PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：非侵入性产前检测（NIPT），它可以筛选非整倍体，如21三体，正在欧洲的几个公共医疗保健系统中实施。文献中强调了全面的沟通和信息是支持妇女生殖决策和解决相关道德问题（如程序化）的重要因素。英国和法国等国家正在采用大致相似的实施模式，为具有高非整倍体概率的妊娠提供NIPT。然而,我们没有更深入地了解专业人员的咨询价值观和实践在这些背景下可能有什么不同。
方法：在本文中，我们探讨了英国和法国的专业人员如何在提供NIPT时支持患者决策,并批判性地比较专业实践和价值观.我们利用半结构化的医疗保健专业人员访谈数据。
结果：英国和法国专业人士都强调与患者选择和同意有关的价值观。然而,这些价值观在NIPT规定实践中的理解和应用是不同的。英语受访者更加强调通过“原则”镜头解释和描述咨询患者和临床护理的过程。他们专注于非指向性，标准化,以及医疗保健专业人员作为患者的“决策促进者”。法国受访者通过“程序”镜头描述了他们的方法。他们的重点是正式同意，信息,和医疗保健专业人员作为“信息提供者”。英语和法语专业人员都表示，资源不足是有效将其价值观转化为实践的关键障碍。
结论：我们的研究结果表明，在提供NIPT时支持患者选择可能在表面水平上被认为是一个重要的共同价值，但可以以不同的方式理解并转化为实践。我们的发现可以指导进一步的研究，并为NIPT规定的实践和政策提供有益的信息。
方法：在本文中，我们探讨了英国和法国的专业人员如何在提供NIPT时支持患者决策,并批判性地比较专业实践和价值观.我们利用半结构化的医疗保健专业人员访谈数据。
结果：英国和法国专业人士都强调与患者选择和同意有关的价值观。然而,这些价值观在NIPT规定实践中的理解和应用是不同的。英语受访者更加强调通过“原则”镜头解释和描述咨询患者和临床护理的过程。他们专注于非指向性，标准化,以及医疗保健专业人员作为患者的“决策促进者”。法国受访者通过“程序”镜头描述了他们的方法。他们的重点是正式同意，信息,和医疗保健专业人员作为“信息提供者”。英语和法语专业人员都表示，资源不足是有效将其价值观转化为实践的关键障碍。
结论：我们的研究结果表明，在提供NIPT时支持患者选择可能在表面水平上被认为是一个重要的共同价值，但可以以不同的方式理解并转化为实践。我们的发现可以指导进一步的研究，并为NIPT规定的实践和政策提供有益的信息。
