P=0.006). More than half of the respondents from both private (N=56, 56.0%) and public (N=60, 54.5%) hospitals similarly considered their knowledge inadequate, with only 2.0% (N=2) of participants from private and 1.8% (N=2) from public hospitals having an excellent fund of knowledge.

Additionally, significantly more HCPs in the public sector compared to their private counterparts believed they were better prepared to counsel a patient regarding genetic testing [24 (21.8%) vs 8 (8.0%); P= 0.021] and were more confident about their ability to interpret the results of CGT [19 (17.3%) vs 5 (5.0%); P= 0.020].

Attitude towards Cancer Genetic Testing:

Table 2 demonstrates the attitudes of participants towards CGT.

This section of the questionnaire consisted of 5 questions and was scored as follows:

“Yes” was scored as (1/1) point, and “No” as (0/1). “Very” was assigned (2/2) points, “Somewhat/Little” (1/2) point, and “Not at all” as (0/2) points. Thus, from a total of 7 points, using 75% and 25% as upper and lower limit cutoffs:

≥6/7: Good Attitude

2-5/7: Fair Attitude

<2/7: Poor Attitude

Overall, HCPs in both private and public sector agreed to a dedicated need for specific training courses in cancer genetics, and that it is important to increase their knowledge about the clinical applicability of CGT. Our results demonstrate that 68.6% (N=144) participants have a positive attitude towards CGT, with a mean total score of 5.81 ± 1.35.

Perceptions about Cancer Genetic Testing:

Table 3 outlines and compares perceptions of doctors regarding cancer genetic testing in private and public settings.

This section of the questionnaire consisted of 17 questions and was scored as follows:

Least Important (0/2 points), Somewhat Important/Important (1/2 point), and Very Important/Most Important (2/2 points). Agree (2/2 points), Uncertain (1/2 point) and Disagree (0/0 points). Thus, from a total of 34 points, using 75% and 25% as upper and lower limit cutoffs:

≥26/34: Good Perception

9-25/34: Fair Perception

<9/34: Poor Perception

Generally, participants agreed that CGT can increase chances of cancer prevention and that research in cancer genetics will yield important improvements in how the disease is treated. While there were no significant differences between public and private HCP respondents, participants overall perceived cancer genetic testing in a positive light (N=116, 55.2%) with a total perception score of 25.84 ± 3.85.

Respondents were asked to prioritize the financing of possible health interventions to improve the current state of CGT in our healthcare system. “Screening tests for specific cancers e.g., mammography every other year in women over 50” proved to be the most popular option with 47.6% (N=100) of the doctors opting in its favor, while “Evaluation of new combination therapies and complementary medicine” proved to be the least popular, with only 7.1% (N=15) votes for top priority financing. Participant responses are discussed in Table 4.

Genetic testing has become an essential tool for the optimal treatment of various oncological diseases. It is imperative to determine health professionals’ knowledge and attitude towards cancer genetic testing (CGT), as doctors are the linchpin to ensuring that these testing techniques are appropriately incorporated into the healthcare system. This study was conducted to determine the knowledge, attitude, and behaviors of doctors in Pakistan regarding CGT. Our cross-sectional study reports that most health professionals have an inadequate understanding of cancer genetics and feel unqualified to counsel and prescribe genetic tests. Despite this, many recognize the importance of learning these testing modalities and to utilize them in their practice, which is encouraging.

There were few significant differences found in responses between both public and private sectors. However, respondents from public hospitals felt more confident than their private counterparts in interpreting (P = 0.020) and counseling (P = 0.021) a patient regarding genetic testing. In Pakistan, public hospitals cater to the many patients who are unable to afford private care, allowing providers working in public sectors to see a greater array of cases and diseases. This may have contributed to a greater confidence in dealing with patients with genetic analysis requirements (16).

Out of our respondents, 55.2% were seen to have positive attitudes towards CGT, giving hope that many will be receptive towards changes made to implement CGT in practical care. This is strengthened by the report of Ashfaq et al., which similarly concluded that Pakistani physicians were receptive to the inclusion of genetic services in healthcare (17). Approximately 63% of physicians in our survey admitted there was a strong need to increase their own understanding of genetic testing in their clinical practice. Additionally, most HCPs endorsed the need for post-graduate courses on CGT. This attitude is consistent with other studies that have also reported on the eagerness of healthcare professionals to attend courses on genetic testing (11, 13, 18). An overwhelming majority of physicians in both public and private sectors did not receive any sort of cancer genetic training in either medical school or residency/CME courses. Several studies have previously identified a gap in the knowledge among physicians on CGT (14, 15, 19–21); however, after an exhaustive literature search, no such study has been conducted in Pakistan, to the best of our knowledge. Primary care physicians who are non-experts in genetics are usually the first professionals to encounter patients with a possible need for genetic testing, and it is essential that competency is adequate to recognize these cases (19). Therefore, high-quality genomic courses must be developed to ensure these gaps in knowledge are addressed.

