Baseline characteristics
We sent out 982 questionnaires and 549 of them were returned by 21 hospitals with a response rate of 68.8%. A total of 501 clinicians were involved, after excluding 48 clinicians who were not clear of the status of prenatal genetic service in their hospitals, including 108 (21.56%) obstetricians, 141 (28.14%) cardiologists, 81 (16.17%) fetal echocardiography sonographers, and 171 (34.13%) anatomic survey ultrasonographers at last. Clinicians in group 1 had higher educational levels (P<0.001) and majority of them were working in tertiary hospitals (P<0.001). Over half of clinicians in group 1 were working in Maternal and Child Care Hospitals (P<0.001). Gender (P=0.998) and working years (P=0.597) of clinicians were no difference between two groups (Table 1).
Awareness of providing prenatal genetic tests for fetal CHD
We found that, regarding the appropriateness of prenatal genetic tests for fetuses with various kinds of fetal CHD, the answers were significantly different between two groups (P=0.023). In total 501 clinicians, only 27.94% received a high score and 53.09% received a medium score, indicating a low level of awareness about prenatal genetic tests among clinicians. Clinicians in group 1 obtained higher scores than group 2 (Figure 1). Specifically, 31.62% clinicians in group 1, but only 24.19% in group 2 obtained a high score. A low score was obtained by 23.39% in group 2 compared to 14.62% in group 1, reflecting a lower perception of the opportunity to provide prenatal genetic tests for patient in clinicians of group 2. In addition, groups 1 and 2 did not significantly differ in the proportion of medium scores. The level of awareness was not significantly different between professionals with distinct specialties (P=0.296).
To control for potential confounders, we performed stepwise multiple linear regression with the level of awareness as the response and all of the other aforementioned variables (Table 1) as predictors. We allowed variable selection to proceed in both directions, namely, forward selection and backward elimination. With the Akaike Information Criterion (AIC) as the target, the best model selected was a regression of the level of awareness on the status of genetic service in hospital, hospital type and the major of clinicians (Table 2). In other words, after taking into account the impact of all variables, the status of genetic service in hospital, hospital type and the major of clinicians were considered to be the most relevant variables to the level of awareness.
Attitude towards TOP for fetal CHD
We found that attitude towards TOP also varied significantly between these 2 groups (P=0.023). Specifically, a score of 5 was obtained by 44.3% of clinicians in group 1, but only by 29.4% of those in group 2 (Figure 2). Among clinicians who achieved a score of 5, who would therefore hold more optimistic attitude and less favor of TOP in minor CHD, group 1 occupied 60.54%. In addition, compared to clinicians who obtained a score of 5, those who obtained 0 were more likely to suggest TOP in particular CHDs (Figure 3). Independently of the obtained score, completion of pregnancy was always taken into consideration in the case of fetuses with echogenic foci, and over 90% of clinicians did not suggest TOP.
Counseling skill about controlling emotions during prenatal counseling
In this question, 309 clinicians indicated that they remained neutral (P=0.148). Of these, 170 clinicians (55.02%) were from group 1 and 139 (44.98%) were from group 2 (Table 3). Moreover, 93 clinicians (18.56%) said they felt sad during prenatal genetic counseling, while others felt anxious (8.78%) or depressed (5.19%). Few of them declared to be confident (1.4%).