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Coulombe F, Laberge AM. The Need to Consider Context: A Systematic Review of Factors Involved in the Consent Process for Genetic Tests from the Perspective of Patients. AJOB Empir Bioeth 2024; 15:93-107. [PMID: 38189769 DOI: 10.1080/23294515.2023.2297935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background: Informed consent for genetic tests is a well-established practice. It should be based on good quality information and in keeping with the patient's values. Existing informed consent assessment tools assess knowledge and values. Nevertheless, there is no consensus on what specific elements need to be discussed or considered in the consent process for genetic tests.Methods: We performed a systematic review to identify all factors involved in the decision-making and consent process about genetic testing, from the perspective of patients. Through public databases, we identified studies reporting factors that influence the decision to accept or decline genetic testing. Studies were included if they reported the perspective of patients or at-risk individuals. All articles were thematically coded.Results: 1989 articles were reviewed: 70 met inclusion criteria and 12 additional articles were identified through the references of included studies. Coding of the 82 articles led to the identification of 45 factors involved in decision-making and consent, which were initially divided into three domains: in favor of, against or with an undetermined influence on genetic testing. Each factor was also divided into three subdomains relating to the informed choice concept: knowledge, values or other. The factors in the "other" subdomain were all related to the context of testing (e.g. timing, cost, influence of family members, etc), and were present in all three domains.Conclusions: We describe the network of factors contributing to decision-making and consent process and identify the context of genetic testing as a third component to influence this process. Future studies should consider the evaluation of contextual factors as an important and relevant component of the consent and decision-making process about genetic tests. Based on these results, we plan to develop and test a more comprehensive tool to assess informed consent for genetic testing.
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Affiliation(s)
- Frédéric Coulombe
- Medical Genetics, McGill University Health Center and McGill University, Montreal, Canada
| | - Anne-Marie Laberge
- Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, Canada
- Bioethics Program, School of Public Health, Université de Montréal, Montreal, Canada
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2
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Damman OC, Henneman L, IJssel DVVD, Timmermans DRM. Conditions for autonomous reproductive decision-making in prenatal screening: A mixed methods study. Midwifery 2023; 119:103607. [PMID: 36753831 DOI: 10.1016/j.midw.2023.103607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 07/18/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pregnant women should be able to make autonomous and meaningful decisions about prenatal screening for fetal abnormalities. It remains largely unclear which circumstances facilitate or hinder such a decision-making process. OBJECTIVE To investigate what conditions Dutch pregnant women and professional experts consider important for autonomous reproductive decision-making in prenatal screening for fetal abnormalities, and the extent to which, according to women, those conditions are met in practice. METHODS A mixed methods study was conducted in the Netherlands in 2016-2017. A conceptual model was used to interview professional experts (n = 16) and pregnant women (n = 19). Thematic analysis was performed to identify important conditions. Subsequently, a questionnaire assessed the perceived importance of those conditions and the extent to which these were met, in the experience of pregnant women (n = 200). RESULTS Professional experts stressed the importance of information provision, and emphasized a rational decision-making model. Pregnant women differed in what information they felt was needed, and this depended on the screening decision made. Questionnaire findings showed that women prioritized discussion and consensus with partners. Information about test accuracy and miscarriage risk of invasive follow-up testing was also considered important. Two key conditions were not adequately met, in the experience of women: (1) having information about miscarriage risk; (2) not being directed by health professionals in decision-making. CONCLUSION According to women, discussion and consensus with partners was considered a highly important condition for an autonomous and meaningful decision-making process. Access to information about safety of testing and ensuring that women are not being directed in their decision-making by health professionals seem to be areas for improvement in prenatal care practice.
