Digital vs face-to-face information provision in patient counselling for prenatal screening: A noninferiority randomized controlled trial

Exploring the impact of integrating telehealth in obstetric care: A scoping review

BACKGROUND

The use of telemedicine has spread to all areas of medicine, including obstetrics, over the last few decades.

OBJECTIVE

To identify and map the diversity and applicability of telemedicine in the obstetric literature, in the antenatal, intrapartum or postnatal period. To assess patient satisfaction and possible areas for future development.

METHODS

This scoping review was conducted following the Joanna Briggs Institute (JBI) methodological guidelines for scoping reviews and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and its extension for scoping reviews (PRISMA-ScR). We searched the databases PubMed (Medline), CINAHL, CENTRAL (Cochrane Library), EMBASE Ovid and Scopus. We also searched Google Scholar, clinicaltrial.gov, the WHO International Clinical Trials Registry Platform (ICTRP-WHO) and the reference lists of the included studies. We included any primary study design that focused on a population of women in the antenatal, intrapartum or postnatal period. Studies selection and data extraction were performed blindly and independently by two authors. We summarised the results narratively and used graphs and tables to present key concepts thematically.

RESULTS

We included 66 studies. We categorised the studies according to population, type of intervention, outcomes and user satisfaction. Most of the studies involved pathological (36%) and physiological (30%) pregnancy management, the type of intervention was mainly divided into televisits or video calls with professionals (43%) and the use of specific apps or devices (40%). The maternal outcomes studied were mainly quantitative, i.e., improvement in blood chemistry tests or vital parameters (65%) and treatment adherence (frequency of follow-up visits or keeping appointments, 27%). Patient satisfaction was positive in the majority of cases.

CONCLUSIONS

There is still little international agreement on the concept and possible applications of telemedicine in obstetrics, although it is increasingly being used in clinical practice. Studies have shown positive results in terms of improved care, particularly in terms of treatment adherence and as an alternative strategy in the management of pregnancy, postpartum and abortion care. Both patients and health professionals were satisfied with it, especially when offered as a complement or alternative to the traditional method of face-to-face visits. Future developments seem to be the time and cost-saving potential of telemedicine and its application to couples' infertility.

The Influence of the Partner's Involvement in Antenatal Genetic Group Counseling on Pregnant individuals' Scores on Tests of Vital Knowledge Relating to Pregnancy

OBJECTIVE

Physicians and other medical providers counsel patients to provide them with most important information and available medical service options. How to provide the most effective antenatal counseling is an important focus among experts. Our study focuses on the influence of the partner's involvement during antenatal genetic group counseling (AGGC). This study aimed to compare the ratio of pregnant individuals who have knowledge score improvement after AGGC, with a focus on pregnant individuals who attend counseling with/without their partner and to identify other possible factors that could influence the knowledge improvement.

STUDY DESIGN

A prospective cohort study was conducted. Pregnant individuals were assessed for their knowledge by using a self-questionnaire prior to and immediately after AGGC.

RESULTS

A total of 553 pregnant women were enrolled; 310 and 243 participants attended the AGGC without and with their partner, respectively. The ratio of the participants who increased their overall knowledge score was significantly higher after the AGGC for those who were with partner compared with those without. The medians (Q1-Q3) of the overall knowledge scores before and after the AGGC were 32 (29-36) and 36 (31-39) in the AGGC with their partner, respectively, and 33 (30-36) and 35 (32-39) in the AGGC without their partner, respectively. Knowledge of trisomy-21 screening of all participants got the lowest score and less improvement when compared with other topics.

CONCLUSION

Partner's involvement in the AGGC was associated with a higher ratio of the participants who increased their overall knowledge score when comparing the scores prior to and immediately after the AGGC.

Multisite assessment of the impact of a prenatal testing educational App on patient knowledge and preparedness for prenatal testing decision making

In this study, we wanted to assess the impact of the use of a patient educational app on patient knowledge about noninvasive prenatal testing (NIPT) and preparedness for prenatal screening decision-making. A randomized control study was carried out at three international sites between January 2019 and October 2020. Study participants completed a pre-consultation survey and post-consultation survey to assess knowledge, satisfaction, and preparedness for prenatal screening consultation. Providers completed a post-consultation survey. In the control arm, the pre-consultation survey was completed prior to consultation with their prenatal care provider. In the intervention arm, the pre-consultation survey was completed after using the app but prior to consultation with their prenatal care provider. Mean knowledge scores in the 203 participants using the app were significantly higher pre-consultation (p < 0.001) and post-consultation (p < 0.005) than those not using the app. Higher pre-consultation knowledge scores in the intervention group were observed at all sites. Most (86%) app users stated they were "Satisfied" or "Very Satisfied" with it as a tool. Providers rated the intervention group as more prepared than controls (p = 0.027); provider assessment of knowledge was not significantly different (p = 0.073). This study shows that clinical implementation of a patient educational app in a real-world setting was feasible, acceptable to pregnant people, and positively impacted patient knowledge.

The role of digital patient education in maternal health: A systematic review

OBJECTIVE

To assess the recent trends, acceptability, and effectiveness of digital maternal patient education through summarizing the literature.