In our study, a majority of HCPs from both public (51.8%) and private sector (61.0%) were in a consensus that CGT should be performed only if economical evaluations show cost effectiveness ratios favorable compared to alternative health interventions. This is a favorable response, since in low-resource settings such as Pakistan, it is imperative to ensure that tests are ordered in a cost-effective manner, dictated by the patients’ needs and individual risk (16). Two cross sectional studies conducted in Italy reported a lack of cost-conscious behavior regarding CGT amongst residents and physicians respectively (11, 13). In a Lower-Middle-Income-Country like Pakistan, CGT availability is limited and expensive. Furthermore, 70% of the population is dependent on out-of-pocket expenditure (17). Considering the majority of our population takes up a low socioeconomic stratum (16), we recommend that healthcare professionals should be trained on cost-conscious strategies, optimizing CGT for underprivileged patients.

There were a number of potential limitations in our study that must be noted. Inherent limitations of a cross-sectional study are present, such as missing data and a wide disparity which would not merit any meaningful analysis. Additionally, our sample size was small (N = 210), so external validity may be affected as a result. Subjectivity of physician training, self-awareness, and confidence in interpretation of genetic testing would likely have played a role in the clinical decision making and delivery of care for their patients. While one strength of our study is that it was carried out at two institutions, large multi-center studies should be developed to determine the burden of suboptimal CTG referral in Pakistan. House officers and interns were not included in this study—we urge for further research for an insight into these demographics, with a focus on development of training programs/courses about CGT so physicians can hone their clinical acumen regarding CGT early in their career.

In conclusion, the knowledge of Pakistani doctors regarding cancer genetics is lacking. Our data supports the need for additional training surrounding the field of genetic testing. Surveys may be conducted to identify specific objectives healthcare professionals may be less knowledgeable about. These deficient areas can be used to develop specific post-graduate training programs targeted to promote the incorporation of cancer genetic testing in healthcare settings. Future studies may be conducted analyzing the efficacy of such programs in improving CGT practices.

Author Contributions

Authors S.S, M.N, M.R, Z.N, W.A, M.D.M, A.Z, A.S.S, M.B.M, M.N, S.K, R.I, A.I, and M.I confirm that they had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All of the authors gave final approval of this version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

None

Conflict of Interest

Shameel Shafqat,^,Masooma Naseem, Masooma Rana, Zehra Naseem,Warda Ahmed,Muhammad Daniyal Musharraf, Arisha Zaheer,Ahmed Safiullah Shaikh, Muhammad Bazil Musharraf, Mahnoor Niaz,Saifullah Khan, Rabiya Irfan, Areeba Imran, andZahid Mehmooddeclare that they have no conflict of interest.

Human Studies and Informed Consent

Approval was obtained from the Institutional Review Board of JPMC. All methods were carried out in accordance with relevant institutional guidelines and recommendations. In formed consent was taken from all subjects involved in our study.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Funding

None

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Table 1. Knowledge and Training of Participants from Public and Private Hospitals regarding Cancer Genetic Testing. *P-value is significant.

Variable

Total; N=210

n (%)

Private; N=100

n (%)

Public; N=110

n (%)

P-value

Have you received any training in cancer genetic during medical school?

Yes

31 (14.8)

179 (85.2)

14 (14.0)

86 (86.0)

17 (8.1)

93 (84.5)

0.767

Have you had exposure to cancer genetic testing during residency /CME courses?

Yes

52 (24.8)

158 (75.2)

28 (28.0)

72 (72.0)

24 (21.8)

86 (78.2)

0.300

How many hours per week do you dedicate to Continuing Medical Education?

≤5

≥5

140 (66.7)

70 (33.3)

76 (76.0)

24 (24.0)

64 (58.2)

46 (41.8)

0.006*

Have there been patient requests of cancer genetic tests in previous year?

Yes

64 (30.5)

146 (69.5)

32 (32.0)

68 (68.0)

32 (29.1)

78 (70.9)

0.647

When was the last time you referred a patient for cancer genetic testing?

≤12 months

≥24 months

110 (52.4)

100 (47.6)

48 (48.0)

52 (52.0)

62 (56.4)

48 (43.6)

0.226

How would you rate your level of knowledge on the appropriate use of genetic tests for cancer in clinical practice?

Poor/Inadequate

Sufficient

Excellent

116 (55.2)

90 (42.9)

4 (1.9)

56 (56.0)

42 (42.0)

2 (2.0)

60 (54.5)

48 (43.6)

2 (1.8)

0.970

How qualified do you find yourself to prescribe cancer genetic testing?