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Affiliation(s)
- Olga C Damman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Lidewij Henneman
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Section Community Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Dalisa V van den IJssel
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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3
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Severijns Y, van der Linden H, de Die-Smulders CEM, Hoving C, Jansen J, van Osch LADM. To what extent do decision aids for prenatal screening and diagnosis address involvement of partners in decision-making? - An environmental scan. PATIENT EDUCATION AND COUNSELING 2021; 104:2952-2962. [PMID: 33941420 DOI: 10.1016/j.pec.2021.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/18/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Numerous decision aids (DAs) have been developed to inform pregnant people about prenatal screening as the decision whether or not to accept the prenatal screening offer may be difficult. Currently, little is known about the role of the decisional partner of the pregnant people in this decision-making process and to what extent DAs involve and engage the partner. METHODS A broad search was conducted to identify publicly available DAs in English and/or Dutch regarding prenatal screening and diagnosis. These DAs were analysed on aspects of partner involvement. RESULTS Ten of the 19 identified DAs (52.6%) contained at least one aspect of partner involvement. Several DAs acknowledged that both partners should be involved in the decision (n = 7). The content that was least likely to contain aspects of partner involvement in the DA was value clarification content (n = 2) and only one DA contained content with plural addressing. CONCLUSION Just over half of the included DAs included some aspect(s) of partner involvement. PRACTICAL IMPLICATIONS More research is needed to determine to what extent, and how, the partner should be involved in the decision-making process as expectant people consider the input of their partner as important.
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Affiliation(s)
- Y Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, the Netherlands.
| | - H van der Linden
- Department of Health Promotion/CAPHRI, Maastricht University, the Netherlands
| | - C E M de Die-Smulders
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, the Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre+, the Netherlands
| | - C Hoving
- Department of Health Promotion/CAPHRI, Maastricht University, the Netherlands
| | - J Jansen
- Department of Family Medicine/CAPHRI, Maastricht University, the Netherlands
| | - L A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, the Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre+, the Netherlands
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4
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Law WK, Yaremych HE, Ferrer RA, Richardson E, Wu YP, Turbitt E. Decision-making about genetic health information among family dyads: a systematic literature review. Health Psychol Rev 2021; 16:412-429. [PMID: 34546151 DOI: 10.1080/17437199.2021.1980083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Decisions involving two individuals (i.e., dyadic decision-making) have been increasingly studied in healthcare research. There is evidence of bi-directional influences in decision-making processes among spousal, provider-patient and parent-child dyads. Genetic information can directly impact biologically related individuals. Thus, it is important to understand dyadic decision-making about genetic health information among family members. This systematic literature review aimed to identify literature examining decision-making among family dyads. Peer-reviewed publications were included if they reported quantitative empirical research on dyadic decision-making about genetic information, published between January 1998 and August 2020 and written in English. The search was conducted in 6 databases and returned 3167 articles, of which 15 met the inclusion criteria. Most studies were in the context of cancer genetic testing (n = 8) or reproductive testing or screening (n = 5). Studies reported two broad categories of decisions with dyadic influence: undergoing screening or testing (n = 10) and sharing information with family (n = 5). Factors were correlated between dyads such as attitudes, knowledge, behaviors and psychological wellbeing. Emerging evidence shows that dyad members influence each other when making decisions about receiving or sharing genetic information. Our findings emphasize the importance of considering both members of a dyad in intervention design and clinical interactions.
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Affiliation(s)
- Wai Ki Law
- The Discipline of Genetic Counselling, The University of Technology Sydney, Ultimo, Australia
| | - Haley E Yaremych
- Department of Psychology & Human Development, Vanderbilt University, Nashville, TN, USA.,Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, National Cancer Institute, Bethesda, MD, USA
| | - Ebony Richardson
- The Discipline of Genetic Counselling, The University of Technology Sydney, Ultimo, Australia
| | - Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Erin Turbitt
- The Discipline of Genetic Counselling, The University of Technology Sydney, Ultimo, Australia.,Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
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5
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Severijns Y, de Die-Smulders CEM, Gültzow T, de Vries H, van Osch LADM. Hereditary diseases and child wish: exploring motives, considerations, and the (joint) decision-making process of genetically at-risk couples. J Community Genet 2021; 12:325-335. [PMID: 33611773 PMCID: PMC8241960 DOI: 10.1007/s12687-021-00510-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
Couples who are at risk of transmitting a genetic disease to their offspring may face difficult challenges regarding reproductive decision-making. Deciding if, and how, to purse their child wish can be a demanding process. This study aims to describe the reproductive joint decision-making process of genetically at-risk couples. A qualitative study was conducted with 16 couples (N=31) at risk of transmitting a genetic disease to their offspring and who received genetic counseling. Most couples were not aware of all available reproductive options in the Netherlands. A variety of motives was reported with almost all couples expressing a preference towards a reproductive option in which the child is genetically related to both parents. Only a few couples considered other options such as the use of donor gametes, adoption, and foster parenting. All couples indicated that they had multiple conversations to reach a mutually supported reproductive decision. Several carriers reported feelings of guilt and in some couples, the woman appeared to have a greater impact in the decision-making process as she should carry a pregnancy and should undergo medical treatments. This study provides insight in the extensive decision-making process of genetically at-risk couples and the role of both partners in this process. These findings can guide the development of genetic counseling (e.g., increase awareness of available reproductive options) and decision support for these couples.
