Health professional observations of the Joint Decision-Making Process for Prenatal Screening: Presenter(s): Ciska Hoving, Maastricht University, Netherlands

Prenatal screening decision--making is ideally a joint process between all relevant decisional partners (commonly both prospective parents) and based on informed choice principles (identified by us as Joint Informed Decision-Making; J-IDM). As prenatal screening is commonly an unfamiliar decisional topic for most decisional partners, prenatal health care professionals might be helpful in supporting the J-IDM process. It is, however, currently unclear to what extent professionals observe this decision-making process developing over time and which role they take and want. Semi-structured individual qualitative interviews with 19 prenatal health care professionals (e.g., midwives, physicians) were conducted in 2021. Interviews explored observed joint decisional processes between decisional partners, the role of the health professional in this process and barriers to J-IDM. Data was analysed using Framework methodology. Most interviewed health professionals felt that prenatal screening decisions appeared to be joint by the prospective parents, but they did not regularly confirm whether the decision was informed (especially concerning the 20-week medical ultrasound). Some health professionals reported taking on an intentionally limited role, focused on knowledge transfer, as they felt an active role in the decision was inappropriate. Others extended their role to stimulating J-IDM, although involvement in the actual deliberation process was limited. Cultural, relational, and practical barriers were identified that might interfere with the joint decision-making process and subsequent decisions. Our Findings: show that prenatal health care professionals perceived prenatal screening decisions as predominantly made jointly by decisional partners, but largely taking place outside the professional’s consultation room. Health professionals are in a good position to support the J-IDM process, but currently take on a role that is mostly restricted to offering information. We recommend exploring possibilities to expand their role to further facilitate J-IDM within their range of abilities and preferences.