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Pleasants E, Parham L, Karen W, Dolgins E, Upadhyay UD, Marshall C, Prata N. Waiting to start abortion: A qualitative exploration of narratives of waiting shared in a Reddit community for abortion post-Dobbs leak in 2022. Soc Sci Med 2024; 349:116877. [PMID: 38657319 DOI: 10.1016/j.socscimed.2024.116877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/22/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
With the Dobbs leak introducing uncertainty about access and the Dobbs v. Jackson Women's Health Organization decision in June of 2022 overturning the US constitutional right to abortion, delays in accessing desired abortion care are likely growing longer and more common. Timely research on people's experiences waiting to access abortion care is needed. Using data from an abortion subreddit (r/abortion), we analyzed posts that described waiting after having decided to terminate the pregnancy, either by having an in-clinic appointment or ordering medication(s) online for self-managed abortion. Our analysis explored described 1) wait time length, 2) factors contributing to waiting, and 3) impacts of waiting. We used a hybrid inductive and deductive thematic qualitative coding approach to analyze a month-stratified 10% random sample of posts to the r/abortion community in 2022 surrounding the Dobbs leak and decision (May-December, n = 523 posts). Among posts to r/abortion that described waiting to start an abortion (n = 80), wait times ranged from one day to more than a month. Lack of appointment availability and waiting for mailed medications were commonly described as causing delays in accessing in-clinic abortion care and self-managed abortion, respectively. People shared challenges with pregnancy symptoms and feelings of anxiety, fear, isolation, and uncertainty. Posters also commonly described needing additional support while waiting. Overall, waiting to start an abortion was extremely stressful and isolating., with people often waiting weeks between ordering medication or scheduling an appointment and initiating the abortion process. Experiences of waiting to start an abortion and their impacts are of increasing concern as abortion access is further restricted. Additional targeted information and support are needed to mitigate these challenges. Providing timely access is imperative to quality care and overall abortion experiences.
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Affiliation(s)
- Elizabeth Pleasants
- University of California, Berkeley School of Public Health, USA; Wallace Center for Maternal, Child, and Adolescent Health Research, USA.
| | - Lindsay Parham
- University of California, Berkeley School of Public Health, USA; Wallace Center for Maternal, Child, and Adolescent Health Research, USA
| | - Weidert Karen
- University of California, Berkeley School of Public Health, USA; Bixby Center for Population, Health, and Sustainability, USA
| | - Eliza Dolgins
- University of California, Berkeley School of Public Health, USA; Wallace Center for Maternal, Child, and Adolescent Health Research, USA
| | - Ushma D Upadhyay
- University of California, San Francisco Department of Obstetrics, Gynecology, & Reproductive Sciences, USA.
| | - Cassondra Marshall
- University of California, Berkeley School of Public Health, USA; Wallace Center for Maternal, Child, and Adolescent Health Research, USA.
| | - Ndola Prata
- University of California, Berkeley School of Public Health, USA; Bixby Center for Population, Health, and Sustainability, USA
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Ehrich M, Sagaser KG, Porreco RP, Bellesheim D, Patil AS, Shulman LP, Van Den Boom D. Capillary blood collection: exploring a new method to promote noninvasive prenatal screening access. Am J Obstet Gynecol 2023; 229:75-76. [PMID: 36921913 DOI: 10.1016/j.ajog.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Mathias Ehrich
- Juno Diagnostics, 11760 Sorrento Valley Rd, Ste J, San Diego, CA.