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Affiliation(s)
- Y Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. .,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - C E M de Die-Smulders
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - T Gültzow
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - H de Vries
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - L A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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Munro S, Sou J, Zhang W, Mohammadi T, Trenaman L, Langlois S, Anis AH. Attitudes toward prenatal screening for chromosomal abnormalities: A focus group study. Women Birth 2019; 32:364-371. [DOI: 10.1016/j.wombi.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/16/2022]
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Crabbe RE, Stone P, Filoche SK. What are women saying about noninvasive prenatal testing? An analysis of online pregnancy discussion forums. Prenat Diagn 2019; 39:890-895. [DOI: 10.1002/pd.5500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/07/2019] [Accepted: 05/17/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Rebecca E.S. Crabbe
- Department of Obstetrics, Gynaecology and Women's HealthUniversity of Otago, Wellington Wellington New Zealand
| | - Peter Stone
- Department of Obstetrics and GynaecologyThe University of Auckland Auckland New Zealand
| | - Sara K. Filoche
- Department of Obstetrics, Gynaecology and Women's HealthUniversity of Otago, Wellington Wellington New Zealand
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Lou S, Carstensen K, Vogel I, Hvidman L, Nielsen CP, Lanther M, Petersen OB. Receiving a prenatal diagnosis of Down syndrome by phone: a qualitative study of the experiences of pregnant couples. BMJ Open 2019; 9:e026825. [PMID: 30867204 PMCID: PMC6429881 DOI: 10.1136/bmjopen-2018-026825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine how pregnant couples experience receiving a prenatal diagnosis of Down syndrome (DS) by phone-a practice that has been routine care in the Central Denmark Region for years. DESIGN Qualitative interview study. SETTING Participants were recruited from hospitals in Central Denmark Region, Denmark. PARTICIPANTS Couples who had received a prenatal diagnosis of DS by phone and decided to terminate the pregnancy. They were recruited from the obstetric department where the termination was undertaken. During the study period (February 2016 to July 2017), 21 semistructured, audio-recorded interviews were conducted by an experienced anthropologist. Interviews were conducted 4-22 weeks after the diagnosis and analysed using thematic analysis. RESULTS A prearranged phone call was considered an acceptable practice. However, the first theme 'Expected but unexpected' shows how the call often came earlier than expected. Consequently, most women were not with their partner and were thus initially alone with their grief and furthermore responsible for informing their partner, which some considered difficult. The second theme 'Now what?' shows how during the phone calls, physicians were quick to enquire about the couples' agendas. As the majority had already decided to seek termination of pregnancy, the dialogue focused on related questions and arrangements. Only half of the couples received additional counselling. CONCLUSION A prearranged phone call was considered an acceptable and appropriate practice. However, some aspects of this practice (particularly related to the context of the call) showed to be less than optimal for the couples. To make sure that a diagnostic result is delivered in accordance with the couples' needs and requests, the context of the call could be addressed and agreed on in advance by physicians and couples.
