Obstetric professionals’ perceptions of non-invasive prenatal testing for Down syndrome: clinical usefulness compared with existing tests and ethical implications

Abstract

BackgroundWhile non-invasive prenatal testing (NIPT) for fetal aneuploidy is commercially available in many countries, little is known about how obstetric professionals in non-Western populations perceive the clinical usefulness of NIPT in comparison with existing first-trimester combined screening (FTS) for Down syndrome (DS) or invasive prenatal diagnosis (IPD), or perceptions of their ethical concerns arising from the use of NIPT.MethodsA cross-sectional survey among 327 obstetric professionals (237 midwives, 90 obstetricians) in Hong Kong.ResultsCompared to FTS, NIPT was believed to: provide more psychological benefits and enable earlier consideration of termination of pregnancy. Compared to IPD, NIPT was believed to: provide less psychological stress for high-risk women and more psychological assurance for low-risk women, and offer an advantage to detect chromosomal abnormalities earlier. Significant differences in perceived clinical usefulness were found by profession and healthcare sector: (1) obstetricians reported more certain views towards the usefulness of NIPT than midwives and (2) professionals in the public sector perceived less usefulness of NIPT than the private sector. Beliefs about earlier detection of DS using NIPT were associated with ethical concerns about increasing abortion. Participants believing that NIPT provided psychological assurance among low-risk women were less likely to be concerned about ethical issues relating to informed decision-making and pre-test consultation for NIPT.ConclusionsOur findings suggest the need for political debate initially on how to ensure pregnant women accessing public services are informed about commercially available more advanced technology, but also on the potential implementation of NIPT within public services to improve access and equity to DS screening services.

Obstetrical provider knowledge and attitudes towards cell–free DNA screening: results of a cross-sectional national survey

“…This is in keeping with previous findings where even within a group of only USA-based MFM Fellows, the accuracy of a MFM fellow’s knowledge regarding possible indications for cfDNA screening trended towards higher levels with increasing year in the MFM fellowship [ 20 ]. As a whole, the majority of our Canadian participants demonstrated support towards use of cfDNA screening, a similar finding to attitudes of healthcare providers found in other countries like the USA, United Kingdom, Netherlands, and China [ 11 , 20 – 22 ]. However, we discovered that MFM and OB/GYN demonstrated significantly more support towards the use of cfDNA screening than GP and MW.…”

Second tier non-invasive prenatal testing in a regional prenatal diagnosis service unit: a retrospective analysis and literature review

“…22 Studies have found that obstetricians had more certain views about the usefulness of NIPT than midwives had. 23 To consider this potential bias, a questionnaire to the healthcare providers would be useful for understanding their perceptions, attitudes, and the extent of any bias towards NIPT or invasive diagnostic procedures. Standardised counselling materials (interview scripts, booklets, videos, question and answer information sheets) distributed to women may also minimise dynamic human factors during the counselling session.…”

Service provision of non-invasive prenatal testing for Down syndrome in public and private healthcare sectors: a qualitative study with obstetric providers

“…Using a sequential explanatory mixed-methods design [ 27 ], the first phase of a cross-sectional survey among DS screening providers assessed knowledge, attitudes and clinical experiences of NIPT compared to conventional screening and diagnosis. One of the significant findings was that obstetric providers in public sectors reported significantly more ethical concerns in the clinical implementation of NIPT than private providers, including women’s informed decision making, lack of consultation, unequal access to NIPT, and unnecessary use of resource (e.g., multiple DS screening tests) [ 18 ]. The finding addressed the importance of addressing system-level interventions in facilitating informed choice for reproductive autonomy, effective coordination between public and private sectors, and fairer resource allocation for better DS screening techniques, including an option of introducing NIPT in public antenatal care settings.…”