METHODS

Articles published in 2010-2020 on patient education, digital tools, and maternal health were searched on PubMed. Abstract and full texts were reviewed to identify eligible studies and extract key information.

RESULTS

Digital patient education studies covered various topics throughout pregnancy, with the greatest number of studies targeting the prenatal period. Among the 55 studies, 38 (69%) reported significant patient outcomes, with the main benefits of increased knowledge (83.3%), emotional benefits (73.7%), and behavioral changes (60.6%). The number of studies per year increased steadily over the past decade, with frequently utilized formats of texts with images (40%), SMS (30.9%), and videos (25.5%). Video produced the highest rate of positive patient outcomes; however, no statistical significance was found.

CONCLUSION

Our study presented evidence supporting the high effectiveness and prevalence of digital tools in maternal patient education, and analyzed the content, platforms, and formats utilized by digital tools of the past decade.

PRACTICE IMPLICATIONS

Digital tools are effective and feasible in conducting maternal patient education. No specific patient education format is found to be superior in improving patient's health outcomes.

Cross-Cultural Adaptation and Validation of a French Version of the Genetic Counseling Satisfaction Scale (GCSS) as an Outcome Measure of Genetic Counseling for Hereditary Breast and Ovarian Cancer

(1) Background: The Genetic Counseling Satisfaction Scale (GCSS) is a widely used tool to evaluate patient satisfaction. To our knowledge, a validated French-language version of this tool is not yet available. This article reports on the cross-cultural adaptation and validation of a French version of the Genetic Counseling Satisfaction Scale (GCSS) to evaluate genetic counseling services for patient consultation in hereditary breast and ovarian cancer (HBOC). (2) Methods: The scale was culturally adapted following guidelines from Beaton et al. (2000). Cognitive interviews were conducted to ensure items were understood according to the intended meaning. The internal consistency, floor and ceiling effects, and testing of group differences were assessed using a sample of 172 patients who attended a pretest group genetic counseling session. (3) Results: Participants understood all items according to the intended meaning. The internal consistency was high for the total scale (0.90) and for the corrected item-to-total correlations (varying between 0.62 and 0.78). No floor or ceiling effects were observed. Group difference analyses generally followed expectations. (4) Conclusion: This process generated a French version of the GCSS that is clearly understood by patients, and has psychometric properties adequately in line those reported for its original English version.

Evaluation of the effect of education on perceived stress of mother candidates for amniocentesis

BACKGROUND

Amniocentesis is one of the methods for diagnosing prenatal abnormalities. Pregnant women with high-risk fetal screening results are the candidates for amniocentesis. Most of these women are afraid of this procedure because they predict that the test will be painful and worried about its adverse effects on pregnancy, fetal injury, or the risk of maternal death. Therefore, the aim of this study was to determine the effect of education on the perceived stress of mothers who are the candidates for amniocentesis.

MATERIALS AND METHODS

The present study was a quasi-experimental, two-group clinical trial with a parallel design. This study was in three stages: pretest (before intervention), posttest (after intervention), and after amniocentesis. This study was performed on 80 pregnant women who were the candidates for amniocentesis (15-20 weeks of pregnancy) with high-risk fetal screening results referred to the perinatology clinic in Yazd in 2020. The intervention package included training and using breathing techniques, broadcasting educational animations on how to perform amniocentesis, expressing experiences by people who had experienced amniocentesis, and finally visiting the amniocentesis site and getting to know the relevant perinatologist. Data collection tools were demographic and midwifery profile questionnaires and Cohen perceived stress. SPSS software version 16 was used for statistical analysis of data.

RESULTS

The results showed that the research units had high stress at the beginning of the study. The perceived stress score at the beginning of the study in the intervention group was 30.1750 ± 6.53153 and in the control group was 28.2750 ± 8.57841. After the intervention, the participants' stress level decreased below the cutting point. In the experimental group, the mean stresses after the intervention and after amniocentesis were significantly lower than before the intervention; however, after amniocentesis, it was somewhat higher than the postintervention stage. In the preintervention stage, the mean stress score between the two groups was not statistically significant. The difference after the intervention between the two groups was significant (P < 001.0); however, in the postamniocentesis stage, the difference in stress was not significant. After the intervention and after amniocentesis, the perceived stress of pregnant mothers in the experimental group was less than the control group.

CONCLUSION

Considering that the perceived stress in amniocentesis candidate mothers was high in the present study, so that after performing the method, mothers left the center with high stress, it is very important to pay attention to its psychological aspects. Therefore, it is suggested that educational interventions before and during amniocentesis be considered for them along with psychological support and follow-up care after amniocentesis.

The effect of education on anxiety of pregnant mothers before amniocentesis

BACKGROUND

Pregnancy alone is associated with many anxieties and worries for many women. Prenatal diagnosis of fetal malformations is one of the most important anxious events for women. Increasing knowledge empowers the person to identify the important issues and by increasing understanding, creates a positive attitude in people. Therefore, the aim of this study was to investigate the effect of education on the level of anxiety of pregnant mothers before invasive screening for fetal abnormalities (amniocentesis).

