1
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Ternby E, Axelsson O, Georgsson S, Malmgren CI. Pregnant women's informational needs prior to decisions about prenatal diagnosis for chromosomal anomalies-A Q methodological study. Prenat Diagn 2024; 44:480-491. [PMID: 38167810 DOI: 10.1002/pd.6514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To study pregnant women's subjective viewpoints on what is important when receiving information prior to decision-making regarding prenatal testing for chromosomal anomalies. METHOD Data were collected using Q methodology. During January 2020-October 2021, 45 pregnant women in Sweden completed a 50-item Q sort. Statements regarding what is important when receiving information about prenatal screening and diagnosis were prioritized through ranking in a fixed sorting grid on an 11-point scale, from "most important" to "least important." Socio-demographics and coping styles were surveyed through questionnaires. RESULTS Three groups represented different viewpoints on what pregnant women consider important when receiving information about prenatal screening and diagnosis. Factor 1: Stepwise information and decision-making: viewing information and decision-making as a step-by-step process. Factor 2: Decision-making as a continuous process based on couple autonomy: Striving for an informed decision as a couple about tests, test results and conditions screened. Factor 3: As much information as early as possible-the importance of personal autonomy in decision-making: Prioritizing autonomous decision-making based on non-directive information early in the pregnancy. CONCLUSION This study highlights the complexities involved when providing information. As shown by the differing viewpoints in this study, pregnant women's informational needs differ, making individual and personalized information preferable.
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Affiliation(s)
- Ellen Ternby
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ove Axelsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | | | - Charlotta Ingvoldstad Malmgren
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
- Centre for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Centre for Research and Bioethics, Uppsala University, Uppsala, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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2
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Lannoo L, van der Meij KRM, Bekker MN, De Catte L, Deckers S, Devriendt K, Roggen N, Galjaard RJH, Gitsels-van der Wal J, Macville MVE, Martin L, Sistermans EA, Van Calsteren K, Van Keirsbilck J, Crombag N, Henneman L. A cross-country comparison of pregnant women's decision-making and perspectives when opting for non-invasive prenatal testing in the Netherlands and Belgium. Prenat Diagn 2023; 43:294-303. [PMID: 36740754 DOI: 10.1002/pd.6329] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Netherlands and Belgium have been among the first countries to offer non-invasive prenatal testing (NIPT) as a first-tier screening test. Despite similarities, differences exist in counseling modalities and test uptake. This study explored decision-making and perspectives of pregnant women who opted for NIPT in both countries. METHODS A questionnaire study was performed among pregnant women in the Netherlands (NL) (n = 587) and Belgium (BE) (n = 444) opting for NIPT, including measures on informed choice, personal and societal perspectives on trisomy 21, 18 and 13 and pregnancy termination. RESULTS Differences between Dutch and Belgian women were shown in the level of informed choice (NL: 83% vs. BE: 59%, p < 0.001), intention to terminate the pregnancy in case of confirmed trisomy 21 (NL: 51% vs. BE: 62%, p = 0.003) and trisomy 13/18 (NL: 80% vs. BE: 73%, p = 0.020). More Belgian women considered trisomy 21 a severe condition (NL: 64% vs. BE: 81%, p < 0.001). Belgian women more frequently indicated that they believed parents are judged for having a child with trisomy 21 (BE: 42% vs. NL: 16%, p < 0.001) and were less positive about quality of care and support for children with trisomy 21 (BE: 23% vs. NL: 62%, p < 0.001). CONCLUSION Differences in women's decision-making regarding NIPT and the conditions screened for may be influenced by counseling aspects and country-specific societal and cultural contexts.
