Christina Collart

Objective: To characterize the quality, consistency, and framing of information about prenatal cell‐free DNA (cfDNA) screening generated by publicly available chatbots, including variation across simulated user age profiles. Methods: We conducted a qualitative content analysis of outputs from three publicly available chatbots. To reduce carryover effects and personalization, prompts were entered using a VPN, private browsing, and cleared browser cookies. Outputs were generated using distinct simulated user age profiles. Analysis examined informational completeness, framing of benefits and limitations, terminology, source transparency, and age‐related differences in responses. Results: Chatbot outputs varied substantially across platforms and user profiles, with misinformation, omissions, and incomplete information identified. Common themes included inconsistent explanations of the purpose and scope of cfDNA screening, frequent omission of test limitations and downstream implications, and variable readability scores (at a 9th–14th grade level) and terminology that sometimes conflate screening with diagnostic testing. Citations to high‐quality sources were limited or absent. Age‐based profile variation was associated with differences in tone, complexity, and emphasis, suggesting implicit tailoring of information presentation. Conclusion: Publicly available chatbots may provide inaccurate or inconsistent information about cfDNA screening. As these tools are increasingly used outside clinical settings, improving accuracy, transparency, discussion of limitations, and source citation is essential to support reliable patient‐facing health information.

Introduction: Prenatal genetic screening and diagnostic tests (PS&D) are a core component of the delivery of high-quality, evidence-based prenatal care. There is a paucity of evidence on how to structure decision-making processes that are responsive to rapid advances in prenatal genetics, perinatology, and neonatology, which complicate such decisions. We sought to explore patients’ decision-making preferences as a pathway to support medical decisions about the informed use of prenatal genetic testing, which requires more than standardized counseling and underscores the importance of PS&D. Methods: We conducted a qualitative preference study of pregnant and postpartum patients to characterize experiences with PS&D. In-depth semi-structured interviews were conducted to explore decision-making needs and preferences regarding PS&D. Demographics, reproductive history, and PS&D use data were collected from the electronic medical record. Thematic analysis was used to identify leading themes. Results: Most participants were ≥35 y of age ( n = 48/61; 78.7%) and had a prior pregnancy ( n = 42/61; 68.9%). The analysis identified 2 superordinate themes related to patients’ preferred decision-making approach needed to set the stage to make an informed choice about PS&D: 1) a comprehensive approach in which the full scope of pretest and posttest options are outlined before using or declining PS&D or 2) a step-by-step approach with pacing of information acquisition and decision-making in response to individual options. Conclusions: Our findings suggest that supporting prenatal genetic testing decisions requires more than standardized counseling and underscores the importance of understanding patients’ preferences for decision making and information delivery. These preferences should be considered alongside factors such as reproductive history and maternal age, which may further shape how testing options and outcomes are understood. Together, these findings reinforce the need for a more individualized approach to counseling in an increasingly complex prenatal testing landscape.

