Navigating uncertainty during non-invasive prenatal testing: Genetic counselors' experiences of supporting autonomous reproductive decision-making.

There is limited understanding of how healthcare professionals understand and apply the concept of reproductive autonomy in their clinical practice with non-invasive prenatal testing (NIPT). Existing research indicates potential misalignment between theoretical understandings of reproductive autonomy and its operationalization by healthcare professionals in clinical practice. Despite genetic counselors (GCs) having unique expertise and experience in prenatal genetic counseling, there is a dearth of research regarding their understanding and practices relating to reproductive autonomy. To address this gap, we explored GCs' NIPT clinical practice, particularly focusing on their conceptualization and facilitation of autonomous reproductive decision-making. Semi-structured interviews were undertaken with 23 GCs experienced in providing NIPT in Australia. Data were analyzed using inductive content analysis. GCs viewed their role as facilitating reproductive genetics decision-making and supporting patients to navigate the uncertainty inherent to prenatal screening, including phenotypic uncertainty. Uncertainty was viewed by GCs as an inherent feature of prenatal genetic testing, but not one that was incompatible with reproductive autonomy. Diverse views were expressed regarding the scope of conditions available via NIPT. Cost was viewed as a source of inequity, with all GCs supporting some level of public funding for NIPT.