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Affiliation(s)
- Lore Lannoo
- Department of Obstetrics and Gynaecology, Fetomaternal Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Karuna R M van der Meij
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Luc De Catte
- Department of Obstetrics and Gynaecology, Fetomaternal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Sarah Deckers
- Department of Obstetrics and Gynaecology, Fetomaternal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Koenraad Devriendt
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Nele Roggen
- Department of Obstetrics and Gynaecology, AZ Imelda, Bonheiden, Belgium
| | - Robert-Jan H Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Janneke Gitsels-van der Wal
- Department of Midwifery Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Merryn V E Macville
- Department of Clinical Genetics, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Linda Martin
- Department of Midwifery Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
| | - Erik A Sistermans
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, Fetomaternal Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium
| | | | - Neeltje Crombag
- Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynaecology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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3
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Ghiasi M, Armour C, Walker M, Shaver N, Bennett A, Little J. Issues associated with possible implementation of Non-Invasive Prenatal Testing (NIPT) in first-tier screening: A rapid scoping review. Prenat Diagn 2023; 43:62-71. [PMID: 36461628 DOI: 10.1002/pd.6278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/24/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022]
Abstract
In recent years, as the implementation and use of Non-Invasive Prenatal Testing (NIPT) have increased, the cost of the test has been decreasing. The cost of NIPT is expected to fall further in the upcoming years. As a result of the decreasing cost of NIPT, many jurisdictions may change their prenatal screening policies toward abandoning serum-based screening and instead, implement and support NIPT as the first-tier screening for all women. There are several concerns in replacing first-trimester screening with NIPT. In this scoping review, we aimed to map the existing knowledge about possible issues in the systematic implementation of NIPT as the primary method of first-tier screening and to assess if any jurisdiction has altered its policy and discontinued serum-based prenatal screening in exchange for NIPT. The Medline database (Ovid) and Google Scholar was searched and all the studies discussing, investigating, or reporting on the systematic implementation of NIPT as the primary method of first-tier screening were included. All the studies went through a two-stage screening process and included full-text articles were reviewed. We did not find any articles indicating a country or region that replaced traditional prenatal screening by NIPT. The included articles were charted, and the data about the possible issues in the systematic implementation of NIPT as the primary method of first-tier screening are summarized narratively and presented in tables in four categories. The findings of this scoping review may be informative for stakeholders and policymakers regarding recent changes in NIPT implementation policies around the world and may aid with developing policy for NIPT implementation with a broader perspective.
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Affiliation(s)
- Maryam Ghiasi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Armour
- Department of Medical Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Prenatal Screening Ontario (PSO), Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Walker
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nicole Shaver
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandria Bennett
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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4
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de Vries M, Oostdijk D, Janssen KGT, de Vries R, Sanders J. Negotiating Awareness: Dutch Midwives' Experiences of Noninvasive Prenatal Screening Counseling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15283. [PMID: 36430001 PMCID: PMC9691187 DOI: 10.3390/ijerph192215283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Discussion of the topic of noninvasive prenatal screening (NIPS) has become a standard part of Dutch maternity care practice. This means that pregnant women who are contemplating NIPS can receive counseling from their midwife or obstetrician. The aim of this study is to understand the communicative practices and decision-making principles regarding first-tier use of NIPS, as experienced by Dutch midwives. METHODS Qualitative analysis of in-depth interviews with Dutch midwives (n = 10) exploring their conversations about NIPS counseling and decision making. RESULTS Midwives value the autonomy of women in decisions on NIPS. They consider it a midwifery task to assess women's awareness of the risks and implications of using or not using this mode of screening. The optimal level of awareness may differ between women and midwives, creating novel challenges for informed decision making in midwifery communication. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Negotiating awareness about NIPS in individual women is a relatively new and complex midwifery task in need of counseling time and skill. NIPS practices call for a reflection on midwifery values in the context of integrated maternity care.