Background: Prenatal genetic screening and diagnostic testing (PS&D) requires pregnant patients to make time‐sensitive, high‐stakes decisions that often involve multifaceted risk assessments and deeply personal values. These decisions are becoming increasingly complex as the clinical integration of new genomic science and technologies advances alongside parallel changes in maternal‐foetal medicine, neonatology, and reproductive health services. Despite these changes, there is limited guidance on how best to prepare patients to formulate PS&D decisions with significant implications for obstetric outcomes. The goal of this study was to characterise pregnant patients' perceptions of the decision‐making process and identify facilitators and barriers for them to make informed decisions about their PS&D options. Methods: We conducted a qualitative study of pregnant and postpartum individuals receiving obstetric care within a large healthcare system. Participants, enroled across early pregnancy, late pregnancy, and postpartum periods, completed in‐depth semi‐structured interviews exploring their experiences, preferences, and needs related to PS&D decision‐making. Interviews were recorded, transcribed verbatim, and analysed by a multidisciplinary team using inductive thematic analysis, supported by iterative coding, memoing, and theme identification. Results: Most participants were < 35 years of age (48 of 61) and had a prior pregnancy (42 of 61). Four major subthemes emerged around a central concept of trust affecting medical decision‐making: (1) Trust as a means of navigating the complexity of PS&D: Patients relied heavily on their obstetric (OB) providers to interpret complex information and guide decisions, particularly as testing decisions became more consequential and time sensitive. (2) Trust as a prerequisite for informed decision‐making: Patients emphasised that psychological safety and relational continuity were necessary before they could ask questions, disclose concerns, or integrate medical information with personal values. (3) Erosion of trust due to perceived bias, judgement, or assumptions: Provider bias, whether expressed through communication style, assumptions about patient preferences, or perceived judgement, undermined trust and impeded informed, values‐aligned decisions. (4) Structural barriers in prenatal care models: Limited continuity, time constraints, and triaged group‐based care created obstacles to building trust and compounded difficulties in discussing sensitive topics across multiple providers. Conclusions: Our findings suggest that trust is a core component of informed PGT decision‐making and central to supporting patient‐centred communication amid uncertainty, cascading decisions, and evolving genomic technologies. Strategies to build and maintain trust, particularly within multi‐provider prenatal care models, are essential to enabling informed, values‐concordant prenatal decision‐making. System‐level interventions that promote continuity, unbiased communication, and structured agenda‐setting help strengthen prenatal care delivery and improve patient experience and outcomes. Patient or Public Contribution: Patients were involved in three main aspects of the study: (1) identifying the need for research that supports PS&D decision‐making through our prior work with patients as part study participation in focus groups, interviews, and survey studies, (2) contributing to the development of the interview guide through direct feedback to the instrument's questions and methods of data collection, and (3) participating in the study interview and providing their perspectives on how to support them and other pregnant patients as they face a myriad of pre and posttest decisions.

Purpose: Prenatal genetic screens and diagnostic tests are vital components of prenatal care. The first prenatal visit is a critical time in the decision-making process when patients decide whether to use these tests in addition to address a series of other essential prenatal care aspects. We conducted this study to examine the role of a shared decision-making (SDM) instrument to support these discussions. Methods: We conducted a cluster randomized controlled trial of patients allocated to an SDM tool or usual care at their first prenatal visit. Participants completed a baseline survey to measure decision-making needs and preferences. Direct observation was conducted and analyzed using the OPTION scale to measure SDM during prenatal genetic testing discussions. Results: Levels of SDM were similar across groups ( P = 0.081). The highest levels of SDM were observed during screening test discussions (NEST 2.4 ± 0.9 v. control 2.6 ± 1.0). Lowest levels were observed in discussions about patients’ preference for risk versus diagnostic information (NEST 1.0 ± 1.1 v. control 1.2 ± 1.3). Conclusion: Study findings demonstrate the need for targeted patient-focused and provider-focused efforts to improve SDM to enhance patients’ informed decision making about these options. Importantly, patients’ baseline knowledge and attitudes need to be considered given that patients with less knowledge may need more carefully crafted communication. Highlights: Choices about whether, when, and how to use prenatal genetic tests are highly preference-based decisions, with patients’ baseline attitudes about these options as a major driver in health care discussions. The decision-making process is also shaped by patient preferences regarding a shared or informed decision-making process for medical decisions that are highly personal and have significant ramifications for obstetric outcomes. There is a need to develop targeted efforts to improve decision making and enhance patients’ ability to make informed decisions about prenatal genetic tests in early pregnancy.

Objectives: Decisional conflict and regret about prenatal genetic screening and diagnostic tests may have important consequences in the current pregnancy and for future reproductive decisions. Identifying mechanisms that reduce conflict associated with the decision to use or decline these options is necessary for optimal patient counseling. Methods: We conducted a cluster-randomized controlled trial of a shared decision-making tool (NEST) at the beginning of prenatal care. Enrolled patients completed follow-up surveys at the time of testing (QTT) and in the second–third trimester (QFF), including the Decision Conflict Scale (DCS). Total DCS scores were analyzed using a multivariate linear mixed-effect model. Results: Of the total number of participants (n=502) enrolled, 449 completed the QTT and QFF surveys. The mean age of participants was 31.6±3.8, with most parous at the time of study participation (n=321; 71.7 %). Both the NEST (the intervention) and control groups had lower median total DCS scores at QFF (NEST 13.3 [1.7, 25.0] vs. control 16.7 [1.7, 25.0]; p=0.24) compared to QTT (NEST 20.8 [5.0, 25.0] vs. control 18.3 [3.3, 26.7]; p=0.89). Participants exposed to NEST had lower decisional conflict at QFF compared to control (β −3.889; [CI −7.341, −0.437]; p=0.027). Conclusions: Using a shared decision-making tool at the start of prenatal care decreased decisional conflict regarding prenatal genetic testing. Such interventions have the potential to provide an important form of decision-making support for patients facing the unique type of complex and preference-based choices about the use of prenatal genetic tests.