| | | | | | | | - Avinash S Patil
- Department of Obstetrics and Gynecology, The University of Arizona College of Medicine - Phoenix, Phoenix, AZ
| | - Lee P Shulman
- Division of Clinical Genetics, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Zhang H, Wang J, Qin Y, Zhang C, Wang B, Wang Y. Anticipatory Governance of Noninvasive Prenatal Testing for "Non-Medical" Traits: Lessons from Regulation of Medically Assisted Reproduction. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:45-47. [PMID: 36919543 DOI: 10.1080/15265161.2023.2169398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Hui Zhang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
| | - Jing Wang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
| | - Yan Qin
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
| | - Chuanfeng Zhang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
| | - Bingwei Wang
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital
| | - Yuming Wang
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Provincial Key Laboratory of Genetic Diseases and Functional Genomics
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Lewit-Mendes MF, Robson H, Kelley J, Elliott J, Brown E, Menezes M, Archibald AD. Experiences of receiving an increased chance of sex chromosome aneuploidy result from non-invasive prenatal testing in Australia: "A more complicated scenario than what I had ever realized". J Genet Couns 2023; 32:213-223. [PMID: 36114608 DOI: 10.1002/jgc4.1635] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022]
Abstract
Many non-invasive prenatal testing (NIPT) platforms screen for sex chromosome aneuploidy (SCA) and SCA analysis is generally included in Australia where NIPT is available as a self-funded test. Little is known about the experience of receiving an NIPT result indicating an increased chance of SCA. This study aimed to explore the experiences of people who received this result and their perspectives on the information, care, and support they received from healthcare practitioners (HCPs). Semi-structured interviews were conducted with people who received an NIPT result indicating an increased chance of SCA and continued their pregnancy. Most participants only had contact with a genetic counselor after receiving their result. Transcribed data were analyzed using rigorous thematic analysis to identify important patterns and themes. Participants (18 women, 2 male partners) described embarking on NIPT, primarily based on advice from their HCP and without much consideration. Consequently, participants expressed feeling unprepared for the unanticipated complexity of their NIPT result and were faced with making a time-sensitive decision about a condition they had not previously considered. While more pre-test information was desired, timely access to genetic counseling post-test assisted with adjustment to the result. These findings suggest that routinization of NIPT may be compromising informed decision-making, resulting in unpreparedness for an increased chance result. Given the increasing uptake and expanding scope of NIPT, resources should be dedicated to educating HCPs offering NIPT and ensuring timely access to genetic counseling post-result. With appropriate funding, genetics services may be able to play a central role in offering information and support to both people who undertake NIPT and their HCPs ordering the testing. Implementing a publicly funded screening program in Australia could assist with standardizing prenatal screening care pathways and consequently better access to appropriate resources.
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Affiliation(s)
- Miranda F Lewit-Mendes
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Monash Genetics, Monash Health, Melbourne, Victoria, Australia
| | - Hazel Robson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Genetics Department, Number 1 Fertility, Melbourne, Victoria, Australia
| | - Joanne Kelley
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Justine Elliott
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Erica Brown
- Genetics Clinic, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Melody Menezes
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Monash Ultrasound for Women, Monash IVF, Melbourne, Victoria, Australia
| | - Alison D Archibald
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Parobek CM, Thorsen MM, Has P, Lorenzi P, Clark MA, Russo ML, Lewkowitz AK. Video education about genetic privacy and patient perspectives about sharing prenatal genetic data: a randomized trial. Am J Obstet Gynecol 2022; 227:87.e1-87.e13. [PMID: 35351406 DOI: 10.1016/j.ajog.2022.