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Affiliation(s)
- Marieke de Vries
- Institute for Computing and Information Sciences, Radboud University Nijmegen, 6525 EC Nijmegen, The Netherlands
| | - Danique Oostdijk
- Communication and Information Sciences, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands
| | - Kim G. T. Janssen
- Medical Biology, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands
| | - Raymond de Vries
- Center of Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - José Sanders
- Centre for Language Studies, Radboud University Nijmegen, 6500 HD Nijmegen, The Netherlands
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5
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Koopmanschap I, Martin L, Gitsels - van der Wal JT, Suurmond J. Counselling for prenatal anomaly screening to migrant women in the Netherlands: An interview study of primary care midwives’ perceived barriers with client–midwife communication. Eur J Midwifery 2022; 6:29. [PMID: 35633755 PMCID: PMC9118623 DOI: 10.18332/ejm/147911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/27/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Large ethnic inequalities exist in the prenatal screening offer, counselling, informed decision-making, and uptake of prenatal anomaly tests. More insight into midwives’ experiences with offering prenatal counselling to migrant women may provide better insight into the origins and consequences of these ethnic inequalities. METHODS We conducted interviews with 12 midwives certified as counsellors for prenatal anomaly screening for women they identified as migrants. Interviews were analyzed using thematic analysis. RESULTS Midwives reported most difficulties in communicating with women of ‘non-western migrant background’, which include first- and second-generation migrants from Africa, Latin-America, Asia, and Turkey. They experienced barriers in communication related to linguistics, health literacy, sociocultural and religious differences, with midwife stereotyping affecting all three aspects of counselling: health education, decision-making support, and the client–midwife relation. Health education was difficult because of language barriers and low health-literacy of clients, decision-making support was hampered by sociocultural and religious midwife–client differences, and client–midwife relations were under pressure due to sociocultural and religious midwife–client differences and midwife stereotyping. CONCLUSIONS Barriers to optimal communication seem to contribute to suboptimal counselling, especially for women of ‘non-western migrant background’. Client–midwife communication thus potentially adds to the ethnic disparities observed in the offer of and informed decision-making about prenatal anomaly screening in the Netherlands. The quality of prenatal counselling for women from all ethnic backgrounds might be improved by addressing linguistic, health literacy, sociocultural and religious barriers in future training and continuing education of prenatal counsellors.
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Affiliation(s)
- Isabel Koopmanschap
- Amsterdam University Medical Center, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Martin
- Department of Midwifery Science, Academy Midwifery Amsterdam and Groningen (AVAG), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Janneke T. Gitsels - van der Wal
- Department of Midwifery Science, Academy Midwifery Amsterdam and Groningen (AVAG), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jeanine Suurmond
- Amsterdam University Medical Center, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
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6
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Nationwide implementation of the non-invasive prenatal test: Evaluation of a blended learning program for counselors. PLoS One 2022; 17:e0267865. [PMID: 35499995 PMCID: PMC9060360 DOI: 10.1371/journal.pone.0267865] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/16/2022] [Indexed: 11/19/2022] Open
Abstract
This study assesses the results of a mandatory blended learning-program for counselors (e.g. midwives, sonographers, obstetricians) guiding national implementation of the Non-Invasive Prenatal Test (NIPT). We assessed counselors’ 1) knowledge about prenatal aneuploidy screening, 2) factors associated with their knowledge (e.g. counselors’ characteristics, attitudes towards NIPT), and 3) counselors’ attitudes regarding the blended learning. A cross-sectional online pretest-posttest implementation survey was sent to all 2,813 Dutch prenatal counselors. Multivariate linear regression analyses were performed to identify associations between counselors’ knowledge and e.g. their professional backgrounds, work experience and attitudes towards NIPT. At T0 and T1 1,635 and 913 counselors completed the survey, respectively. Overall results show an increased mean number of correct answered knowledge questions; 23/35 (66%) items at T0 and 28/37 (76%) items at T1. Knowledge gaps on highly specific topics remained. Work experience and secondary care work-setting were positively associated with a higher level of knowledge. Most counselors (74%) showed positive attitudes towards the blended learning program. The mandatory blended learning, along with learning by experience through implementation of NIPT, has facilitated an increase in counselors’ knowledge and was well received. New implementations in healthcare may benefit from requiring blended learning for healthcare providers, especially if tailored to professionals’ learning goals.