Background: The COVID-19 pandemic brought significant changes in health care, specifically the accelerated use of telehealth. Given the unique aspects of prenatal care, it is important to understand the impact of telehealth on health care communication and quality, and patient satisfaction. This mixed methods study examined the challenges associated with the rapid and broad implementation of telehealth for prenatal care delivery during the pandemic. Objective: In this study, we examined patients’ perspectives, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: Pregnant patients who received outpatient prenatal care in Cleveland, Ohio participated in in-depth interviews and completed the Coronavirus Perinatal Experiences-Impact Survey (COPE-IS) between January and December 2021. Transcripts were coded using NVivo 12, and qualitative analysis was used, an approach consistent with the grounded theory. Quantitative data were summarized and integrated during analysis. Results: Thematic saturation was achieved with 60 interviews. We learned that 58% (35/60) of women had telehealth experience prior to their current pregnancy. However, only 8% (5/60) of women had used both in-person and virtual visits during this pregnancy, while the majority (54/60, 90%) of women participated in only in-person visits. Among 59 women who responded to the COPE-IS, 59 (100%) felt very well supported by their provider, 31 (53%) were moderately to highly concerned about their child’s health, and 17 (29%) reported that the single greatest stress of COVID-19 was its impact on their child. Lead themes focused on establishing patient-provider relationships that supported shared decision-making, accessing the information needed for shared decision-making, and using technology effectively to foster discussions during the COVID-19 pandemic. Key findings indicated that participants felt in-person visits were more personal, established greater rapport, and built better trust in the patient-provider relationship as compared to telehealth visits. Further, participants felt they could achieve a greater dialogue and ask more questions regarding time-sensitive information, including prenatal genetic testing information, through an in-person visit. Finally, privacy concerns arose if prenatal genetic testing or general pregnancy conversations were to take place outside of the health care facility. Conclusions: While telehealth was recognized as an option to ensure timely access to prenatal care during the COVID-19 pandemic, it also came with multiple challenges for the patient-provider relationship. These findings highlighted the barriers and opportunities to achieve effective and patient-centered communication with the continued integration of telehealth in prenatal care delivery. It is important to address the unique needs of this population during the pandemic and as health care increasingly adopts a telehealth model.

Introduction: During the early months of the COVID-19 pandemic, several health care facilities enacted visitor restrictions to help reduce the spread of SARS-CoV-2 among patients, front-line workers in health care systems, and communities. The impact and burden of policy updates on visitor restrictions put forth by the COVID-19 pandemic can be seen on patients and families, most often in the acute care setting and skilled nursing facilities. Yet, the effects of visitor restrictions in the prenatal care setting were unknown. We conducted a study to investigate the impact of these policies on pregnant patients who received outpatient prenatal care. Methods: We conducted a qualitative study to explore pregnant patients' experiences with prenatal health care delivery between May and July 2020. In-depth interviews were conducted with pregnant patients in the first and second trimester of pregnancy, who received their prenatal care at the onset of the pandemic in the United States. Results: Participants noted increased maternal concern, anxiety, and mental health concerns stemming from the lack of in-person partner support. They noted disappointment and lost experiences for the patient during pregnancy, seeking support from her partner during pregnancy, experiences felt to be critical for postpartum health and wellbeing. There was also concern about the negative impact of restrictions on prenatal care quality and experience. Conclusions: This study demonstrates the impact of visitor restrictions on patients' prenatal care experience and perception of health care quality during the COVID-19 pandemic. Future public health strategies should be individualized to different patient populations addressing knowledge, health literacy, and socioeconomic status, and developed in conjunction with pregnant patients as key stakeholders in the delivery of prenatal health care.

