Lenicia Jenkins

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.