Counselling for prenatal anomaly screening to migrant women in the Netherlands: An interview study of primary care midwives' perceived barriers with client-midwife communication.

INTRODUCTION: Large ethnic inequalities exist in the prenatal screening offer, counselling, informed decision-making, and uptake of prenatal anomaly tests. More insight into midwives' experiences with offering prenatal counselling to migrant women may provide better insight into the origins and consequences of these ethnic inequalities. METHODS: We conducted interviews with 12 midwives certified as counsellors for prenatal anomaly screening for women they identified as migrants. Interviews were analyzed using thematic analysis. RESULTS: Midwives reported most difficulties in communicating with women of 'non-western migrant background', which include first- and second-generation migrants from Africa, Latin-America, Asia, and Turkey. They experienced barriers in communication related to linguistics, health literacy, sociocultural and religious differences, with midwife stereotyping affecting all three aspects of counselling: health education, decision-making support, and the client-midwife relation. Health education was difficult because of language barriers and low health-literacy of clients, decision-making support was hampered by sociocultural and religious midwife-client differences, and client-midwife relations were under pressure due to sociocultural and religious midwife-client differences and midwife stereotyping. CONCLUSIONS: Barriers to optimal communication seem to contribute to suboptimal counselling, especially for women of 'non-western migrant background'. Client-midwife communication thus potentially adds to the ethnic disparities observed in the offer of and informed decision-making about prenatal anomaly screening in the Netherlands. The quality of prenatal counselling for women from all ethnic backgrounds might be improved by addressing linguistic, health literacy, sociocultural and religious barriers in future training and continuing education of prenatal counsellors.

Non-invasive prenatal testing (NIPT) and pregnant women's views on good motherhood: a qualitative study.

Women's views on responsible motherhood influence decision-making regarding participation in prenatal screening. Previous studies showed that the probabilistic nature of the first-trimester combined test and the potential requirement for subsequent invasive diagnostics serve as legitimate reasons for women to exclude prenatal screening from their moral responsibilities. These moral barriers might now be less relevant with the introduction of the non-invasive prenatal test (NIPT) resulting in women feeling a moral duty to use NIPT screening as part of responsible motherhood. This qualitative study explores the impact of NIPT on women's moral beliefs about the meaning of prenatal screening in relation to responsible motherhood. We performed semi-structured interviews with 29 pregnant women who were offered NIPT as a first-tier screening test within a Dutch nationwide study (TRIDENT-2). Results show that the inherent uncertainty about the fetus's health despite improved accuracy and the lack of treatment for a detected disorder, combined with the possibility to obtain information about actionable anomalies through the fetal anomaly scan, support women's perspectives that NIPT is not an obligation of responsible motherhood. Acceptance of NIPT is considered to be a free decision related to the information each woman needs to be a good mother for her child and her family. Women's views may change when NIPT has expanded to include treatable or preventable conditions.

How does the radiology community discuss the benefits and limitations of artificial intelligence for their work? A systematic discourse analysis.

PURPOSE: We aimed to systematically analyse how the radiology community discusses the concept of artificial intelligence (AI), perceives its benefits, and reflects on its limitations. METHODS: We conducted a qualitative, systematic discourse analysis on 200 social-media posts collected over a period of five months (April-August 2020). RESULTS: The discourse on AI is active, albeit often referring to AI as an umbrella term and lacking precision on the context (e.g. research, clinical) and the temporal focus (e.g. current AI, future AI). The discourse is also somewhat split between optimism and pessimism. The latter considers a wider range of social, ethical and legal factors than the former, which tends to focus on concrete technologies and their functionalities. CONCLUSIONS: Further precision in the discourse could lead to more constructive conversations around AI. The split between optimism and pessimism calls for a constant exchange and synthesis between the two perspectives. Practical conversations (e.g. business models) remain rare, but may be crucial for an effective implementation of AI in clinical practice.