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.