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7
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Yeşilçinar İ, Güvenç G. Counselling and education for prenatal screening and diagnostic tests for pregnant women: Randomized controlled trial. Int J Nurs Pract 2021; 27:e13000. [PMID: 34374162 DOI: 10.1111/ijn.13000] [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: 03/26/2020] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study is to evaluate the effect of education and counselling on prenatal screening and diagnostic tests on pregnant women's decisional conflict, anxiety levels and attitudes towards the tests. BACKGROUND Clinical practice guidelines recommend prenatal genetic counselling for pregnant women before participation in the tests. METHODS A total of 210 pregnant women participated in the study by completing the State-Trait Anxiety Inventory-I, Decisional Conflict Scale, SURE Scale, Knowledge Assessment Forms, Decision Satisfaction Form and Attitudes Scale between June 2017 and March 2018. In the first stage, pregnant women were evaluated who had only prenatal genetic screening tests and in the second stage, pregnant women who had been recommended to receive diagnostic tests. The intervention group received face-to-face individual education and counselling about prenatal genetic tests. Independent samples t test, t tests and Pearson correlation tests were used. RESULTS Education and counselling for prenatal screening tests and diagnostic tests from the first weeks of pregnancy were effective in decreasing anxiety, decisional conflict, increasing attitudes towards tests and had positive effects on pregnant women's knowledge level and decision satisfaction (P < 0.005). CONCLUSION Prenatal genetic counselling and education are more effective if provided from the first weeks of pregnancy. Decreasing anxiety, decisional conflict and increasing knowledge levels of pregnant women are important to make informed decisions.
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Affiliation(s)
- İlknur Yeşilçinar
- Health Sciences Faculty, Nursing Department, Izmir Katip Celebi University, Izmir, Turkey
| | - Gülten Güvenç
- Gülhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
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8
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Martin L, Gitsels-van der Wal JT, Hitzert M, Henrichs J. Clients' perspectives on the quality of counseling for prenatal anomaly screening. A comparison between 2011 and 2019. PATIENT EDUCATION AND COUNSELING 2021; 104:1796-1805. [PMID: 33388195 DOI: 10.1016/j.pec.2020.12.012] [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: 04/25/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There have been substantial medical developments in prenatal anomaly and aneuploidy screening. However, the quality of counseling about these tests tends to lag behind. Additional quality requirements were therefore implemented in the Netherlands in 2017 to optimize this counseling. We compared clients' counseling preferences and experiences before and after implementation of these requirements. METHODS We used the validated 57-item QUOTEprenatal questionnaire, to measure clients' counseling preferences and experiences before and after counseling in 20 obstetric organizations throughout the Netherlands. Clients' preferences and experiences were compared between pregnant women and partners, nulliparous versus multiparous clients and between results of a Dutch survey in 2011 and the current one. RESULTS Sixty-five counselors and 649 clients (353 pregnant women and 296 partners) participated in this study. Compared to 2011, slightly more clients considered the three QUOTEprenatal components of counseling (client-counselor relationship, health education, and decision-making support) to be either important or very important, especially decision-making support. More clients than in 2011 perceived their needs as being well addressed, with the lowest percentages for decision-making support. CONCLUSION Quality requirements seem to benefit the quality of counseling, as perceived by clients. PRACTICAL IMPLICATIONS Counselors should consider tailoring their decision-making support more to clients' needs.
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Affiliation(s)
- Linda Martin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam, the Netherlands.
| | | | - Marit Hitzert
- National Institute for Public Health and the Environment (RIVM), Centre for Population Screening, Bilthoven, the Netherlands
| | - Jens Henrichs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam, the Netherlands
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9
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Bawazeer S, AlSayed M, Kurdi W, Balobaid A. Knowledge and attitudes regarding non-invasive prenatal testing among women in Saudi Arabia. Prenat Diagn 2021; 41:1343-1350. [PMID: 34159638 DOI: 10.1002/pd.5991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/02/2021] [Accepted: 06/04/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To explore women's knowledge and attitudes regarding NIPT, its implications, the factors affecting their decision to undergo the test and actions taken following a positive result. METHODS In this descriptive study, women who were offered NIPT through the foetal maternal clinic, were asked to complete an anonymous questionnaire about NIPT. The questionnaire consisted of 29 statements and covered four areas: demographics, knowledge, attitudes and decision-making. RESULTS A total of 150 women who were offered NIPT participated in this study. The results showed that generally women had poor knowledge of critical aspects of NIPT. This included the conditions tested for, the implications of the test and its limitations. Over 90% of women were in favour of NIPT and it being offered to all women of advanced maternal age while 66% of the tested women agreed to having confirmatory invasive testing in the case of a positive result. CONCLUSION This study shows that the acceptance rate for NIPT is high despite incomplete understanding of the benefits and limitations of the test. The study findings support the need for education regarding this test through dedicated genetic counselling sessions in order to ensure that an informed decision can be made.