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Affiliation(s)
- Stina Lou
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrine Carstensen
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus Universitetshospital, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus Universitetshospital, Aarhus, Denmark
| | | | - Maja Lanther
- Central Denmark Region, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus Universitetshospital, Aarhus, Denmark
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9
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Seven M, Paşalak Şİ, Sahin E, Akyuz A. Genetic Literacy of pregnant women and their use of prenatal screening and diagnostic tests in Turkey. J Genet Couns 2019; 28:578-586. [PMID: 30680841 DOI: 10.1002/jgc4.1082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/03/2018] [Indexed: 11/07/2022]
Abstract
This study evaluated how genetic literacy of pregnant women in Turkey affects their use of prenatal screening and diagnostic tests. As a descriptive cross-sectional study, a Participant Identification Form and the Genetic literacy and Comprehension Measure (GLAC) were used to collect data. The sample of study consisted of 189 pregnant women who made regular antenatal care visits in Giresun, Turkey. The mean age was 29.5 ± 5.9 years and mean gestational week was 34.9 ± 5.09. Of the women, 76.7% had undergone prenatal screening tests, and 85.5% of them had learned about the tests from their doctors. The mean GLAC score of familiarity was 3.67 ± 1.78 (out of seven), and the genetic concepts answered correctly were 5.30 ± 1.79 (out of eight). No statistically significant relationship emerged between the women's genetic literacy and their use of prenatal screening or diagnostic tests. However, relationships were statistically significant between the genetic literacy of the women and the educational levels of the women themselves or their spouses, consanguineous marital status, parity, and use of folic acid supplements. Primiparous women who were highly educated, had a highly educated spouse, were not in consanguineous marriages, and had taken folic acid supplements during pregnancy were more literate in genetics. There is a need for more educational opportunities in order for women to increase their familiarity with genetic terms. Educating women will improve their understanding of genetics-related health services and increase their awareness of genetic diseases, which will allow them to take the appropriate actions for primary prevention.
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Affiliation(s)
- Memnun Seven
- Koç University School of Nursing, İstanbul, Turkey
| | | | - Eda Sahin
- Faculty of Health Sciences, Giresun University, Giresun, Turkey
| | - Aygul Akyuz
- Koç University School of Nursing, İstanbul, Turkey
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10
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Smith SK, Cai A, Wong M, Sousa MS, Peate M, Welsh A, Meiser B, Kaur R, Halliday J, Lewis S, Trevena L, Yanes T, Barlow-Stewart K, Barclay M. Improving women's knowledge about prenatal screening in the era of non-invasive prenatal testing for Down syndrome - development and acceptability of a low literacy decision aid. BMC Pregnancy Childbirth 2018; 18:499. [PMID: 30558569 PMCID: PMC6296052 DOI: 10.1186/s12884-018-2135-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023] Open
Abstract
Background Access to information about prenatal screening is important particularly in light of new techniques such as non-invasive prenatal testing (NIPT). This study aimed to develop and examine the acceptability of a low literacy decision aid (DA) about Down syndrome screening among pregnant women with varying education levels and GPs. Methods We developed a DA booklet providing information about first-trimester combined testing, maternal serum screening, and NIPT. GPs and women participated in a telephone interview to examine the acceptability of the DA and measure screening knowledge before and after reading the DA. The knowledge measure was designed to assess whether women had understood the gist of the information presented in the decision aid. It comprised conceptual questions (e.g. screening tells you the chance of having a baby with Down syndrome) and numeric questions (e.g. the accuracy of different screening tests). Results Twenty-nine women and 18 GPs participated. Regardless of education level, most women found the booklet ‘very’ clearly presented (n = 22, 76%), and ‘very’ informative (n = 23, 80%). Overall, women’s conceptual and numeric knowledge improved after exposure to the DA, from 4% having adequate knowledge to 69%. Women’s knowledge of NIPT also improved after receiving the decision aid, irrespective of education. Most GPs found it ‘very’ clearly presented (n = 13, 72%), and that it would ‘very much’ facilitate decision-making (n = 16, 89%). Conclusions The DA was found to be acceptable to women as well as GPs. A comprehensive evaluation of the efficacy of the decision aid compared to standard information is an important next step. Strategies are needed on how to implement the tool in practice. Electronic supplementary material The online version of this article (10.1186/s12884-018-2135-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sian Karen Smith
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.
