Evaluation of Washington State Department of Health Prenatal Genetics Resources

Abstract

Background: Prenatal care is one of the most utilized healthcare services in the United States (Osterman & Martin, 2018). Genetic screening and carrier screening are both an important aspect of prenatal care. A Prenatal Genetics Task Force, comprising experts from varied disciplines, was convened by the Washington State Department of Health (WA DOH) to address a recent Washington Administrative Code update (WAC Chapter 246.680), rapid uptake in prenatal screening tests, direct-to-consumer tests being marketed as gender reveal tests, and prenatal genetic tests happening in non-genetic clinical settings. This study aimed to evaluate two provider resources published by the task force on prenatal genetic screening and carrier screening and obtain feedback to determine if the resources met provider needs and increased provider confidence to order tests and interpret results for these topics.Methods: An online survey was created, and IRB approval was received. The survey was then uploaded to Survey Monkey and sent to providers via email by members of the Prenatal Genetics Task Force. The survey was open for three weeks. Qualitative responses were coded utilizing both deductive and inductive coding. Quantitative analysis included a Wilcoxon signed rank test, performed on questions pertaining to provider confidence in ordering and interpreting both carrier screening and prenatal genetic screening tests, before and after reviewing the Department of Health resources. Results: The survey gathered 37 responses. Three themes were unveiled through the coding process that easily summarize the results of this survey. For the carrier screening landing pages and fact sheets, the biggest feedback we received was the need for these resources to be translated into more languages, cost and insurance estimates to be added, and these resources were too much information for a busy provider to review when in a rush. For prenatal genetic screening, we found the most important feedback to be on cost/insurance estimates, more consideration around maternal age and what tests would be best to order for older women, and that these resources are expecting too much from providers. In our quantitative comparisons, we determined that there was a difference detected before and after reviewing the resources for ordering carrier screening tests and interpreting prenatal genetic screening results. Discussion: According to our Wilcoxon signed rank tests, there was a confidence increase in ordering carrier screening tests and interpreting prenatal genetic screening results, before and after exploring the Department of Health resources. There was no change in confidence between the carrier screening resources and the prenatal genetic screening resources, leading us to believe both resources are performing well. There are both strengths and limitations to this work. Conclusion: The survey results confirmed that the resources created are helpful, full of necessary and correct information, and can help increase confidence in non-genetic providers who order genetic testing for their prenatal and preconception patients.