Using an implementation research tool to guide the implementation of non-invasive prenatal screening

Tierry M. Laforce, MA, PhD Candidate - Université de Montréal

ELSIconversations - April 16, 2021

cffDNA screening has changed the landscape of prenatal screening. In Canada, 2 provinces and 1 territory are covering its cost through medicare for women with a high chance of having a fetus with trisomy 21. For the rest of the country, the situation is similar to the one in the United States: some insurers cover it while many women are paying out of pocket. Yet, various stakeholders are calling for universal coverage, not only for trisomy 21, but rather an expanded list of genetic conditions. This presentation will focus on the normative evaluation of the implementation of cffDNA screening. Using research translation as a theoretical framework, we argue that it is currently being implemented as a novel intervention. It needs to be evaluated accordingly before it moves forward. To do so, we are applying the Consolidated Framework for implementation Research (CFIR) to the implementation of cffDNA screening in the Canadian context as a case study. The CFIR is a validated tool used to evaluate contextual factors for a successful implementation of an intervention. It has never been applied to cffDNA screening. The CFIR has been used mostly to analyze the impact of interventions post-implementation. We argue that its strength resides in its ability to identify barriers and facilitators to implementation preemptively. By using the CFIR to identify factors that will influence the implementation of cffDNA screening in practice, this work will help decision-makers select the implementation strategy most likely to be successful with the data emerging from stakeholders.