BACKGROUND The COVID-19 pandemic brought significant changes in healthcare, specifically the accelerated use of telehealth. Given the unique aspects of prenatal care, it is important to understand the impact of telehealth on healthcare communication, quality, and patient satisfaction. This mixed-methods study examined challenges associated with the rapid and broad implementation of telehealth for prenatal care delivery during the pandemic. OBJECTIVE In this study, we examine patients' perspectives, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. METHODS Pregnant patients who received outpatient prenatal care in Cleveland, Ohio participated in in-depth interviews and completed the Coronavirus Perinatal Experiences- Impact Survey (COPE-IS) between January-December 2021. Transcripts were coded using NVivo12 and qualitative analysis used an approach consistent with grounded theory. Quantitative data were summarized and integrated during analysis. RESULTS Thematic saturation was achieved with 60 interviews. Lead themes focused on: establishing patient-provider relationships that support shared decision-making (SDM), accessing the information needed for SDM, and using technology effectively to foster discussions during the COVID-19 pandemic. In the COPE-IS, 59 (100.0%) felt very well supported by their provider, 31 (52.5%) were moderately to highly concerned about their child’s health, and 17 (28.8%) reported the single greatest stress of COVID-19 was its impact on their child. CONCLUSIONS While telehealth was recognized as an option to ensure timely access to prenatal care during the COVID-19 pandemic, it also came with multiple challenges and opportunities to adapt to diverse patient populations. It is important to address the unique needs of this population during the pandemic and as healthcare increasingly adopts a telehealth model.

Background: Although telehealth appears to have been accepted among some obstetric populations before the COVID-19 pandemic, patients’ receptivity and experience with the rapid conversion of this mode of health care delivery are unknown. Objective: In this study, we examine patients' prenatal care needs, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: This study involved qualitative methods to explore pregnant patients’ experiences with prenatal health care delivery at the onset of the COVID-19 pandemic. We conducted in-depth interviews with pregnant patients in the first and second trimester of pregnancy who received prenatal care in Cleveland, Ohio, from May to July 2020. An interview guide was used to probe experiences with health care delivery as it rapidly evolved at the onset of the pandemic. Results: Although advantages of telehealth were noted, there were several concerns noted with the broad implementation of telehealth for prenatal care during the pandemic. This included concerns about monitoring the pregnancy at home; the need for additional reassurance for the pregnancy, given the uncertainties presented by the pandemic; and the ability to have effective patient-provider discussions via a telehealth visit. The need to tailor telehealth to prenatal health care delivery was noted. Conclusions: Although previous studies have demonstrated that telehealth is a flexible and convenient alternative for some prenatal appointments, our study suggests that there may be specific needs and concerns among the diverse patient groups using this modality during the pandemic. More research is needed to understand patients' experiences with telehealth during the pandemic and develop approaches that are responsive to the needs and preferences of patients.

BACKGROUND Although telehealth appears to have been accepted among some obstetric populations before the COVID-19 pandemic, patients’ receptivity and experience with the rapid conversion of this mode of health care delivery are unknown. OBJECTIVE In this study, we examine patients' prenatal care needs, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. METHODS This study involved qualitative methods to explore pregnant patients’ experiences with prenatal health care delivery at the onset of the COVID-19 pandemic. We conducted in-depth interviews with pregnant patients in the first and second trimester of pregnancy who received prenatal care in Cleveland, Ohio, from May to July 2020. An interview guide was used to probe experiences with health care delivery as it rapidly evolved at the onset of the pandemic. RESULTS Although advantages of telehealth were noted, there were several concerns noted with the broad implementation of telehealth for prenatal care during the pandemic. This included concerns about monitoring the pregnancy at home; the need for additional reassurance for the pregnancy, given the uncertainties presented by the pandemic; and the ability to have effective patient-provider discussions via a telehealth visit. The need to tailor telehealth to prenatal health care delivery was noted. CONCLUSIONS Although previous studies have demonstrated that telehealth is a flexible and convenient alternative for some prenatal appointments, our study suggests that there may be specific needs and concerns among the diverse patient groups using this modality during the pandemic. More research is needed to understand patients' experiences with telehealth during the pandemic and develop approaches that are responsive to the needs and preferences of patients.