PRENATAL GENETIC COUNSELORS’ CHANGING MEDICAL DOCUMENTATION PRACTICES IN THE AFTERMATH OF THE DOBBS V JACKSON SUPREME COURT DECISION

Objectives

We aimed to identify and document the impacts of evolving abortion regulations on prenatal genetic counseling (GC) practice and training.

Methods

We conducted semi-structured qualitative interviews with 27 GC Masters program directors, instructors, and clinical supervisors in 15 states and performed thematic content analysis after inductive and deductive coding.

Results

We found that documentation practices are changing in states with abortion restrictions. GCs described their medical record documentation as becoming more “vague” or “generic.” Some reported using code words agreed upon among colleagues, making clinical notes more inconspicuous, or not documenting discussions about abortion altogether. Some relied on verbal rather than written communication. Further, GCs reported receiving vague guidance from their institutions’ legal teams, while those practicing in states with exceptions for lethal fetal anomalies highlight complexity in defining ‘lethal’ and specific documentation required to justify abortion. For those in protective states, it can be unclear how best to document care for patients referred from restrictive states.

Conclusions

In the aftermath of Dobbs, the risk calculus for documenting abortion, and even pregnancy status in the medical record is shifting. Our study shows GCs are changing documentation practices, sometimes in coordination with other providers (eg, maternal-fetal medicine and complex family planning), or with guidance from institutional lawyers, but often in ad hoc ways. Medical documentation has the potential to impact trust and rapport between patients and providers, care continuity, research and public health surveillance. Our results have implications for providers who work in care teams with GCs and are facing similar challenges in the post-Dobbs environment.