Discussion
The use of PG testing in clinical practice essentially aims to optimize treatment protocols, minimize the frequency of ADRs, and generally improve therapeutic outcomes35. Since physicians are the most valuable source in passing medical information to patients36, they should have a basic understanding of PG and conceptualize its validity. Ideally, physicians should also be aware of the most recent advancements in PG research. Our study, therefore, took impetus from this fact, and gauged the knowledge, attitude, and practice of PG among medical students and clinicians in different academic and non-academic health sectors, in addition to identifying the perceived barriers to its future application. The major highlight of this study is that physicians and medical students in North Jordan have, overall, low knowledge, however strongly positive attitude and future expectations toward PG, in spite of the perceived high cost and lack of clinical guidelines.
Despite our finding of poor overall knowledge about PG among medical students and physicians, a deeper look into knowledge items suggests a promising future for PG in Jordan. Indeed, the majority of respondents were aware of PG and its importance in clinical practice, and the foreseen benefits on pharmaco-economy. Almost two thirds of the respondents were aware that PG tests are available in Jordan and could identify which medications require a genetic testing. Therefore, our results should be discussed in the wider context of novelty and recent emergence of PG as a concept. Poor overall knowledge of PG was actually evident in several similar studies around the world. For instance, Elewaet al. showed in 2015 a low mean awareness score among Qatari doctors and pharmacists about PG29. Furthermore, Abdela et al. reported in 2017 a generally low knowledge about PG among Ethiopian healthcare providers33. Similar results were additionally obtained from India37 and Kuwait34.
Interestingly, stratifying our respondents based on age using a cutoff point of 30 years revealed a significant difference in the mean total PG knowledge score between the younger and older generation. Those below 30 years of age were significantly more knowledgeable about PG than those above 30 years of age. This interesting finding could in part be attributed to the wide access and reliance of the younger generation on the modern and advanced means of education and learning, such as the social media applications and the various reputable open educational resources. Furthermore, one cannot overlook the fact that those students, interns, and residents have grown in an era of the expansive global interest in genetics post conclusion of the big human genome project in 200338. Despite this seemingly higher knowledge level of the younger generation, we must emphasize here that academic institutions in Jordan still do not cover topics related to PG applications in their curricula. This indeed could largely explain the low overall knowledge scores among Jordanian students and physicians alike.
A previous study from Jordan by Jarrar in 2019 assessed the perception and knowledge of internist physicians about PG from various private and public Jordanian hospitals39. The study reported a generally good knowledge regarding the basic principles of PG, albeit still not widely practiced. It must be noted, however, that the author only included internist physicians in the study, and did not explore the perceptions of other medical and surgical disciplines, as well as medical students, interns, and residents, contrary to our study. Moreover, the report by Jarrar did not discuss issues related to future expectations and perceived barriers to PG application.
Several studies worldwide highlighted the overall positive attitude of healthcare professionals toward PG and its importance in improving the quality of health services they provided. These include studies from the USA40, Canada41, Kuwait34, Qatar29 , India37, and Jordan39. Our results here reinforce such observations. Counterintuitive to our aforementioned findings on knowledge, specialists had a slightly stronger positive attitude towards PG application than residents (p=0.03), possibly because the latter fear that such tool might add an extra load on their job duties. Nonetheless, this finding encouragingly sheds light on the importance of PG in clinical practice from the point of view of the most senior professionals. Our results, as well as of others, of a low overall knowledge coupled with a strongly positive attitude about PG among physicians represent an urgent call for a quick goal-oriented educational strategy. Such strategy should comprehensively aim to integrate PG concepts into medical curricula, promote the culture of continuous medical education for practitioners, and introduce PG application into clinical practice.
On the other hand, the overall future expectations and practice score in our sample was remarkably high. The majority of respondents were interested in applying PG in their future practice, representing a promising outcome of our study. In spite of the statistically significant differences in future expectations of respondents depending on age and primary work settings, perhaps due to variability in sample sizes of these groups, the overall context remains bright.
The current study had the advent of gauging the perceived barriers to practice of PG testing in Jordan by clinicians and medical students. According to our survey, the major concern of clinicians was the expensive cost of PG tests coupled with a lack of insurance coverage, in agreement with several other studies published elsewhere29,40. Additionally, lack of approved clinical guidelines and the limited provider knowledge and awareness about PG were high among our respondents. Importantly, this finding emphasizes our belief that our clinicians still struggle to interpret PG test results and would find it difficult counseling the patients about their consequences. Intriguingly, only a minority of our clinicians and medical students (39.6%) believed that their cultural and/or religious beliefs would affect the clinical practice of PG in a conservative community like North Jordan.
Our study manifests a few limitations. First, the response rate was fairly low. However, we assume that a higher response rate might have a more detrimental impact on the overall knowledge and attitude of participants. Second, generalizability of our results is of concern, as the sample was recruited solely from North Jordan, although national differences in knowledge, attitude, and practice of PG by geographic location have not been previously reported. Furthermore, we believe that this study presents a pilot assessment that has a potential on national aspects. Third, the scales utilized in the current study were collapsed into the minimum categories. Such approach is justified by the evidence showing that Arabs, similar to other non-European-American groups, are less likely to use middle response categories when presented a greater number of options42,43.
In conclusion, physicians and medical students in Jordan have low overall knowledge, however strongly positive attitude and future expectations toward PG. High cost, lack of clinical guidelines and insurance coverage, and poor awareness are among the major barriers towards PG applications in Jordan. Our study supports the findings of several other studies worldwide to adopt PG and calls for urgent training and educational programs to enhance its practical practice.