| | - Antonia Cai
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Michelle Wong
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Mariana S Sousa
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.,Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University, Ingham, Sydney, Australia.,South Western Sydney Local Health District, Institute for Applied Medical Research, Sydney, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Alec Welsh
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Rajneesh Kaur
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tatiane Yanes
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | | | - Margot Barclay
- Women's Services, Liverpool Hospital, Sydney, Australia.,Western Sydney University, Parramatta, Sydney, Australia
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11
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Møller A, Vogel I, Petersen OB, Lou S. Danish Sonographers' Experiences of the Introduction of "Moderate Risk" in Prenatal Screening for Down Syndrome. J Pregnancy 2018; 2018:1646035. [PMID: 30402287 PMCID: PMC6198582 DOI: 10.1155/2018/1646035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/27/2018] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine sonographers' experiences with the introduction of an offer of noninvasive prenatal testing (NIPT) to a new moderate-risk (MR) group at the combined first-trimester prenatal screening (cFTS). STUDY DESIGN A qualitative approach consisting of seven semistructured interviews with five sonographers (midwives and nurses). Data was analyzed using thematic analysis. MAIN OUTCOME MEASURES Sonographers' perception of offering NIPT to women in MR. RESULTS The sonographers understood NIPT as a positive development in prenatal screening due to a safe procedure and high detection rates for trisomies 13, 18, and 21. Prior to the introduction of MR, the sonographers were concerned about inducing worry in pregnant women in this new risk group. However, the pregnant women responded very positively, which the sonographers attributed to several factors such as the women's overall reason for participating in prenatal screening, the simplicity of the NIPT procedure, and the communicative strategies used by the sonographers. The strategies included all sonographers using the same words and explanations, emphasizing that statistics were in the women's favor, initiating the presentation of MR with a positive message, and downplaying the MR category. CONCLUSION Sonographers' communicative strategies succeeded in limiting worry in pregnant women in MR. As such, the findings are valuable for health professionals, who are responsible for communicating about prenatal screening results and diagnostic options.
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Affiliation(s)
- Anne Møller
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- DEFACTUM, Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
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12
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Villeneuve E, Landa P, Allen M, Spencer A, Prosser S, Gibson A, Kelsey K, Mujica-Mota R, Manktelow B, Modi N, Thornton S, Pitt M. A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BackgroundThere is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale.Objectives(1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives.Main outcome measuresThe ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents.DesignDescriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study.SettingNHS neonatal services across England.DataNeonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey.ResultsLocation analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling > 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families.LimitationsThe following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface.ConclusionsAn evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents.Future workTo extend the modelling to encompass the interface between maternity and neonatal services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Villeneuve
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Paolo Landa
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Michael Allen
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anne Spencer
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sue Prosser
- Neonatal Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - Andrew Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Katie Kelsey
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruben Mujica-Mota
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Brad Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neena Modi
- Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Steve Thornton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Pitt
- National Institute for Health Research: Collaborations for Leadership in Applied Health Research and Care – South West Peninsula, University of Exeter Medical School, University of Exeter, Exeter, UK
- Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Roadhouse C, Shuman C, Anstey K, Sappleton K, Chitayat D, Ignagni E. Disability Experiences and Perspectives Regarding Reproductive Decisions, Parenting, and the Utility of Genetic Services: a Qualitative Study. J Genet Couns 2018; 27:10.1007/s10897-018-0265-1. [PMID: 29909595 DOI: 10.1007/s10897-018-0265-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
Genetic counselors adopt seemingly contradictory roles: advocating for individuals with genetic conditions while offering prenatal diagnosis and the option of selective termination to prevent the birth of a child with a disability. This duality contributes to the tension between the disability and clinical genetics communities. Varying opinions exist amongst the disability community: some value genetic services while others are opposed. However, there is limited research exploring the opinions of individuals with a disability regarding issues related to reproduction and genetic services in the context of personal experience. This exploratory qualitative study involved interviews with seven women and three men who self-identify as having a disability. We sought to gain their perspectives on experiences with disability, thoughts about reproduction and parenting, and perceptions of genetic services. Transcripts of the interviews were analyzed thematically using qualitative content analysis. Data analysis showed that societal views of disability affected the lived experience and impacted reproductive decision-making for those with a disability. It also showed differing interest in genetic services. Concerns about the perceived collective implications of genetic services were also raised. These findings contribute to the understanding of the disability perspective toward reproductive decision-making and genetic services. A further goal is to promote a meaningful dialogue between the genetics and disability communities, with the potential to enhance the genetic and reproductive care provided to individuals with disabilities.
