Prenatal Care Providers’ Experience With Pre-test Counselling for NIPT in Ontario: Counselling Challenges and Support Required
Abstract
Non-invasive prenatal testing (NIPT) is a prenatal test that has experienced unprecedented commercial development and transformed prenatal care. The Ontario Ministry of Health presently funds NIPT as a first-tier prenatal screening option for high-risk singleton pregnancies and all twin pregnancies. Individuals who do not qualify for public funding or would like to screen for additional conditions can pay for NIPT privately, starting at approximately $495-$550 (CA) for baseline panels. Prenatal care providers such as family physicians, maternal-fetal-medicine specialists, obstetrician-gynaecologists, residents, midwives and registered nurses have an increasingly important role in offering NIPT in Ontario. Although these healthcare professionals do not have a specific genetic focus to their practice, little research exists exploring their experience of being at the forefront of counselling for this technology. This dissertation explores how these prenatal care providers in Ontario provide counselling for NIPT within their clinical practice.
Charmaz’s constructivist grounded theory methodology was used to explore how prenatal care providers have enacted the process of prenatal pre-test counselling since the introduction of NIPT in Ontario. A total of 19 providers who encounter NIPT professionally in the Ontario cities of London, Hamilton, Toronto and Kingston participated in this study. The resulting theoretical model describes how providers experience pre-test counselling considerations for NIPT, including challenges, ethical considerations, and patient engagement in decision-making. To address these issues and effectively counsel patients about this expanding technology requires ongoing education, support and resources.
Findings suggest practical, educational, and ethical inequalities between current NIPT panel options and prenatal care providers’ comfort and ability to provide pre-test counselling. Prenatal care providers require ongoing guidance and support as their role in prenatal screening is shifting to involve more complex counselling for NIPT. It is also essential to be proactive and develop supportive strategies to help providers navigate this technology's rapid expansion in the future.