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Laboratories offering cell-free DNA often reserve the right to share prenatal genetic data for research or even commercial purposes, and obtain this permission on the patient consent form. Although it is known that nonpregnant patients are often reluctant to share their genetic data for research, pregnant patients' knowledge of, and opinions about, genetic data privacy are unknown. OBJECTIVE We investigated whether pregnant patients who had already undergone cell-free DNA screening were aware that genetic data derived from cell-free DNA may be shared for research. Furthermore, we examined whether pregnant patients exposed to video education about the Genetic Information Nondiscrimination Act-a federal law that mandates workplace and health insurance protections against genetic discrimination-were more willing to share cell-free DNA-related genetic data for research than pregnant patients who were unexposed. STUDY DESIGN In this randomized controlled trial (ClinicalTrials.gov Identifier: NCT04420858), English-speaking patients with singleton pregnancies who underwent cell-free DNA and subsequently presented at 17 0/7 to 23 6/7 weeks of gestation for a detailed anatomy scan were randomized 1:1 to a control or intervention group. Both groups viewed an infographic about cell-free DNA. In addition, the intervention group viewed an educational video about the Genetic Information Nondiscrimination Act. The primary outcomes were knowledge about, and willingness to share, prenatal genetic data from cell-free DNA by commercial laboratories for nonclinical purposes, such as research. The secondary outcomes included knowledge about existing genetic privacy laws, knowledge about the potential for reidentification of anonymized genetic data, and acceptability of various use and sharing scenarios for prenatal genetic data. Eighty-one participants per group were required for 80% power to detect an increase in willingness to share data from 60% to 80% (α=0.05). RESULTS A total of 747 pregnant patients were screened, and 213 patients were deemed eligible and approached for potential study participation. Of these patients, 163 (76.5%) consented and were randomized; one participant discontinued the intervention, and two participants were excluded from analysis after the intervention when it was discovered that they did not fulfill all eligibility criteria. Overall, 160 (75.1%) of those approached were included in the final analysis. Most patients in the control group (72 [90.0%]) and intervention (76 [97.4%]) group were either unsure about or incorrectly thought that cell-free DNA companies could not share prenatal genetic data for research. Participants in the intervention group were more likely to incorrectly believe that their prenatal genetic data would not be shared for nonclinical purposes than participants in the control group (28.8% in the control group vs 46.2% in the intervention; P=.03). However, video education did not increase participant willingness to share genetic data in multiple scenarios. Non-White participants were less willing than White participants to allow sharing of genetic data specifically for academic research (P<.001). CONCLUSION Most participants were unaware that their prenatal genetic data may be used for nonclinical purposes. Pregnant patients who were educated about the Genetic Information Nondiscrimination Act were not more willing to share genetic data than those who did not receive this education. Surprisingly, video education about the Genetic Information Nondiscrimination Act led patients to falsely believe that their data would not be shared for research, and participants who identified as racial minorities were less willing to share genetic data. New strategies are needed to improve pregnant patients' understanding of genetic privacy.
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Chang JW, Chen VL, Rubenstein JH, Dellon ES, Wallner LP, De Vries R. What patients with eosinophilic esophagitis may not share with their providers: a qualitative assessment of online health communities. Dis Esophagus 2021; 35:6414418. [PMID: 34718475 PMCID: PMC9393058 DOI: 10.1093/dote/doab073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/09/2021] [Accepted: 09/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Little is known about how patients with eosinophilic esophagitis (EoE) experience their symptoms, receive care, and cope with their disease. Patients commonly seek peer support from online communities, which provide insights on unmet needs and barriers to care. We performed a qualitative analysis of electronic health forums to characterize patient-to-patient conversations about EoE symptoms and the experience of disease. METHODS We identified three publicly accessible electronic health forums hosting EoE communities. Conversation threads posted between July 2018 and June 2020 were coded using emergent and a priori codes based on the THRIVE conceptual framework of coping with chronic illness. RESULTS Of 659 threads (4,933 posts) collected over two years, a random sample of 240 threads (30 per 3-month quarter) were selected for analysis. Thematic saturation was reached after 172 threads. Patient experience of EoE was driven by their perspectives in four key domains: (i) perception of EoE as episodic rather than chronic, (ii) treatment choices, (iii) personal definitions of success in the disease, and (iv) views of providers. CONCLUSION Online health communities are a valuable and unfiltered source of patient perspectives that can be used to understand patient needs and goals. EoE patients interpret their disease as sporadic events and lack reliable sources of knowledge, which may influence how patients prioritize treatment. If providers are to succeed in providing high-quality EoE care, they need to equip themselves with evidence-based knowledge, engage in shared decision making, and look outside of clinical settings to recognize barriers to disease management.
