Young Peter D, Sahan Katherine M
Ethox Centre Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
BMC Med Ethics. 2025 Jul 19;26(1):101. doi: 10.1186/s12910-025-01227-z.
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.
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.
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.
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.
Not applicable.
医疗保健专业人员有道德义务根据医患关系的理念提供信息，而在实践中确立这一责任的一种方式是英国关于共同决策的指导意见。非侵入性产前检测（NIPT）是自2021年以来英国国家医疗服务体系（NHS）提供的一种相对较新的产前筛查检测。由于与其他产前筛查和检测（如联合检测和羊膜穿刺术）相比，NIPT具有不同的特点，因此在检测前咨询中应如何提供信息尚不清楚。回答这个问题的关键是更多地了解围绕NIPT提供的医护人员与患者之间的关系动态。以往的研究主要关注女性在其中的作用；孕妇对NIPT提供过程中决策的看法和态度在其他地方已有探讨。然而，医护人员的观点和态度以及这些观点如何影响NIPT的提供方式和决策过程却很少受到关注。
本研究对20名提供NIPT和/或为NIPT提供咨询的英国医护人员进行了定性访谈。对访谈结果进行分析，并就医护人员报告的NIPT提供方式及其原因形成了主题。
医护人员表示，在提供检测时，他们向女性传达了NIPT的性质信息。这包括医护人员如何描述NIPT的风险、他们对阐明NIPT非诊断性质的看法、他们如何向女性解释NIPT的准确性，以及他们如何强调检测选项的决定权在患者手中。医护人员还报告了他们如何将NIPT与其他筛查和检测区分开来，并将NIPT描述为一种不同类型的筛查检测。此外，许多医护人员表示，他们要么向患者提供预先确定的信息，要么报告在提供过程中以患者为主导。
本研究探讨了医护人员如何报告NIPT的提供情况，以及他们认为应该如何进行提供，并给出了他们报告内容的原因。这表明了他们对于应该提供哪些信息的规范意识（即他们认为对决策至关重要的信息）。这也表明了他们认为在提供过程中哪些方面应该强调或淡化。这里报告的医护人员的经历引发了关于在NIPT提供过程中应如何向女性提供信息问题。这可能有助于我们建立更好的告知使用NIPT女性的做法。本研究结果对产前检测实践中的伦理问题有诸多启示。首先，它们表明需要更好地指导和教育如何讨论提供过程中的某些信息方面，如NIPT的特征和统计数据。其次，它们表明当前提供过程的某些方面可能充满价值判断，并且医护人员为患者提供NIPT咨询的方式可能没有充分以患者为主导。该领域更多的研究可能会告诉我们是否应该制定不同的指导或教育机会，以帮助医护人员讨论NIPT及其特征。
不适用。
