Journal Article

Implementation challenges for an ethical introduction of noninvasive prenatal testing: a qualitative study of healthcare professionals’ views from Lebanon and Quebec

Ravitsky, Vardit, Ghulmiyyah, Labib, Haidar, Hazar, Vanstone, Meredith, Bibeau, Gilles, Laberge, Anne-Marie

2020

Overview

Background The clinical introduction of non-invasive prenatal testing for fetal aneuploidies is currently transforming the landscape of prenatal screening in many countries. Since it is noninvasive, safe and allows the early detection of abnormalities, NIPT expanded rapidly and the test is currently commercially available in most of the world. As NIPT is being introduced globally, its clinical implementation should consider various challenges, including the role of the surrounding social and cultural contexts. We conducted a qualitative study with healthcare professionals in Lebanon and Quebec as case studies, to highlight the relevance of cultural contexts and to explore the concerns that should be taken into account for an ethical implementation of NIPT. Methods We conducted semi-structured interviews with 20 healthcare professionals (HCPs), 10 from each country, practicing in the field of prenatal screening and follow up diagnostic testing, including obstetricians and gynecologists, nurses, medical geneticists and, genetic counselors. We aimed to 1) explore HCPs’ perceptions and views regarding issues raised by NIPT and 2) to shed light on ways in which the introduction of the same technology (NIPT) in two different contexts (Lebanon and Quebec) raises common and different challenges that are influenced by the cultural norms and legal policies in place. Results We identified challenges to the ethical implementation of NIPT. Some are common to both contexts, including financial/economic, social, and organizational/ educational challenges. Others are specific to each context. For example, challenges for Lebanon include abortion policy and financial profit, and in Quebec challenges include lobbying by Disability rights associations and geographical access to NIPT. Conclusions Our findings highlight the need to consider specific issues related to various cultural contexts when developing frameworks that can guide an ethically sound implementation of NIPT. Further, they show that healthcare professional education and training remain paramount in order to provide NIPT counseling in a way that supports pregnant women and couples’ choice.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abortion / Abortion policy / Beliefs, opinions and attitudes / Data analysis / Data collection / Diagnostic tests / Disabilities / Disability rights / Education / Ethical aspects / Ethical introduction / Ethics / Ethics in Biomedical Research / Finance / Genetic counseling / Gynecology / Health care policy / Husband-wife relations / Implementation / Interviews / Lebanon / Lobbying / Medical ethics / Medical personnel / Medical personnel training / Medical research / Non-invasive prenatal testing (NIPT) / Nurses / Obstetricians / Philosophy / Philosophy of Medicine / Pregnant women / Prenatal diagnosis / Qualitative interview study / Qualitative research / Quebec / Research Article / Researchers / Social aspects / Technology / Theory of Medicine/Bioethics