Barriers To Genetic Testing Adoption in Oncology: A Cross-Sectional Survey from Pakistan

Area of Science:

• Oncology
• Genetics
• Health Services Research

Background:

• Personalized cancer care relies heavily on genetic testing.
• Adoption of genetic testing is limited in low- and middle-income countries (LMICs), like Pakistan.
• Barriers to genetic testing adoption in LMICs are not well understood.

Purpose of the Study:

• To identify key barriers influencing genetic testing use in Pakistani oncology.
• To explore practical strategies for strengthening genetic testing adoption in clinical practice.

Main Methods:

• A cross-sectional survey of 49 oncology clinicians in Pakistan (August-December 2023).
• Assessed clinician confidence, ordering practices, knowledge, training, and perceived barriers.
• Analyzed outcomes (low confidence, infrequent ordering) using Fisher's exact test and odds ratios.
• Qualitative analysis of open-ended responses using an inductive thematic approach.

Main Results:

• 14% reported low confidence, 18% rarely ordered genetic tests.
• Limited lab access strongly associated with low confidence (OR 22.0) and infrequent ordering (OR 14.0).
• Patient cost (93%) and stigma (69%) were common but not significant predictors of clinician behavior.
• Qualitative themes: system workflow delays, clinician training gaps, and patient financial/misconception issues.

Conclusions:

• Improving laboratory and referral infrastructure is crucial for expanding precision oncology access.
• Integrating genetics education and supportive policies can enhance routine cancer genetic testing in Pakistan and similar LMICs.