“Do you want to know or not?” How prenatal providers manage clinical uncertainty related to chromosomal risk and noninvasive prenatal testing

Abstract

In 2011, noninvasive prenatal testing (NIPT) disrupted clinical screening and testing paradigms. While concerns have been raised over public and patient-oriented NIPT usage, providers’ views of NIPT remain understudied. This is significant because providers offer pre-test counseling to pregnant patients. This study sought to better understand how prenatal care providers view NIPT in the context of risk and uncertainty. After obtaining institutional ethical approval, semi-structured interviews were conducted with certified nurse-midwives and obstetrician-gynecologists (n = 20). Interviews were audio-recorded, transcribed and coded using abductive analysis. Providers perceived chromosomal risk as an ever-present uncertainty that they worked to help patients make sense of, and providers perceived NIPT as a binary risk assessment tool to decrease uncertainty and increase patient knowledge. These results indicate that while providers may be more likely to use NIPT as a way to limit uncertainty, the social consequences of this move are that providers may inadvertently offload decisional responsibility onto patients, impacting respect for patients’ autonomy.