Cancer genetics: consultants' perceptions of their roles, confidence and satisfaction with knowledge

The African Genomic Medicine Training Initiative (AGMT): Showcasing a Community and Framework Driven Genomic Medicine Training for Nurses in Africa

The potential of genomic medicine in improving the quality of healthcare both at population and individual-level is well-recognized globally. However, successful adoption of genetic and genomic evidence into clinical practice depends on training the healthcare workforce and clinical researchers in genomic medicine. Due to limited expertise in the medical genetics and genomics field, widespread uptake largely depends on task-shifting for the implementation of genomic medicine implementation to key healthcare professionals such as nurses. Their knowledge would be developed through courses aimed at professional development. Globally, trainers, and training initiatives in genomic medicine are in early stages of development, but resource limited settings such as the African continent face additional logistical and institutional challenges. The African Genomic Medicine Training (AGMT) Initiative was conceived during a combined conference of the African Society of Human Genetics (AfSHG) and the Human Heredity and Health in Africa Consortium (H3Africa) in 2016, Senegal, in response to the needs for developing knowledge and skills in genomic medicine. AGMT was established to implement a sustainable genomic medicine training initiative primarily for healthcare professionals who are not geneticists but are nurses, doctors, and pharmacists in Africa. This paper reports on the establishment of the AGMT initiative and the strategies developed and piloted by this initiative in designing and implementing an accredited frame-work and community-based blended learning course for nurses across 11 African countries. The global implementation experiences, outcomes and lessons learnt are highlighted. The AGMT initiative strategy takes advantage of existing research consortia and networks to train and create a pool of trainers and has adopted evidence-based approaches to guide curriculum and content development/adaptation. This initiative established the first Africa-wide online blended learning genomic medicine course which forms the basis from which to develop courses for other healthcare professionals and the wider public.

Attitudes and knowledge of medical practitioners to hereditary cancer clinics and cancer genetic testing

Genetic testing for susceptibility for common cancers is widely available. Thus, doctors have a role in identifying and referring patients who would benefit from a consultation with a specialist in genetics. This study aims to assess doctors' referral rates, knowledge and attitudes towards cancer genetic testing, broken down by specialty (gastrointestinal, breast/ovarian, other specialties and General Practitioners-GPs). A 4-page questionnaire was mailed out to the GPs of all patients seen in 2012 in the Hereditary Cancer Clinic of St. Vincent's Hospital Sydney (n = 128) and all the specialists in St. Vincent's Hospital Sydney that might refer to the HCC (n = 33). 50 questionnaires were returned (31 %). Most doctors had referred a patient for cancer genetic testing (90 %). The average proportion of patients referred was 1 in 68.5 patients with breast/ovarian specialists referring the most, followed by gastrointestinal specialists and GPs. There was suboptimal knowledge of cancer genetic testing amongst doctors. Breast/ovarian specialists were most knowledgeable, followed by gastrointestinal specialists, other specialists and GPs. There were indications of inappropriate referral amongst doctors. Most (77.6 %) doctors were willing to receive further information on cancer genetics. Nearly all (94 %) doctors believe that it is their duty to inform an individual at high risk for hereditary cancer that cancer genetic counselling and testing is available. The majority of doctors have positive attitudes towards cancer genetic testing. Defective knowledge scores, however, indicate that doctors need further training or tools to enable them to refer patients appropriately for cancer genetic testing.

Barriers to and motivations for physician referral of patients to cancer genetics clinics

Although it is well known that under-referral of colon cancer patients to cancer genetics clinics is a chronic problem, no study has yet examined why physicians may be ordering testing independently rather than referring patients to cancer genetics clinics. The current study explored variables which may impact a physician's preference for ordering testing independently or referring patients to outside cancer genetics experts. An online questionnaire, distributed to the membership of the American College of Gastroenterology and the American Society of Colorectal Surgeons, yielded responses from 298 physicians. Motivations to refer to cancer genetics clinics rather than order testing independently included fear of genetic discrimination and a belief that patients benefit from genetic counseling about the risks, benefits and consequences of testing. These results suggest that in order to increase referrals, genetic counselors must educate physicians about the unique benefits patients receive from participating in genetic counseling.