Pregnant women's and their partners' perception of an information model on prenatal screening: Information model on prenatal screening

Evaluation of a prenatal screening decision aid: A mixed methods pilot study

BACKGROUND

We developed a decision aid (DA) to help pregnant women and their partners make informed decisions about prenatal screening for trisomy. We aimed to determine its usefulness for preparing for decision-making and its acceptability among end-users.

METHODS

In this mixed-methods pilot study, we recruited participants in three prenatal care settings in Quebec City. Eligible women were over 18 and more than 16 weeks pregnant or had given birth recently. We asked them about the usefulness of the DA using an interview grid based on the Technology Acceptance Model. We performed descriptive statistics and deductive analysis.

RESULTS

Thirty-nine dyads or individuals participated in the study. Mean usefulness score was 86.2 ± 13. Most participants found the amount of information in the DA just right (79.5%), balanced (89.7%), and very useful (61.5%). They were less satisfied with the presentation and the values worksheet and suggested different values clarification methods.

CONCLUSION

Rigorous pilot tests of DAs with patients are an important stage in their development before the more formal assessments that precede scaling up the DA in clinical practice.

PRACTICE IMPLICATIONS

The next version of the DA will integrate the suggestions of end-users for better decision-making processes about prenatal screening for trisomy.

Parents' experiences of the information provided at the antenatal clinic regarding foetal diagnostics - A qualitative interview study

OBJECTIVE

This study aimed to examine the pregnant women's and their partner's experience of the information given at the antenatal clinic regarding screening methods.

METHODS

A qualitative interview study was conducted in the Gothenburg area in Sweden. Ten women and seven partners expecting their first child were interviewed adjacent to the second-trimester ultrasound examination. The data were analysed using qualitative content analysis.

RESULTS

The findings present an overall theme, three main categories, and ten subcategories. The overall theme showed a nonhomogeneous and individually based picture concerning the meaning and purpose of the methods, need for improvement of information, parents own information seeking, and the encounter with the midwife was also experienced as an influential encounter. The main categories show that diversity relates to the level of information given, voluntariness, the possibility of abnormal findings, and varying needs to thorough information and pre-existing knowledge. The midwifés impact was related to attitude, openness for questions, time for explanations, and the balance between providing enough information to support without worrying the parents.

CONCLUSIONS

Although previous research has pointed out a decade ago that information regarding foetal diagnostics is lacking, this study shows that these shortcomings still exist and that improvement is needed. The given information should be explicit concerning the purpose, limitations, and voluntariness of prenatal testing. Sufficient time for questions and discussion is as important as considering the parents' pre-existing knowledge, individual thoughts or questions, and a neutral attitude from the midwife is desirable.

Preferences for aspects of antenatal and newborn screening: a systematic review

BACKGROUND

Many countries offer screening programmes to unborn and newborn babies (antenatal and newborn screening) to identify those at risk of certain conditions to aid earlier diagnosis and treatment. Technological advances have stimulated the development of screening programmes to include more conditions, subsequently changing the information required and potential benefit-risk trade-offs driving participation. Quantifying preferences for screening programmes can provide programme commissioners with data to understand potential demand, the drivers of this demand, information provision required to support the programmes and the extent to which preferences differ in a population. This study aimed to identify published studies eliciting preferences for antenatal and newborn screening programmes and provide an overview of key methods and findings.

METHODS

A systematic search of electronic databases for key terms identified eligible studies (discrete choice experiments (DCEs) or best-worst scaling (BWS) studies related to antenatal/newborn testing/screening published between 1990 and October 2018). Data were systematically extracted, tabulated and summarised in a narrative review.

RESULTS

A total of 19 studies using a DCE or BWS to elicit preferences for antenatal (n = 15; 79%) and newborn screening (n = 4; 21%) programmes were identified. Most of the studies were conducted in Europe (n = 12; 63%) but there were some examples from North America (n = 2; 11%) and Australia (n = 2; 11%). Attributes most commonly included were accuracy of screening (n = 15; 79%) and when screening occurred (n = 13; 68%). Other commonly occurring attributes included information content (n = 11; 58%) and risk of miscarriage (n = 10; 53%). Pregnant women (n = 11; 58%) and healthcare professionals (n = 11; 58%) were the most common study samples. Ten studies (53%) compared preferences across different respondents. Two studies (11%) made comparisons between countries. The most popular analytical model was a standard conditional logit model (n = 11; 58%) and one study investigated preference heterogeneity with latent class analysis.

CONCLUSION

There is an existing literature identifying stated preferences for antenatal and newborn screening but the incorporation of more sophisticated design and analytical methods to investigate preference heterogeneity could extend the relevance of the findings to inform commissioning of new screening programmes.