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Affiliation(s)
- C Roadhouse
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Pediatrics, Clinical Genetics Program, McMaster University Medical Center and McMaster Children's Hospital, Hamilton, ON, Canada.
| | - C Shuman
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Anstey
- Clinical Ethics, Alberta Health Services, Calgary AB, Calgary, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Therapy, University of Toronto, Toronto, ON, Canada
| | - K Sappleton
- Centre for Innovation and Excellence in Child & Family Centered Care, The Hospital for Sick Children, Toronto, ON, Canada
| | - D Chitayat
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada
| | - E Ignagni
- School of Disability Studies, Ryerson University, Toronto, ON, Canada
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Lou S, Jensen LG, Petersen OB, Vogel I, Hvidman L, Møller A, Nielsen CP. Parental response to severe or lethal prenatal diagnosis: a systematic review of qualitative studies. Prenat Diagn 2017; 37:731-743. [DOI: 10.1002/pd.5093] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/24/2017] [Accepted: 06/10/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Stina Lou
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
| | - Lotte Groth Jensen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Olav Bjørn Petersen
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ida Vogel
- Centre for Prenatal Diagnostics; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Genetics; Aarhus University Hospital; Aarhus Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Anne Møller
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health & Health Services Research; Central Denmark Region; Aarhus Denmark
- Department of Public Health; Aarhus University; Aarhus Denmark
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15
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Shea TL. Prenatal paradox: an integrative review of women’s experiences with prenatal screening for fetal aneuploidy and neural tube defects. Contemp Nurse 2016; 53:235-261. [DOI: 10.1080/10376178.2016.1269609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Tamra L. Shea
- School of Nursing, The University of North Carolina at Greensboro, 101 McIver House, North Drive Extension, Greensboro, NC 27412, USA
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16
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Murphy H, Phillippi JC. Isolated intracardiac echogenic focus on routine ultrasound: implications for practice. J Midwifery Womens Health 2016; 60:83-8. [PMID: 25712280 DOI: 10.1111/jmwh.12282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ultrasound is widely used as a screening tool for fetal anomalies. An intracardiac echogenic focus (ICEF) is associated with fetal aneuploidy, particularly trisomy 21, when found with other minor abnormalities known as soft markers. However, when found in isolation, intracardiac echogenic foci are morphologic variations with little or no pathologic significance for the fetus. Ambiguity about the significance of ICEF and other soft markers and the lack of preparation prior to ultrasound can result in unnecessary worry for women and their partners. A variety of tools exist that providers can use to help pregnant women and their partners make informed decisions about ultrasound and fetal screening.
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17
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Lou S, Nielsen CP, Hvidman L, Petersen OB, Risør MB. Coping with worry while waiting for diagnostic results: a qualitative study of the experiences of pregnant couples following a high-risk prenatal screening result. BMC Pregnancy Childbirth 2016; 16:321. [PMID: 27769247 PMCID: PMC5073971 DOI: 10.1186/s12884-016-1114-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well documented that pregnant women experience increased worry and uncertainty following a high-risk prenatal screening result. While waiting for diagnostic results this worry continues to linger. It has been suggested that high-risk women put the pregnancy mentally 'on hold' during this period, however, not enough is known about how high-risk women and their partners cope while waiting for diagnostic results. The aim of this study was to identify the strategies employed to cope with worry and uncertainty. METHODS Qualitative, semi-structured interviews with 16 high-risk couples who underwent diagnostic testing. The couples were recruited at a university hospital fetal medicine unit in Denmark. Data were analysed using thematic analysis. RESULTS All couples reported feeling worried and sad upon receiving a high-risk screening result. While waiting for diagnostic results, the couples focused on coming to their own understanding of the situation and employed both social withdrawal and social engagement as strategies to prevent worry from escalating. Additionally, couples used gratitude, reassuring reasoning and selective memory as means to maintain hopes for a good outcome. Discussions about what to do in case of an abnormal test result were notably absent in the accounts of waiting. This bracketing of the potential abnormal result allowed the couples to hold on to a 'normal' pregnancy and to employ an 'innocent-till-proven-guilty' approach to their worries about the fetus's health. None of the interviewed couples regretted having prenatal screening and all of them expected to have prenatal screening in a future pregnancy. CONCLUSIONS The couples in this study did not put the pregnancy mentally 'on hold'. Worry and uncertainty must be understood as managed through a diverse range of practical and emotional strategies that change and overlap in the process of waiting. Clinicians may support appropriate ways of coping with worry and waiting through empathetic and empowering clinical communication. In addition to providing adequate information and presenting options available, clinicians may support high-risk women/couples by encouraging them to seek their own personal understandings and management strategies as a way to gain some control in an uncertain situation.
