Maternity care professionals’ views on good counselling for prenatal anomaly screening: a qualitative inquiry

Abstract

Background: Maternity care professionals find the art of counselling for prenatal screening challenging. An approach that could help professionals support patients' self-regulated behavior, enabling them to make their own choices, is autonomy-supportive counselling, which is based on the self-determination theory. This study aimed to gain insight into professionals' views on good counselling. Understanding their perspectives can shed light on the underlying mechanisms that drive professionals to focus on providing information and options rather than on decision-making support. These insights, in turn, can be instrumental in tailoring education. Methods: This qualitative survey study was conducted in the Netherlands among Dutch maternity care professionals involved in counselling for prenatal screening. Thematic analysis was used to analyze the answers to the open-ended question: In your opinion, what constitutes ‘good’ counselling for prenatal anomaly screening? Next, the research team discussed the identified themes and related these themes to the concept of autonomy-supportive counselling. Lastly, the researchers conducted a quantitative analysis of the qualitative data to draw attention to specific patterns. Results: Of 2813 invited registered counsellors, 1426 were included in the study. The themes regarding the context of good counselling were time, counsellors’ competence, and ethical sensitivity. Exploring the parents' values was found to be an overarching theme in the interaction between patients and professionals during the process of good counselling. Almost all participants mentioned providing information and facilitating free choice as essential themes in the interaction before and during decision-making. Other identified themes were exploring the impact of the test result on the parents and guiding. Regarding the outcome, the most frequently mentioned theme was parents making their own choices, other themes were making the right choice and no assurance of getting a healthy baby. Conclusions: Most participants consider that in good counselling, important themes are providing information as a mechanism, and parents making their own free choices as an outcome. The results and discourse reflect a more non-directive attitude before and during the decision-making process. Since a non-directive attitude can complicate parents’ more autonomous decision-making, we suggest paying attention to more directive guidance by providing structure to facilitate parents’ more autonomous decision-making.