Views and attitudes about the offer of NIPT: a qualitative study of UK healthcare professionals.

Abstract

Background: Healthcare professionals have ethical duties to provide information according to conceptions of the doctor-patient relationship, and one way this responsibility is established in practice is by UK guidance on shared decision making. Non-invasive prenatal testing (NIPT) is a relatively new prenatal screening test offered by the UK National Health Service (NHS) since 2021. Since NIPT has different characteristics when compared to other prenatal screens and tests-such as the combined test and amniocentesis-it is not clear how information should be offered in a pre-test consultation. Key to answering this question is to understand more about the HCP-patient relational dynamics surrounding the offer of NIPT. Previous studies have focused on the woman's role in this; the views and attitudes of pregnant women about decision making in the offer of NIPT has been interrogated elsewhere. However, little attention has been given to the views and attitudes of healthcare professionals (HCPs) and how those views might shape the dynamics of how NIPT is offered and how the decision-making process goes.

Methods: This study carried out qualitative interviews with 20 UK HCPs who offered NIPT and/or provided counselling for NIPT. Findings from the interviews were analysed and themes were developed about how HCPs reported they offered NIPT and their reasons for this.

Results: HCPs say they conveyed information about the nature of NIPT to women when offering the test. This includes how HCPs say they described the risks of NIPT, their views about clarifying the non-diagnostic nature of NIPT, how they explained NIPT accuracy to women, and how they stressed that decisions about test options were up to the patient. HCPs also reported how they distinguished NIPT from other screens and tests and described NIPT as a different category of screening test. Furthermore, many HCPs say they either provided predetermined information to patients or reported being patient-led in the offer.

Conclusions: This study explores how HCPs reported the offer of NIPT and also how they thought the offer should go, by giving their reasons for what they report. This indicates their normative sense of which information ought to be given (that is, what they believed was critical to provide for decision making). It also indicates which aspects within the offer they believed should be emphasised or played down. The accounts reported here of HCPs' experiences raise questions about how information should be provided to women in the offer of NIPT. This might help us establish better practices of informing women who use NIPT. Results of this study have a number of implications for the ethics of prenatal testing in practice. Firstly, they indicate a need for better guidance and education about how to discuss certain informational aspects within the offer such as NIPT characteristics and statistics. Secondly, they show that aspects of the current offer may be value-laden, and the way HCPs counsel patients about NIPT may be insufficiently patient-led. More research in this area might tell us whether different guidance or educational opportunities ought to be developed to help HCPs discuss NIPT and its characteristics.

Clinical trial number: Not applicable.