Towards a Responsible Implementation of NIPT as a First-Tier Test in Canada: Decision-Makers' Perspectives

To explore decision makers' perspectives on the conditions for a responsible implementation of non-invasive prenatal testing (NIPT) as a first-tier test in Canadian provinces' healthcare systems.

A qualitative study was conducted with 16 Canadian decision makers who were interviewed between February 2021 and July 2022. After anonymization and transcription, interviews were coded inductively using thematic analysis.

Our interviews showed the complexity of the decision making environment regarding prenatal screening funding. Participants agreed that NIPT is superior to maternal serum screening as a first-tier test, but they also recognized that first-tier NIPT has limits and barriers. They described the following conditions for its responsible implementation: (1) need for time and evidence; (2) taking stakeholders' perspectives into account; (3) limit costs for the healthcare system; (4) ensure appropriate logistical conditions and harmonize the test offer; (5) ensure appropriate clinical services; (6) ensure informed consent; (7) ensure the test is presented as an individual choice to avoid eugenic concerns.

Multiple barriers and issues need to be addressed before moving NIPT from second- to first-tier. Decision makers' perspectives should be contrasted with those of other important stakeholders, including pregnant people, disability advocates and healthcare professionals.