MATERIALS AND METHODS

This is a quasi-experimental study with two parallel designs in three stages: Pretest (before intervention), posttest (after intervention), and after amniocentesis. This study was performed on 80 pregnant women candidates for amniocentesis (40 pregnant women in the control group and 40 pregnant women in the intervention group) referred to the perinatology clinic in Yazd in 2020. Data collection tools were demographic and midwifery questionnaires and Spiel Berger anxiety questionnaires. In the experimental group, the intervention was performed as group training for 90 min immediately before amniocentesis. In the control group, only routine procedures (brief description by a perinatologist during amniocentesis) were performed. SPSS software version 16 was used to analyze the data.

RESULTS

The mean age of the research units was 67/5 ± 5/33 years. The results of Mann-Whitney intergroup test showed that the mean scores of overt anxiety before the intervention between the control and intervention groups were not significant (P < 0.014) but were significant after training and after amniocenter (P < 0.001). Furthermore, the results of Mann-Whitney group test showed that the mean scores of overt anxiety in the intervention group before and after training were significant (P < 0.001). Furthermore, the results of the control group showed significant results (P < 0.001). The results of the independent t-test showed that the mean scores of latent anxiety before the intervention between the control and intervention groups were not significant (P < 0.194) but were significant after the training (P < 0.57) but The results were not significant after amniocentesis (P < 0.216). Furthermore, the results of paired t-test within the group showed that the mean scores of overt anxiety in the intervention group before and after training was significant (P < 0.001). Furthermore, the results of the control group showed significant results (P < 0.001).

CONCLUSION

The findings of the present study indicate the positive effect of education on anxiety of pregnant women candidates for amniocentesis. The results also show the important role of education on the psychological dimension of high-risk pregnant women in relation to the consequences of pregnancy and childbirth. According to the research results, it seems that education affects the cognitive system and information processing by increasing people's awareness of the amniocentesis process and its consequences.

Pregnant women's opinions toward prenatal pretest genetic counseling in Japan

In-person models of genetic counseling (GC) have been the common method in Japan for pregnant women to receive GC. However, recent increases in the number of pregnant women considering undergoing prenatal testing have made it challenging to retain individualized in-person care. To explore pregnant women’s opinions toward pretest GC models and the ideal time duration, a self-administered questionnaire survey was conducted for women at their first prenatal visit. A total of 114 valid respondents (93.4%) were included in the analyses. Of these, 80.7% of women preferred in-person GC, followed by classroom (9.6%), group (3.5%), and telegenetic-based GC (2.6%). Women with experience in undergoing prenatal testing significantly did not prefer in-person GC (p = 0.05). Sixty-two women (54.4%) preferred a duration of 15–29 min for pretest GC sessions, followed by 30–59 min (28.9%) and <15 min (14.9%). Women’s preference of ≥30 min in length was significantly associated with anhedonia, singleton pregnancies, acquaintance with people with trisomy 21, and awareness of prenatal testing. Women who were unaware of the need for agreement with the partner for prenatal testing and who did not know the average life expectancy of a trisomy 21 patient significantly preferred <15 min in length over other durations. While the majority of women preferred in-person GC for <30 min, their preferences varied by their background characteristics, experiences, attitudes, and knowledge. These findings will help establish a prenatal GC system offering a choice of GC models in Japan; however, further large-scale studies are needed to confirm these findings.

Digital vs face-to-face information provision in patient counselling for prenatal screening: A noninferiority randomized controlled trial

Objective

To evaluate face‐to‐face information provision in patient counselling for prenatal screening compared with two forms of digital information provision, namely, noninteractive instructional video or interactive video.

Method

We performed a prospective, noninferiority, cluster‐randomized controlled trial comparing face‐to‐face (usual care) with two forms of digital information provision (intervention) in counselling for prenatal screening. This study was performed in the Amsterdam UMC, the Netherlands, in 2017, and included women in the first trimester of pregnancy. Main outcomes were knowledge gained by the patient and counselling duration. We performed a noninferiority analysis.

Results

One hundred forty‐one women were included, randomized, and analysed. The baseline characteristics were comparable. The intervention group was noninferior compared with the control group regarding the level of satisfaction. The knowledge grade difference was higher after using intervention, and the duration was significantly longer in the face‐to‐face group at 23 minutes versus 16 minutes. The addition of interaction with the video made no difference in any of the outcomes.

Conclusion

Adding an instructional video to patient counselling is of added value to improve patient's knowledge and shorten time consumption of the counsellor, therefore possibly saving costs. But this form of counselling maintains the same level of satisfaction.

What is already known about this topic?

Counselling for prenatal screening is a complex process containing education, information, and evaluation in order to make a well‐considered decision.

Counselling for prenatal screening has an increase in interdoctor variation and unpredictable time consumption.

What does this study add?

Digital information provision added to face‐to‐face counselling shortens the counsellors' time significantly without decreasing satisfaction and even improving knowledge.

Shortening the counsellors' time consumption can be a very cost‐effective way of saving time or increasing atient care.

Adding interactivity to patient information provision does not improve knowledge or satisfaction.