Supporting patient decision-making in non-invasive prenatal testing: a comparative study of professional values and practices in England and France

• Published in: BMC medical ethics 2024-03, Vol.25 (1), p.34-13, Article 34
• Main Authors: Bowman-Smart, Hilary, Perrot, Adeline, Horn, Ruth
• Format: Article
• Language: English
• Subjects: Analysis; Aneuploidy; Archives & records; Clinical medicine; Comparative analysis; Consent; Counseling; Data collection; Decision making; Diagnostic tests; Down Syndrome; England; Female; France; Genetic Testing; Genomes; Gynecology; Health aspects; Health counseling; Humans; Interviews; Laboratories; Medical personnel; Medical research; Medicine, Experimental; Methods; Midwifery; Non-invasive prenatal testing; Policy; Practices; Pregnancy; Pregnant women; Prenatal Diagnosis; Professional ethics; Professionals; Professions; Supporting reproductive decision-making; Values
• ISSN: 1472-6939; 1472-6939
• DOI: 10.1186/s12910-024-01032-0

Non-invasive prenatal testing (NIPT), which can screen for aneuploidies such as trisomy 21, is being implemented in several public healthcare systems across Europe. Comprehensive communication and information have been highlighted in the literature as important elements in supporting women's reproductive decision-making and addressing relevant ethical concerns such as routinisation. Countries such as England and France are adopting broadly similar implementation models, offering NIPT for pregnancies with high aneuploidy probability. However, we do not have a deeper understanding of how professionals' counselling values and practices may differ between these contexts. In this paper, we explore how professionals in England and France support patient decision-making in the provision of NIPT and critically compare professional practices and values. We draw on data from semi-structured interviews with healthcare professionals. Both English and French professionals emphasised values relating to patient choice and consent. However, understandings and application of these values into the practice of NIPT provision differed. English interviewees placed a stronger emphasis on interpreting and describing the process of counselling patients and clinical care through a "principle" lens. Their focus was on non-directiveness, standardisation, and the healthcare professional as "decision-facilitator" for patients. French interviewees described their approach through a "procedural" lens. Their focus was on formal consent, information, and the healthcare professional as "information-giver". Both English and French professionals indicated that insufficient resources were a key barrier in effectively translating their values into practice. Our findings illustrate that supporting patient choice in the provision of NIPT may be held as an important value in common on a surface level, but can be understood and translated into practice in different ways. Our findings can guide further research and beneficially inform practice and policy around NIPT provision.