BACKGROUND The clinical introduction of non-invasive prenatal testing for fetal aneuploidies is currently transforming the landscape of prenatal screening in many countries. Since it is noninvasive, safe and allows the early detection of abnormalities, NIPT expanded rapidly and the test is currently commercially available in most of the world. As NIPT is being introduced globally, its clinical implementation should consider various challenges, including the role of the surrounding social and cultural contexts. We conducted a qualitative study with healthcare professionals in Lebanon and Quebec as case studies, to highlight the relevance of cultural contexts and to explore the concerns that should be taken into account for an ethical implementation of NIPT. METHODS We conducted semi-structured interviews with 20 healthcare professionals (HCPs), 10 from each country, practicing in the field of prenatal screening and follow up diagnostic testing, including obstetricians and gynecologists, nurses, medical geneticists and, genetic counselors. We aimed to 1) explore HCPs' perceptions and views regarding issues raised by NIPT and 2) to shed light on ways in which the introduction of the same technology (NIPT) in two different contexts (Lebanon and Quebec) raises common and different challenges that are influenced by the cultural norms and legal policies in place. RESULTS We identified challenges to the ethical implementation of NIPT. Some are common to both contexts, including financial/economic, social, and organizational/ educational challenges. Others are specific to each context. For example, challenges for Lebanon include abortion policy and financial profit, and in Quebec challenges include lobbying by Disability rights associations and geographical access to NIPT. CONCLUSIONS Our findings highlight the need to consider specific issues related to various cultural contexts when developing frameworks that can guide an ethically sound implementation of NIPT. Further, they show that healthcare professional education and training remain paramount in order to provide NIPT counseling in a way that supports pregnant women and couples' choice.

中文翻译：

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道德上引入无创产前检测的实施挑战：来自黎巴嫩和魁北克的医疗保健专业人员观点的定性研究。

背景技术针对胎儿非整倍性的无创产前检查的临床引入目前正在改变许多国家的产前检查的格局。由于NIPT无创，安全且可以及早发现异常，因此NIPT迅速扩展，目前该测试已在世界上大多数国家/地区推出。随着NIPT在全球范围内被引入，其临床实施应考虑各种挑战，包括周围社会和文化背景的作用。我们与黎巴嫩和魁北克的医疗保健专业人员进行了定性研究，作为案例研究，以强调文化背景的相关性并探讨在实施NIPT时应考虑的问题。方法我们对20名医疗保健专业人员（HCP）进行了半结构化访谈，每个国家/地区有10名在产前筛查和随访诊断测试领域执业，其中包括妇产科医生，护士，医学遗传学家和遗传咨询师。我们的目标是：1）探索HCP对NIPT提出的问题的看法和观点； 2）阐明在两种不同背景下（黎巴嫩和魁北克）引入相同技术（NIPT）会带来共同挑战和不同挑战的方式受现行文化规范和法律政策的影响。结果我们确定了在实施NIPT方面面临的挑战。有些情况在两种情况下都是相同的，包括财务/经济，社会和组织/教育方面的挑战。其他特定于每个上下文。例如，黎巴嫩面临的挑战包括堕胎政策和财务利润，在魁北克，挑战包括残疾人权利协会的游说以及对NIPT的地理访问。结论我们的发现强调，在制定可以指导道德规范实施NIPT的框架时，需要考虑与各种文化背景相关的特定问题。此外，他们表明，医疗保健专业教育和培训对于以支持孕妇和夫妻选择的方式提供NIPT咨询仍然至关重要。