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Affiliation(s)
- Joy W Chang
- Address correspondence to: Joy W. Chang, Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Vincent L Chen
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Joel H Rubenstein
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA,Veterans Affairs Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
| | - Evan S Dellon
- Division of Gastroenterology, Center for Esophageal and Swallowing Disorders, University of North Carolina, Chapel Hill, NC, USA
| | - Lauren P Wallner
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Zhou L, Zhang B, Liu J, Shi Y, Wang J, Yu B. The Optimal Cutoff Value of Z-scores Enhances the Judgment Accuracy of Noninvasive Prenatal Screening. Front Genet 2021; 12:690063. [PMID: 34367249 PMCID: PMC8336938 DOI: 10.3389/fgene.2021.690063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/14/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the accuracy of Z-scores of noninvasive prenatal screening (NIPS) in predicting 21, 18 trisomy, and X chromosome aneuploidy. Methods A total of 39,310 prenatal women were recruited for NIPS from September 2015 to September 2020. Interventional prenatal diagnosis was applied to verify the diagnosis of NIPS-positive results. Logistic regression analysis was employed to relate the Z-scores to the positive predictive value (PPV) of NIPS-positive results. Using receiver operating characteristic (ROC) curves, we calculated the optimal cutoff value of Z-scores to predict fetal chromosome aneuploidy. According to the cutoff value, NIPS-positive results were divided into the medium Z-value (MZ) and high Z-value (HZ) groups, and PPV was calculated to access the accuracy of Z-scores. Results A total of 288 effective values of Z-scores were used as the final data set. The logistics regression analysis revealed that Z-scores were significantly associated with true-positive results for 21 trisomy (T21) and 18 trisomy (T18) (P < 0.05), whereas the same was not observed for X chromosome aneuploids (P > 0.05). The optimal cutoff value of the Z-score for T21, T18, XO, XXX, and XXY indicated by ROC curve analysis were 5.79, 6.05, −9.56, 5.89, and 4.47, and the area under the curve (AUC) were 0.89, 0.80, 0.48, 0.42, and 0.45, respectively. PPV in the HZ group was higher than that in the MZ group, and the application of the cutoff value reduced the false discovery rate (FDR), which was only 2.9% in the HZ group compared with 61.1% in the MZ group for T21 and T18. The difference in total PPV between the MZ and HZ groups for X chromosome aneuploids was statistically significant. Moreover, the PPV for XXX and XXY seemed to increase with Z-scores but not for XO. Conclusion The Z-score is helpful for the accurate judgment of NIPS results and for clinical prenatal counseling. Especially for T21 and T18, Z-scores have an excellent clinical association, which is superior to that seen with X chromosome aneuploids. In addition, using Z-scores to judge NIPS results offers a certain reference value for XXX and XXY but not for XO.
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Affiliation(s)
- Lingna Zhou
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Bin Zhang
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Jianbing Liu
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Ye Shi
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Jing Wang
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Bin Yu
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou, China
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Ravitsky V, Roy MC, Haidar H, Henneman L, Marshall J, Newson AJ, Ngan OMY, Nov-Klaiman T. The Emergence and Global Spread of Noninvasive Prenatal Testing. Annu Rev Genomics Hum Genet 2021; 22:309-338. [PMID: 33848430 DOI: 10.1146/annurev-genom-083118-015053] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Since its introduction in 2011, noninvasive prenatal testing (NIPT) has spread rapidly around the world. It carries numerous benefits but also raises challenges, often related to sociocultural, legal, and economic contexts. This article describes the implementation of NIPT in nine countries, each with its own unique characteristics: Australia, Canada, China and Hong Kong, India, Israel, Lebanon, the Netherlands, the United Kingdom, and the United States. Themes covered for each country include the structure of the healthcare system, how NIPT is offered, counseling needs and resources, and cultural and legal context regarding disability and pregnancytermination. Some common issues emerge, including cost as a barrier to equitable access, the complexity of decision-making about public funding, and a shortage of appropriate resources that promote informed choice. Conversely, sociocultural values that underlie the use of NIPT vary greatly among countries. The issues described will become even more challenging as NIPT evolves from a second-tier to a first-tier screening test with expanded use.
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Affiliation(s)
- Vardit Ravitsky
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec H3C 3J7, Canada;
| | - Marie-Christine Roy
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec H3C 3J7, Canada;
| | - Hazar Haidar
- Institute for Health and Social Policy, McGill University, Montreal, Quebec H3A 1A3, Canada;
| | - Lidewij Henneman
- Department of Clinical Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands;
| | - John Marshall
- United Kingdom National Screening Committee, London SE1 8UG, United Kingdom;
| | - Ainsley J Newson
- Sydney Health Ethics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia;
| | - Olivia M Y Ngan
- Centre for Bioethics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China;
| | - Tamar Nov-Klaiman
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel;
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