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Affiliation(s)
- Shahad Bawazeer
- Department of Pediatrics, Section of Medical Genetics, Children's Specialist Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Moeenaldeen AlSayed
- Department of Medical Genetics, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.,Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Wesam Kurdi
- Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Obstetrics and Gynaecology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Ameera Balobaid
- Department of Medical Genetics, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.,Department of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Baumann S, Darquy S, Miry C, Duchange N, Moutel G. Termination of pregnancy for foetal indication in the French context analysis of decision-making in a Multidisciplinary Centre For Prenatal Diagnosis. J Gynecol Obstet Hum Reprod 2021; 50:102067. [PMID: 33484935 DOI: 10.1016/j.jogoh.2021.102067] [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: 12/04/2019] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In France, termination of pregnancy (TOP) for medical reasons is legal, regardless of the term, after authorisation by a Multidisciplinary Centre for Prenatal Diagnosis (MCPD). This study analyses the elements supporting the TOP decision-making process faced with a foetal pathology. STUDY DESIGN Medical records of one MCPD were analysed for the period 2013 and 2014 and semi-structured interviews with MCPD members were conducted. RESULTS Out of 265 files concerning foetal indications, all but one resulted in a decision for TOP. The main indications in number for TOP were malformations and chromosomal abnormalities. For indications such as trisomy 21, authorisations are generally given without discussion. Our results underline the importance that professionals attach to the collegiality of decisions, particularly in situations of uncertainty. CONCLUSION This study provides information about the activity of MCPDs within the field of prenatal diagnosis and shows the importance of these structures in supporting women and couples whilst respecting their autonomy. At present, the role of the MCPD is in the process of evolving and could become an information and advisory board for women, based on collegial expertise to guide their decision-making.
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Affiliation(s)
- Sophie Baumann
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, 14000 Caen, France
| | - Sylviane Darquy
- Univ. Bordeaux, Inserm U1219, EPICENE, Cancer et expositions environnementales, 33000 Bordeaux, France.
| | - Claire Miry
- Hôpital Universitaire de Strasbourg, Service de Médecine fœtale, 67091 Strasbourg cedex, France
| | | | - Grégoire Moutel
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, 14000 Caen, France; Espace régional d'éthique, CHU de Caen, Normandie Université, 14000 Caen, France
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11
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Jansen CH, de Vries JM, Engels M, van de Kamp K, Snijders RJ, Martin L, Henneman L, Pajkrt E. Effect of education and attitude on health professionals' knowledge on prenatal screening. Eur J Midwifery 2020; 4:38. [PMID: 33537639 PMCID: PMC7839104 DOI: 10.18332/ejm/126626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/20/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Ongoing developments in prenatal anomaly screening necessitate continuous updating of counsellors’ knowledge. We explored the effect of a refresher counselling course on participants’ knowledge of prenatal screening. METHODS We investigated the association between knowledge and counsellors’ working experience. Also, the association between knowledge and counsellors’ attitude towards prenatal screening was determined. All counsellors in the North-West region of the Netherlands were invited to attend a refresher counselling course and fill in both a pre-course and a post-course questionnaire. The participants consisted of midwifes, sonographers and gynaecologists. A 55-item questionnaire assessed pre-course (T0) and post-course (T1) knowledge. At T0, counsellors’ attitude towards the prenatal screening program was assessed and its association with knowledge analysed. RESULTS Of 387 counsellors, 68 (18%) attended the course and completed both questionnaires. Knowledge increased significantly from 77.7% to 84.6% (p<0.01). Scores were lowest regarding congenital heart diseases. Participants with ultrasound experience scored higher on T0, but improvement was seen in participants with and without ultrasound experience. Participants with a positive attitude towards a free-of-charge first trimester combined test had higher knowledge scores than participants with a negative attitude (62% vs 46%; p=0.002). CONCLUSIONS A refresher course improved counsellors’ knowledge on prenatal screening. Ultrasound experience and a positive attitude towards free screening may be associated with higher knowledge levels. Participating in a mandatory refresher counselling course is useful for the continuous improvement of healthcare practitioners’ knowledge. More research on the effect of knowledge and attitude on the quality of prenatal screening is necessary.
