Project Inclusive Genetics: Protecting reproductive autonomy from bias via prenatal patient-centered counseling

Abstract

Clinician bias negatively impacts the healthcare received by marginalized communities. In this study, we explored factors that influence clinician and trainee bias against individuals with intellectual disabilities and its impact on clinical judgment in prenatal genetic testing settings. Specifically, we examined bias toward a fetus with a higher chance of developing a disability. We compared genetics specialists with their non-expert counterparts. This web-based study included clinical vignettes, implicit association tests (IATs), and an educational module. 595 participants were recruited via their institution or professional society. We conducted statistical analyses, including regression models controlling for key demographic characteristics, to analyze recommendation patterns and degree of change after the module. Genetics expertise strongly correlated with appropriate testing recommendation when the patient would not consider pregnancy termination (r= 1.784 pre-module, r= 1.502 post-module, p<0.01). Factors that influenced pre-module recommendation to test include increased age (r= -0.029, p<0.05), high religiosity (r= 0.525, p<0.05), and participant personal preference against testing (r= 1.112, p<0.01). Responses among participants without genetics expertise improved after the educational module (Z= -4.435, p<0.01). 42% of non-experts who answered inappropriately changed their answer to match guidelines after the module. Individual bias, along with structural and institutional bias, permeates family planning encounters and significantly decreases quality of care. We demonstrate here that anti-bias training is effective, particularly for non-expert providers, and it can improve the care provided to individuals with intellectual disability. Evidence-based training such as this one can help providers make appropriate genetic counseling recommendations.