CYSTIC-FIBROSIS CARRIER SCREENING - KNOWLEDGE AND ATTITUDES OF PRENATAL-CARE PROVIDERS

We arc conducting a trial of population carrier screening for cystic f ibrosis (CF), targeting pregnant and nonpregnant patients of prenatal care providers. We first enlisted providers by presenting a descriptio n of the trial to the obstetrical staffs of the five Rochester, New Yo rk, hospitals having delivery services. Of the 124 prenatal care provi ders (111 obstetricians and 13 family practitioners) with delivery pri vileges at the five hospitals, only 81 (65%) attended one of our prese ntations. Providers who attended lacked knowledge about CF screening a nd counseling and expressed divergent attitudes about prenatal diagnos is for carrier women having test-negative partners. Of the 79 provider s completing an attitude questionnaire, 68 (86%) were willing to offer carrier screening to all their patients if educational materials, tes ting, and counseling were all provided without charge. After visiting participating physicians' offices to orient their staff, we reached tw o additional conclusions. First, in considering whether to offer CF ca rrier screening to their patients, prenatal care providers arc less co ncerned about imperfect test sensitivity, false reassurance of those t esting negative, or discrimination against those testing positive than about time required to answer patients' questions if they screen and about legal liability if they do not. Second, some providers are more resistant to offering screening to nonpregnant patients than to pregna nt patients, not because they believe that the timing is less appropri ate, but because nonpregnant patients do not routinely receive an adva nce mailing, have phlebotomy, or return for follow-up. Our experience raises concerns about the willingness and capability of prenatal care providers to translate advances in molecular medicine into prenatal sc reening services.