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Affiliation(s)
- Charlotte H Jansen
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
| | - Jana M de Vries
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
| | - Melanie Engels
- EchoXpert, Prenatal Ultrasound and Training Center, Amsterdam,the Netherlands
| | - Karline van de Kamp
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
| | - Rosalinde J Snijders
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
| | - Linda Martin
- Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam,Amsterdam, the Netherlands
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12
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Prinds C, der Wal JGV, Crombag N, Martin L. Counselling for prenatal anomaly screening-A plea for integration of existential life questions. PATIENT EDUCATION AND COUNSELING 2020; 103:1657-1661. [PMID: 32268986 DOI: 10.1016/j.pec.2020.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/04/2020] [Accepted: 03/27/2020] [Indexed: 05/09/2023]
Abstract
The availability in many countries of new prenatal anomaly screening methods, such as the non-invasive prenatal test (NIPT), and the potential broadening of testing for genetic conditions, creates an ongoing debate about the accompanying existential dilemmas at both societal level and for individual new parents. In many countries, the main goal of counselling for prenatal anomaly screening is to facilitate the reproductive decision-making process of future parents. Therefore, counsellors share information to enable a woman and her partner to think about the pros and cons of participating in screening, try to clarify possible moral dilemmas, and dwell on existential life questions. In line with the CanMEDS framework, healthcare professionals must combine the role of communicator (providing health education) with that of professional (by recognising and responding to existential life questions while facilitating decision-making). This is not easy but it is essential for providing balanced counselling. At present, counselling tends to be sufficient regarding health education, whereas guidance in decision-making, including attention for existential life questions and philosophy of life, offers room for improvement. In this paper, we suggest slowing down and turning the traditional prenatal counselling encounter upside down by starting as a counselling professional instead of a healthcare information sharing communicator and thus making the story of the woman and her partner, within their societal context, the starting point and the basis of the counselling encounter.
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Affiliation(s)
- Christina Prinds
- University of Southern Denmark, Institute of Clinical Research, Odense C, Denmark; University College South Denmark, Haderslev, Denmark.
| | | | - Neeltje Crombag
- University of Leuven, Department of Development and Regeneration, Biomedical Sciences, Belgium
| | - Linda Martin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
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Liu Y, Liu H, He Y, Xu W, Ma Q, He Y, Lei W, Chen G, He Z, Huang J, Liu J, Liu Y, Huang Q, Yu F. Clinical performance of non-invasive prenatal served as a first-tier screening test for trisomy 21, 18, 13 and sex chromosome aneuploidy in a pilot city in China. Hum Genomics 2020; 14:21. [PMID: 32503639 PMCID: PMC7275506 DOI: 10.1186/s40246-020-00268-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/10/2020] [Indexed: 12/19/2022] Open
Abstract
Background Cell-free fetal DNA (cffDNA) has opened up new approaches for non-invasive prenatal testing (NIPT), and it is often used as the second-tier test for high-risk pregnant women in detecting trisomy (T) 21, T18, and T13 after serum biochemistry screening. This study aims to discuss the clinical performance of NIPT as an alternative first-tier screening test for pregnant women in detecting T21, T18, T13, and sex chromosome aneuploidies (SCAs) in China. Methods A total of 42,924 samples were recruited. The cell-free plasma DNA was directly sequenced. Each of the chromosome aneuploidies of PPV was analyzed. A total of 22 placental samples were acquired, including 14 FP and 8 TP samples. The placental verification of FP NIPT results was performed. Results Among 42,924 samples, 281 (0.65%) positive cases, including 87 of T21, 31 of T18, 22 of T13, and 141 of SCAs were detected. For the detection of T21, the positive predictive value (PPV) was 78.46%, for trisomy 18, 62.96%, for trisomy 13, 10.00%, for SCAs, 47.22% in the total samples. For trisomy 21, the PPV was 86.67%, for trisomy 18, 80.00%, for trisomy 13, 20.00%, for SCAs, 56.52% in advanced maternal age (AMA) women. The PPV of T21 increased with age. For T18, the PPV showed an overall upward trend. For T13 and SCAs, PPV was raised first and then lowered. Placental verification of false positive (FP) NIPT results confirmed confined placental mosaicism(CPM) was the reason for false positives. Conclusions This study represents the first time that NIPT has been used as a first-tier screening test for fetal aneuploidies in a pilot city with large clinical samples in China. We propose that NIPT could replace serum biochemistry screening as a first-tier test.