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Affiliation(s)
- Stina Lou
- DEFACTUM -Public Health & Health Services Research, Olof Palmes Alle 15, 8200, Aarhus N, Denmark. .,Institute of Public Health, Aarhus University, Aarhus, Denmark.
| | - Camilla P Nielsen
- DEFACTUM -Public Health & Health Services Research, Olof Palmes Alle 15, 8200, Aarhus N, Denmark.,Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Olav B Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Mette B Risør
- General Practice Research Unit, Institute of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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18
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van Schendel RV, Kater-Kuipers A, van Vliet-Lachotzki EH, Dondorp WJ, Cornel MC, Henneman L. What Do Parents of Children with Down Syndrome Think about Non-Invasive Prenatal Testing (NIPT)? J Genet Couns 2016; 26:522-531. [PMID: 27618823 PMCID: PMC5415584 DOI: 10.1007/s10897-016-0012-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/23/2016] [Indexed: 12/14/2022]
Abstract
This study explores the attitudes of parents of children with Down syndrome towards non-invasive prenatal testing (NIPT) and widening the scope of prenatal screening. Three focus groups (n = 16) and eleven individual interviews with Dutch parents (and two relatives) of children with Down syndrome were conducted. Safety, accuracy and earlier testing were seen as the advantages of NIPT. Some participants were critical about the practice of screening for Down syndrome, but acknowledged that NIPT enables people to know whether the fetus is affected and to prepare without risking miscarriage. Many feared uncritical use of NIPT and more abortions for Down syndrome. Concerns included the consequences for the acceptance of and facilities for children with Down syndrome, resulting in more people deciding to screen. Participants stressed the importance of good counseling and balanced, accurate information about Down syndrome. Testing for more disorders might divert the focus away from Down syndrome, but participants worried about “where to draw the line”. They also feared a loss of diversity in society. Findings show that, while parents acknowledge that NIPT offers a better and safer option to know whether the fetus is affected, they also have concerns about NIPT’s impact on the acceptance and care of children with Down syndrome.
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Affiliation(s)
- Rachèl V van Schendel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriana Kater-Kuipers
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Wybo J Dondorp
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Research Institutes GROW and CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Smith SK, Sousa MS, Essink-Bot ML, Halliday J, Peate M, Fransen M. Socioeconomic Differences in Informed Decisions About Down Syndrome Screening: A Systematic Review and Research Agenda. JOURNAL OF HEALTH COMMUNICATION 2016; 21:868-907. [PMID: 27410478 DOI: 10.1080/10810730.2016.1177145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Supporting pregnant women to make informed choices about Down syndrome screening is widely endorsed. We reviewed the literature on: (a) the association between socioeconomic position and informed choices and decision-making about Down syndrome screening, and (b) the possible mediating variables (e.g., health literacy, numeracy skills, behavioral and communication variables) that might explain the relationship. EMBASE, MEDLINE, PubMed, CINAHL, and PsycINFO were searched from January 1999 to September 2014. The methodological quality of studies was determined by predefined criteria regarding the research aims, study design, study population and setting, measurement tools, and statistical analysis. A total of 33 studies met the inclusion criteria. Women from lower socioeconomic groups experience greater difficulties making informed choices about Down syndrome screening compared to women from higher socioeconomic groups. Most studies focus on individual dimensions of informed decision-making rather than assessing elements in conjunction with one another. Few studies have explored why there are socioeconomic differences in women's ability to make informed screening decisions. Future work is needed to identify mediating variables in this pathway. Systematic evidence-based intervention development to improve communication, understanding, and decision-making about Down syndrome screening is needed to ensure that women have an equal opportunity to make an informed choice about screening regardless of their socioeconomic position.
