To neutrally offer or strongly recommend? General practitioners' perspectives on screening for gestational diabetes according to the national guideline in Norway.

ABSTRACT

OBJECTIVE: To explore general practitioners' experiences and reflections on how the current Norwegian guideline for screening for gestational diabetes affects their clinical practice. DESIGN: A qualitive study in which data were collected through semi-structured focus group interviews and analyzed thematically. SETTING AND SUBJECTS: Five focus groups conducted in 2020 among GPs in Norway; three interviews took place face-to-face and two were held digitally. The total number of participants was 31. RESULTS: GPs acknowledged the potential benefits of more extensive screening, but had concerns about the medicalization of pregnancy, stating that some women experienced considerable anxiety. The GPs expressed doubts about the guideline's evidence base but differed in how they interpreted what the guideline was asking them to do. Some offered eligible women the opportunity to be screened, while other set up a screening appointment without consulting the women first. For some, fear of incrimination made them recommend screening without being convinced that it was the right thing for the patient. CONCLUSIONS: It is unclear whether the guideline for gestational diabetes requires GPs to recommend screening to pregnant women or if they should provide neutral information about the availability of screening. This ambiguity should be addressed, and the guideline evaluated against the core principles of general practice.

The Norwegian guideline for gestational diabetes (2017) increased the proportion of pregnant women eligible for screening and spurred considerable debate.The GPs in this study expressed concerns about the lack of evidence and the consequences of screening more women for gestational diabetes.It is unclear to GPs whether they are required to recommend screening to pregnant women or just inform them of its availability.The guideline should be evaluated to better account for the benefits, burdens and costs of screening and any subsequent treatment.