Information about first-trimester screening and self-reported distress among pregnant women and partners - comparing two methods of information giving in Sweden

INTRODUCTION

Balanced information before prenatal diagnosis (PND) aims to help expectant parents to make an informed choice. However, it is important that the information does not increase the expectant parents' psychological distress. The aim was to examine psychological distress among expectant parents, before and after receiving information about PND, to evaluate the possible differences between two different procedures of information giving, and to evaluate the association between satisfaction with the information and psychological distress.

MATERIAL AND METHODS

A longitudinal design, based on questionnaire data from 380 expectant parents from four counties in Sweden. The measurement points; T1, before the information about PND was given and T2, 2 weeks after the prenatal screening or 15 weeks of gestation. The Hospital Anxiety and Depression Scale (HADS) and the Swedish version of the Cambridge Worrying Scale (CWS) measured psychological distress. The Satisfaction with Genetic Counseling Scale (SCS) measured satisfaction with information about PND.

RESULTS

The rate of psychological distress was stable among the pregnant women, but decreased among their partners, after the information was received. General anxiety and the social-medical dimension of pregnancy-related worry decreased among the participants who received information, using the more distinct two-stage process (group A), but was unchanged in group B (less distinct two-stage process). Health-related worry decreased in both groups, whereas relational worry and level of depressive symptoms were unchanged in both groups.

CONCLUSION

Information about PND does not increase the psychological distress among expectant parents. A more distinct two-stage process of information giving might even decrease their anxiety.

The expectations of antenatal screening and experiences of the first-trimester screening scan

AIM

to describe the expectations to and knowledge of antenatal screening of expecting parents, and their experiences concerning the first-trimester screening scan.

DESIGN

survey study with a consecutive sampling method.

SETTING

two hospital districts in Finland, namely the capital area and Eastern Finland. Together these two districts include the six different municipal units in which the first-trimester screening scans discussed in the study were done during spring 2015.

PARTICIPANTS

1037 participants: 654 pregnant women and 346 partners.

MEASUREMENTS AND FINDINGS

the survey was based on an electronic questionnaire containing 29 questions. Almost all the pregnant women involved had received information on screenings during antenatal care, but only 20% reported a good level of familiarity with the various screening methods. Of the respondents, around 30% of the partners and 26% of all participants with lower education considered their knowledge to be poor. Around 30% of nulliparous respondents reported a need for further information. The experiences of the first-trimester screening scans were generally positive, though some of the partners felt they were treated too impersonally. Parents were well informed during the scan.

KEY CONCLUSIONS

the expectations of the antenatal screening of the parents-to-be were realistic, even for those whose knowledge of antenatal screening by their own estimation inadequate. Nulliparous and highly-educated respondents would have needed more counselling. For all respondents the first trimester screening scan generally reinforced the sense of becoming a parent.

IMPLICATIONS FOR PRACTICE

new ways to provide information on antenatal screening are needed. In particular, there should be a focus on making the information more understandable and accessible both to pregnant women and to partners. The results of this study could be used in developing such means of providing such information during antenatal care and services in ultrasound units. The results would also be helpful for improving professional skills of the medical personnel performing the scans, and for providing information on them.

Literature review shows that fathers are still not receiving the support they want and need from Swedish child health professionals

Sweden has a reputation for gender equality, and its child health services seek to support both parents. However, this meta-ethnographic analysis of 62 studies from 2000 to 2015 covering prenatal clinics, labour and birth wards, postnatal wards and child health centres found programmes had not been designed around paternal needs. Therefore, despite the policy change nearly 50 years ago to include both parents, fathers were still not fully accepted and supported.

CONCLUSION

To provide fathers in Sweden with greater support throughout the child health field, organisational changes should be considered, as this could provide further beneficial outcomes for children, families and society.

Reasons for declining extended information visit on prenatal screening among pregnant women and their partners

OBJECTIVE

A two-step model on information on prenatal screening consists of brief information at the first visit at the Maternal Health Care Centre and an offer of extended information at a separate visit. There is a lack of knowledge why some pregnant women and their partners refrain from the extended information visit. The aim of this study was to explore their reasons.

METHOD

Eight qualitative interviews were analyzed using Interpretive Description.

RESULTS

In the first theme 'From an individual view', the interviewees saw the invitation from their own points of view. They refrained because they did not want to receive any more information or had taken an individual position against chromosomal testing. In the theme, 'From a societal view', the interviewees perceived the offer as part of a societal view on prenatal screening that they could not support.

CONCLUSION

The findings show that these interviewees' reasons of declining an extended information visit are multidimensional and influenced by different views, from both an individual perspective and a more societal one. Health care professionals should be aware that some persons could have a different view on health care services and could be reluctant to accept offered services.

Decision-making process of prenatal screening described by pregnant women and their partners

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.