Consent for toxicology testing during pregnancy: a qualitative study of patient and clinician perspectives

Consent for toxicology testing during pregnancy: a qualitative study of patient and clinician perspectives
Leah N. Schwartz, Ellis J. Yeo, Molly R. Siegel, Davida M. Schiff, Sarah N. Bernstein
American Journal of Obstetrics & Gynecology, 1 January 2023
Abstract
Objective
Although state, federal, and professional guidelines stipulate the need for informed consent prior to toxicology testing during pregnancy, consent is often inadequately obtained. Our objective was to explore patient and clinician experiences obtaining consent for toxicology testing during pregnancy.
Study Design
Semi-structured qualitative interviews were conducted with 25 obstetric clinicians and 10 patients who had toxicology testing performed during their delivery hospitalization at two institutions from December 2021-June 2022. Interviews assessed clinical decision-making, perceptions of testing utility, and consent and communication practices. Using a modified grounded theory approach, transcripts were double-coded and analyzed in Dedoose.
Results
When obtaining consent for toxicology testing, clinicians reported they routinely discuss testing indication but rarely address the patient’s right to refuse and the consequences of a positive result, both of which patients identified as important components of consent. Patients expressed discomfort asking questions during the consent process and an inability to decline testing, even among those who were told they could do so. The most frequently cited barriers by clinicians included limited experience with obtaining consent for toxicology testing, inability to explain the risks and benefits of testing, and a perceived erosion of the patient-clinician relationship. In contrast, clinicians reported increased comfort obtaining consent when testing indications were clearly outlined in a hospital policy they could reference.
Conclusion
Obstetric clinicians felt unprepared to obtain informed consent for perinatal toxicology testing, leaving patients without information necessary to make informed choices about their care. Additional provider education emphasizing shared decision-making and an improved understanding of the use of testing by child protective services are needed to adequately protect the rights of birthing persons.