Gynecologic Oncologists Cite Time, Money as Barriers to Global Health Participation

Michelle Lightfoot, MD

Lack of clinical coverage and time off topped the perceived hindrances to gynecologic oncologists’ participation in global health activities, according to a study reported at the Society of Gynecologic Oncology (SGO) in National Harbor, MD.

More than half of clinicians who had participated in global health activities cited lack of clinical coverage and inability to get time off as a barrier to participation. Among those who had not participated in health initiatives outside the United States, lack of time off and lack of support from home institutions headed the list of barriers.

A majority of attending physicians and trainees said that additional time off and increased funding support would stimulate greater participation in global health initiatives.

“Participation in global health activities may be facilitated through increased elective time, funding, and clinical coverage,” said Michelle Lightfoot, MD, an obstetrician-gynecologist at Beth Israel Deaconess Medical Center in Boston. “Formal training in global health is needed. Research opportunities in global health may be a potential area of focus for the future.”

Low- and middle-income countries throughout the world shoulder a disproportionate share of the global burden of gynecologic cancers, including new diagnoses and deaths. At the same time, poorer nations are at the center of global disparities in healthcare resources and access to those resources. Access to surgical oncologic care is especially limited, as fewer than a fourth of patients who need the care have access to it, Lightfoot said.

Gynecologic oncologists face unique barriers to the provision of care in areas with the greatest unmet need. However, they also have significant opportunities to have an impact on delivery of gynecologic oncology services by providing care, training healthcare professionals, and advocating for increased funding and recognition of the work done in the areas, she continued.

Given gynecologic oncologists’ potential contributions to addressing the global burden of cancer, Lightfoot and colleagues at Beth Israel Deaconess conducted a survey of the SGO membership, including trainees and attending physicians. The survey assessed global health experience and perceived barriers to participation in global health initiatives.

Data analysis comprised 272 respondents to the digital survey, 47% of whom had global health experience. Attending physicians made up 82.4% of the respondents, 79.2% of whom were born in the United States. About two-thirds of the survey participants were 40 or older. Of those who had global health experience, 45.6% participated as attending physicians, 6.4% as fellows, 22.4% as residents, and 25.6% at multiple time points.

Responses to survey items about barriers to participation in global health surprised the investigators. “Contrary to what we were expecting, lack of funding and opportunities were not the primary barriers,” Lightfoot said. “Instead, it was the inability to get time off, financial responsibilities, and lack of support from one’s home institution.”

Inability to get time off was cited by 53.6% of respondents with global health experience and 41.4% of those without, financial responsibilities by 42.4% and 30.0%, and lack of support from home institutions by 39.2% and 36.4%. More than half (56.8%) of respondents with global health experience cited lack of clinical coverage as a barrier, versus 25.7% of those without experience. Lack of funding was cited by 26.4% of experience and 16.4% of non-experienced respondents, and lack of opportunities by 18.4% and 14.3%.

Among respondents with global health experience, 81% of fellows and 93.3% of attending physicians said the experience occurred in the form of direct patient care. An additional 28.6% of fellows and 31.7% of attending physicians had research experiences in global health. Humanitarian assistance was cited by 9.5% of fellows and 27.9% of attending physicians.

Despite citing lack of support from home institutions as a key barrier to global health participation, 70% of fellows and 48% of attending physicians participated in global activities through their home institution. About a third of both groups mentioned participation through nongovernmental organizations.

Among all respondents, 85.2% said they received no formal training in global health, and 87.1% said they felt gynecologic oncologists do not receive adequate training in global health. Asked to identify resources needed to increase participation in global health, 64.0% of fellows and 53.7% of attending physicians cited additional elective time, and 52.6% of fellows and 61.0% of attending physicians cited increased funding.

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