Abstract
There is a current shortage of certified clinical genetic counselors to keep up the publics’ growing demand for genetic counseling services. This is especially a concern for the field of prenatal genetic counseling because of the introduction of non-invasive prenatal testing via cell-free DNA analysis and a recent American College of Obstetricians and Gynecologists (ACOG) practice guideline that suggests that this testing be available to all women. The purpose of this study is to assess prenatal genetic counselors’ involvement in offering aneuploidy screening and testing. An anonymous survey was distributed to the National Society of Genetic Counselors listserv and was completed by 193 prenatal genetic counselors. The demographics of the sample were reflective of the 2016 NSGC Professional Status survey. Only 29.7% of the respondents stated that they do follow the ACOG guideline. Barriers for implementing the ACOG guideline reported by all participants included: busy work schedule, adding additional time to counseling sessions, limited insurance coverage, and poor pre-test counseling by other health care providers. Participants reported seeing an average of 4.4 patients daily and a Quantitative Workload Inventory was an average of 16, indicating a reasonable workload. However, 14.7% participants mentioned their busy work schedule as a barrier for implementing the ACOG practice guideline. In general, participants indicated that genetic counselors are the most appropriate provider to consent patients for both screening and diagnostic aneuploidy tests regardless of indication. Participants who indicated that the non-genetics providers in their practice received education on aneuploidy screening and testing found it to be more appropriate for non-genetics providers to consent patients for cffDNA in two circumstances: AMA and isolated echogenic intracardiac foci (p<0.05). Although 43.3% of participants distributed educational pamphlets in their practice, other forms of alternative service delivery were much less frequently utilized. The majority of participants did not utilize genetic counselor assistants. This study suggests that prenatal genetic counselors are not yet offering cffDNA to all women and few are utilizing alternative service delivery to increase workplace efficiency. In order to accommodate the demand for prenatal genetic counseling services it is important for prenatal genetic counselors to focus on education for non-genetics providers and incorporate more alternative service delivery.