Dilemmas encountered by health practitioners offering nuchal translucency screening: a qualitative case study.
OBJECTIVE
To explore dilemmas experienced by practitioners involved in routine prenatal nuchal translucency (NT) screening.


METHODS
Qualitative study incorporating multidisciplinary practitioner discussion groups led by a health care ethicist.


METHODS
Inner-city teaching hospital with fetal medicine unit.


METHODS
Thirty-two practitioners whose work relates directly or indirectly to perinatal care.


RESULTS
Practitioners identified a number of dilemmas, many of which centred on the tension between pregnancy being seen as a normal or a 'risky' time. Practitioners and women were perceived to have contrasting reasons for screening, with women welcoming the opportunity to 'see' their baby on the ultrasound scan, whilst practitioners were screening for abnormalities. These differing agendas led to various dilemmas particularly in relation to information giving, performing scans incorporating NT screening and promoting individual client choice.


CONCLUSIONS
Plans to introduce routine NT screening need careful prospective consideration of the potential implications for both providers and users of the service. The discussion groups also identified the need for training in the complex communication skills required and an awareness of the related ethical dilemmas, plus the need for increased time and resources to enable practitioners to promote informed choice.
Williams
Clare
C
Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. clare@williams-forbes.freeserve.co.uk
Alderson
Priscilla
P
Farsides
Bobbie
B
D022126:Access to Information; D001291:Attitude of Health Personnel; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging; D004314:Down Syndrome / Q000000981:diagnostic imaging; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D007258:Informed Consent; D009333:Neck / Q000000981:diagnostic imaging / Q000196:embryology; D028701:Patient Rights; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012307:Risk Factors; D016216:Ultrasonography, Prenatal / Q000523:psychology*