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Affiliation(s)
- Sian K Smith
- a Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine , University of New South Wales , Sydney , New South Wales , Australia
| | - Mariana S Sousa
- b Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, School of Nursing and Midwifery , University of Western Sydney , Penrith , New South Wales , Australia
- c Prince of Wales Clinical School , University of New South Wales , Sydney , New South Wales , Australia
| | - Marie-Louise Essink-Bot
- d Department of Public Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
| | - Jane Halliday
- e Murdoch Children's Research Institute , Royal Children's Hospital , Melbourne , Victoria , Australia
- f Department of Paediatrics , University of Melbourne , Parkville , Victoria , Australia
| | - Michelle Peate
- g Department of Obstetrics and Gynaecology, Royal Women's Hospital , University of Melbourne , Parkville , Victoria , Australia
| | - Mirjam Fransen
- d Department of Public Health, Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
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20
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Dheensa S, Metcalfe PA, Williams R. What do men want from antenatal screening? Findings from an interview study in England. Midwifery 2015; 31:208-14. [DOI: 10.1016/j.midw.2014.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/21/2014] [Accepted: 08/30/2014] [Indexed: 11/25/2022]
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21
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Wätterbjörk I, Blomberg K, Nilsson K, Sahlberg-Blom E. Decision-making process of prenatal screening described by pregnant women and their partners. Health Expect 2013; 18:1582-92. [PMID: 24118867 DOI: 10.1111/hex.12147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pregnant women are often faced with having to decide about prenatal screening for Down's syndrome. However, the decision to participate in or refrain from prenatal screening can be seen as an important decision not only for the pregnant woman but also for both the partners. OBJECTIVE The aim of this study was to explore the couples' processes of decision making about prenatal screening. METHODS A total of 37 semi-structured interviews conducted at two time points were analysed using the interpretive description. SETTING The study was carried out in Maternal health-care centres, Örebro County Council, Sweden. PARTICIPANTS Fifteen couples of different ages and with different experiences of pregnancy and childbirth were interviewed. RESULTS Three different patterns of decision making were identified. For the couples in 'The open and communicative decision-making process', the process was straightforward and rational, and the couples discussed the decision with each other. 'The closed and personal decision-making process' showed an immediate and non-communicative decision making where the couples decided each for themselves. The couples showing 'The searching and communicative decision-making process' followed an arduous road in deciding whether to participate or not in prenatal screening and how to cope with the result. CONCLUSIONS The decision-making process was for some couples a fairly straightforward decision, while for others it was a more complex process that required a great deal of consideration.
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Affiliation(s)
- Inger Wätterbjörk
- Family Medicine Research Centre, Örebro, Sweden.,School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kerstin Nilsson
- School of Medicine, Örebro University, Örebro, Sweden.,Department of Obstetrics & Gynaecology, Örebro University Hospital, Örebro, Sweden
| | - Eva Sahlberg-Blom
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Current World Literature. Curr Opin Obstet Gynecol 2013. [DOI: 10.1097/gco.0b013e32835f3eec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Carroll FE, Al-Janabi H, Flynn T, Montgomery AA. Women and their partners' preferences for Down's syndrome screening tests: a discrete choice experiment. Prenat Diagn 2013; 33:449-56. [DOI: 10.1002/pd.4086] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Fran E. Carroll
- School of Social and Community Medicine; University of Bristol; England UK
| | - Hareth Al-Janabi
- Health Economics Unit, School of Health and Population Sciences; University of Birmingham; England UK
| | - Terry Flynn
- Centre for the Study of Choice; University of Technology; Sydney Australia
| | - Alan A. Montgomery
- School of Social and Community Medicine; University of Bristol; England UK
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