Very

Somewhat/Little

Not at all

12 (5.7)

159 (75.7)

39 (18.6)

4 (4.0)

75 (75.0)

21 (21.0)

8 (7.3)

84 (76.4)

18 (16.4)

0.449

How prepared do you feel to counsel patient with regards to a particular genetic test?

Very

Somewhat/Little

Not at all

32 (15.2)

160 (76.2)

18 (8.6)

8 (8.0)

83 (83.0)

9 (9.0)

24 (21.8)

77 (70.0)

9 (8.2)

0.021*

How confident are you in your ability to interpret results of cancer genetic test?

Very

Somewhat/Little

Not at all

24 (11.4)

154 (73.3)

32 (15.2)

5 (5.0)

78 (78.0)

17 (17.0)

19 (17.3)

76 (69.1)

15 (13.6)

0.020*

Do you discuss a family history of cancer with your patients?

Frequently

Occasionally/Rarely

Never

107 (51.0)

93 (44.3)

10 (4.8)

52 (52.0)

45 (45.0)

3 (3.0)

55 (50.0)

48 (43.6)

7 (6.4)

0.520

Table 2. Attitude of Participants from Public and Private Hospitals regarding Cancer Genetic Testing.

Variable

Total; N=210

n (%)

Private; N=100

n (%)

Public; N=110

n (%)

P-value

Is there a need for specific postgraduate courses on the use of genetic testing for cancer?

Yes

182 (86.7)

28 (13.3)

86 (86.0)

14 (14.0)

96 (87.3)

14 (12.7)

0.786

Should more time be dedicated to cancer genetics during post-graduate training/courses?

Yes

186 (88.6)

24 (11.4)

90 (90.0)

10 (10.0)

96 (87.3)

14 (12.7)

0.535

Is it important to increase your knowledge about the use of genetic tests for cancer in clinical practice?

Very

Somewhat/Little

Not at all

134 (63.8)

75 (35.7)

1 (0.5)

58 (58.0)

42 (42.0)

76 (69.1)

33 (30.0)

1 (0.9)

0.110

Do you think that genetic testing provides useful information about the risk of cancer and helps tailor screening and preventive surgery recommendations?

Very

Somewhat/Little

Not at all

138 (65.7)

72 (34.3)

61 (61.0)

39 (39.0)

77 (70.0)

33 (30.0)

0.170

Attitude:

Good

Fair

Poor

144 (68.6)

66 (31.4)

66 (66.0)

34 (34.0)

78 (70.9)

32 (29.1)

0.444

Total Attitude Score

5.81 ± 1.35

5.69 ± 1.37

5.91 ± 1.34

0.242

Table 3. Perception of Participants from Public and Private Hospitals regarding Cancer Genetic Testing.

Variable

Total; N=210

n (%)

Private; N=100

n (%)

Public; N=110

n (%)

P-value

Number of family members of the patient with cancer:

Least Important

Somewhat Important/Important

Very Important/ Most Important

18 (8.6)

49 (23.3)

143 (68.1)

7 (7.0)

26 (26.0)

67 (67.0)

11 (10.0)

23 (20.9)

76 (69.1)

0.558

Presence of a known mutation in the family member of the patient:

Least Important

Somewhat Important/Important

Very Important/ Most Important

7 (3.3)

44 (21.0)

159 (75.7)

3 (3.0)

17 (17.0)

80 (80.0)

4 (3.6)

27 (24.5)

79 (71.8)

0.374

Age of onset of cancer in the family member(s):

Least Important

Somewhat Important/Important

Very Important/ Most Important

10 (4.8)

59 (28.1)

141 (67.1)

4 (4.0)

29 (29.0)

67 (67.0)

6 (5.5)

30 (27.3)

74 (67.3)

0.865

The patient’s request:

Least Important

Somewhat Important/Important

Very Important/ Most Important

23 (11.0)

79 (37.6)

108 (51.4)

8 (8.0)

36 (36.0)

56 (56.0)

15 (13.6)

43 (39.1)

52 (47.3)

0.297

Features of the patient’s disease (e.g., triple negative breast cancer or multiple colorectal polyps):

Least Important

Somewhat Important/Important

Very Important/ Most Important

14 (6.7)

56 (26.7)

140 (66.7)

8 (8.0)

29 (29.0)

63 (63.0)

6 (5.5)

27 (24.5)

77 (70.0)

0.526

Impact on further treatment or surveillance:

Least Important

Somewhat Important/Important

Very Important/ Most Important

6 (2.9)

53 (25.2)

151 (71.9)

3 (3.0)

28 (28.0)

69 (69.0)

3 (2.7)

25 (22.7)

82 (74.5)

0.666

Genetic tests for cancer increase the chances of prevention opportunities and early intervention:

Agree

Uncertain

Disagree

188 (89.5)

