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Offering non-invasive prenatal testing as part of routine clinical service. Can high levels of informed choice be maintained?

ABSTRACT: To assess rates of informed choice among women offered non-invasive prenatal testing (NIPT) for aneuploidy as part of routine clinical care.A cross-sectional survey was conducted across 6 antenatal clinics in England. Women with a high risk (?1/150) Down syndrome screening result were offered NIPT, invasive testing, or no further testing. Pretest counselling was delivered as part of routine care by the local maternity team. Women were given a questionnaire containing a measure of informed choice immediately after pretest counselling.In total, 220 of 247 women completed the questionnaire. Seventy-six percent were judged to have made an informed choice, a significant decline from our previous study (89.0% vs 75.6%; ?2 (2) = 20.2, P < .001). Of those making an uninformed choice, 46% had insufficient knowledge, 19% had not deliberated, and 13% had made a value-inconsistent decision. Multivariate analysis showed women who were highly educated (OR, 4.33; 95% CI, 1.08-17.36) or had had screening in a previous pregnancy (OR, 0.24; 95% CI, 0.90-0.65) were significantly more likely to make an informed choice.The findings highlight the challenges of ensuring informed choice in routine prenatal care where NIPT is not discussed at multiple points, less time is available for counselling, and written consent is not required.

SUBMITTER: Lewis C

PROVIDER: S-EPMC5969260 | biostudies-other | 2017 Nov

REPOSITORIES: biostudies-other

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Offering non-invasive prenatal testing as part of routine clinical service. Can high levels of informed choice be maintained?

Lewis Celine C Hill Melissa M Chitty Lyn S LS

Prenatal diagnosis 20171017 11

<h4>Objectives</h4>To assess rates of informed choice among women offered non-invasive prenatal testing (NIPT) for aneuploidy as part of routine clinical care.<h4>Methods</h4>A cross-sectional survey was conducted across 6 antenatal clinics in England. Women with a high risk (≥1/150) Down syndrome screening result were offered NIPT, invasive testing, or no further testing. Pretest counselling was delivered as part of routine care by the local maternity team. Women were given a questionnaire cont ...[more]

PMID: 28892219

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Project description:BackgroundNon-invasive prenatal testing (NIPT) can be used to accurately detect fetal chromosomal anomalies early in pregnancy by assessing cell-free fetal DNA present in maternal blood. The rapid diffusion of NIPT, as well as the ease and simplicity of the test raises concerns around informed decision-making and the potential for routinization. Introducing NIPT in a way that facilitates informed and autonomous decisions is imperative to the ethical application of this technology. We approach this imperative by systematically reviewing and synthesizing primary qualitative research on women's experiences with and preferences for informed decision-making around NIPT.MethodsWe searched multiple bibliographic databases including Ovid MEDLINE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and ISI Web of Science Social Sciences Citation Index (SSCI). Our review was guided by integrative qualitative meta-synthesis, and we used a staged coding process similar to that of grounded theory to conduct our analysis.ResultsThirty empirical primary qualitative research studies were eligible for inclusion. Women preferred to learn about NIPT from their clinicians, but they expressed dissatisfaction with the quality and quantity of information provided during counselling and often sought information from a variety of other sources. Women generally had a good understanding of test characteristics, and the factors of accuracy, physical risk, and test timing were the critical information elements that they used to make informed decisions around NIPT. Women often described NIPT as easy or just another blood test, highlighting threats to informed decision-making such as routinization or a pressure to test.ConclusionsWomen's unique circumstances modulate the information that they value and require most in the context of making an informed decision. Widened availability of trustworthy information about NIPT as well as careful attention to the facilitation of counselling may help facilitate informed decision-making.Trial registrationPROSPERO 2018 CRD42018086261 .

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Offering non-invasive prenatal testing as part of routine clinical service. Can high levels of informed choice be maintained?

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Offering non-invasive prenatal testing as part of routine clinical service. Can high levels of informed choice be maintained?

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