Attitudes and training needs of oncologists and surgeons in mainstreaming breast cancer genetic counseling in a low-to-middle income Asian country

Lee, Yong-Quan and Yoon, Sook-Yee and Hassan, Tiara and Padmanabhan, Heamanthaa and Yip, Cheng-Har and Keng, Wee-Teik and Thong, Meow-Keong and Annuar, Muhammad Azrif Ahmad and Taib, Nur Aishah Mohd and Teo, Soo-Hwang (2022) Attitudes and training needs of oncologists and surgeons in mainstreaming breast cancer genetic counseling in a low-to-middle income Asian country. Journal of Genetic Counseling, 31 (5). pp. 1080-1089. ISSN 1059-7700, DOI

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With the advent of poly-ADP-ribose polymerase inhibitor (PARPi) therapies, the focus of genetic testing for breast, ovarian, and other cancers has shifted from risk management to treatment decision-making in high-resource settings. Due to the shortage of genetic counselors worldwide, alternative ways of delivering genetic counseling have been explored, including training nongenetics healthcare professionals (NGHPs) to provide genetic counseling. However, little is known about the feasibility of adopting such models in healthcare settings with insufficient specialists, where population health literacy is low and where access to new therapies may be limited. In this study, we evaluated the attitudes, considerations, and self-efficacy of oncologists, breast surgeons, and general surgeons in mainstreaming breast cancer genetic counseling in Malaysia, a middle-income Asian country with a universal healthcare system. We developed a 32-item survey via a modified Delphi method, which was then distributed via a purposive and network sampling approach. While 77% of respondents expressed interest in providing breast cancer genetic counseling, 85% preferred to refer patients directly to genetic services for genetic counseling and testing. The main considerations for mainstreaming were the cost of genetic testing and PARPi therapy, as well as the availability of support from genetics professionals. Respondents reported a lack of confidence in communicating genetic risk, particularly to patients with poor health literacy, and in the clinical management of patients with variants of uncertain significance. Our results highlight the urgent need to train more NGHPs in providing genetic counseling and testing in low-to-middle income countries, and suggest that the mainstay for genetic counseling in this setting may be for risk management rather than access to PARPi therapy.

Item Type: Article
Funders: Yayasan Sime Darby, Yayasan PETRONAS, Estee Lauder Companies, Vistage
Uncontrolled Keywords: Attitudes; Breast cancer; Genetic counseling; Low-to-middle income country; Mainstreaming; Self-efficacy; Service delivery models
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 15 Sep 2023 04:21
Last Modified: 15 Sep 2023 04:21

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