19 (9.0)

3 (1.4)

89 (89.0)

9 (9.0)

2 (2.0)

99 (90.0)

10 (9.1)

1 (0.9)

0.799

Research in cancer genetics will lead to significant improvements in the treatment of cancer:

Agree

Uncertain

Disagree

180 (85.7)

19 (13.8)

1 (0.5)

84 (84.0)

16 (16.0)

96 (87.3)

13 (11.8)

1 (0.9)

0.364

Genetic tests that can identify an increased risk of developing cancer should not be performed even if there are no preventive and/or curative interventions of proven efficacy:

Agree

Uncertain

Disagree

109 (51.9)

71 (33.8)

30 (14.3)

45 (45.0)

41 (41.0)

14 (14.0)

64 (58.2)

30 (27.3)

16 (14.5)

0.096

Genetic tests for cancer should be performed only if economical evaluations show cost effectiveness ratios favorable compared to alternative health interventions:

Agree

Uncertain

Disagree

118 (56.2)

67 (31.9)

25 (11.9)

61 (61.0)

27 (27.0)

12 (12.0)

57 (51.8)

40 (26.4)

13 (11.8)

0.328

Authoritative and evidence-based guidelines are required for the appropriate use of genetic tests for different cancers:

Agree

Uncertain

Disagree

183 (87.1)

20 (9.5)

7 (3.3)

89 (89.0)

7 (7.0)

4 (4.0)

94 (85.5)

13 (11.8)

3 (2.7)

0.442

Predictive cancer genetic testing should not be performed without genetic counseling and informing patients of the benefits and risks of the tests:

Agree

Uncertain

Disagree

100 (47.6)

51 (24.3)

59 (28.1)

42 (42.0)

27 (27.0)

31 (31.0)

58 (52.7)

24 (21.8)

28 (25.5)

0.298

Genetic tests can contribute efficaciously to health promotion and cancer prevention, especially at a larger scale considering the other available health interventions:

Agree

Uncertain

Disagree

159 (75.7)

45 (21.4)

6 (2.9)

76 (76.0)

22 (22.0)

2 (2.0)

83 (75.5)

23 (20.9)

4 (3.6)

0.766

The implementation of genetic tests for cancer, being a medical matter, should still consider ethical, legal, and social implications:

Agree

Uncertain

Disagree

85 (40.5)

41 (19.5)

84 (40.0)

43 (43.0)

21 (21.0)

36 (36.0)

42 (38.2)

20 (18.2)

48 (43.6)

0.528

Genetic testing will enhance willingness of individuals at risk for cancer to undergo surveillance/ prophylactic surgery:

Agree

Uncertain

Disagree

160 (76.2)

42 (20.0)

8 (3.8)

72 (72.0)

22 (22.0)

6 (6.0)

88 (80.0)

20 (18.2)

2 (1.8)

0.191

If a cancer genetic test result does not only have consequences for the individual tested, but also their families, then patient confidentiality is at risk:

Agree

Uncertain

Disagree

37 (17.6)

57 (27.1)

116 (55.2)

18 (18.0)

26 (26.0)

56 (56.0)

19 (17.3)

31 (28.2)

60 (54.5)

0.938

Findings of a pathogenic mutation in a cancer genetics test can induce psychological distress and affect mental health overall, therefore causing more harm than good:

Agree

Uncertain

Disagree

89 (42.4)

72 (34.3)

49 (23.3)

45 (45.0)

31 (31.0)

24 (24.0)

44 (40.0)

41 (37.3)

25 (22.7)

0.623

Perception:

Good

Fair

Poor

116 (55.2)

94 (44.8)

53 (53.0)

47 (47.0)

63 (57.3)

47 (42.7)

0.444

Total Perception Score

25.8 ± 3.85

25.9 ± 4.01

25.8 ± 3.71

0.938

Table 4. Participant Responses to priority of interventions to finance.

Variable

Total; N=210

n (%)

Private; N=100

n (%)

Public; N=110

n (%)

P-value

If you could allocate money to cancer in the health care system, what would be your top priority to finance?

0.241

Screening tests for specific cancers e.g., mammography every other year in women over 50.

100 (47.6%)

55 (55.0%)

45 (40.9%)

Measures to develop cancer genetics (research, recruitment of appropriately trained personnel or surveillance and risk reduction measures).

69 (32.9%)

28 (28.0%)

41 (37.3%)

Development of new substances and therapy protocols.

26 (12.4%)

11 (11.0%)

15 (13.6%)

Evaluation of new combination therapies and complementary medicine.

15 (7.1%)

6 (6.0%)

9 (8.2%)

No competing interests reported.

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published 05 May, 2023

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Knowledge, Attitude and Perceptions about Cancer Genetic Testing in Clinical Practice in Karachi, Pakistan

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