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Affiliation(s)
- Yanhui Liu
- Department of Prenatal Diagnosis Center, Dongguan Maternal and Child Health Hospital, Dongguan, 523112, Guangdong, China
| | - Hailiang Liu
- CapitalBio Genomics Co., Ltd., Dongguan, 523808, China
| | - Yi He
- Department of Prenatal Diagnosis Center, Dongguan Maternal and Child Health Hospital, Dongguan, 523112, Guangdong, China
| | - Wanfang Xu
- Department of Prenatal Diagnosis Center, Dongguan Maternal and Child Health Hospital, Dongguan, 523112, Guangdong, China
| | - Qiulin Ma
- Department of Prenatal Diagnosis Center, Dongguan Maternal and Child Health Hospital, Dongguan, 523112, Guangdong, China
| | - Yuzhen He
- Dongguan Municipal Bureau of Health and Family Planning, Dongguan, 523112, Guangdong, China
| | - Wei Lei
- CapitalBio Genomics Co., Ltd., Dongguan, 523808, China
| | - Guoquan Chen
- Dongguan Municipal Bureau of Health and Family Planning, Dongguan, 523112, Guangdong, China
| | - Zheng He
- CapitalBio Genomics Co., Ltd., Dongguan, 523808, China
| | - Jiayi Huang
- CapitalBio Genomics Co., Ltd., Dongguan, 523808, China
| | - Jianan Liu
- Medical Department, Zunyi Medical College, Zunyi, China
| | - Yuanru Liu
- CapitalBio Genomics Co., Ltd., Dongguan, 523808, China
| | - Quanfei Huang
- CapitalBio Genomics Co., Ltd., Dongguan, 523808, China.
| | - Fubing Yu
- Department of Prenatal Diagnosis Center, Dongguan Maternal and Child Health Hospital, Dongguan, 523112, Guangdong, China.
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Murakami K, Kutsunugi S, Tsujino K, Stone TE, Ito M, Iida K. Developing competencies in genetics nursing: Education intervention for perinatal and pediatric nurses. Nurs Health Sci 2020; 22:263-272. [PMID: 31912654 DOI: 10.1111/nhs.12680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 11/18/2019] [Accepted: 12/01/2019] [Indexed: 12/25/2022]
Abstract
Nurses need to be appropriately trained in genetics to provide clinical care based on best practice for patients and families. This exploratory study describes an educational intervention using authentic stimulus material centered on a clinical case study of a family with a baby with Down syndrome. Quantitative and qualitative data were collected from a sample of 15 nurses and 27 students from three universities in Japan before and after completing an entry-level workshop on competency-based genetics nursing. Participants reported increased perceived genetics knowledge and clinical confidence. Despite more than 90% of the participants reporting that they understood the underlying genetics knowledge, their confidence and the ethical aspects of genetics nursing had not been promoted after the seminar. In contrast, the reflections, coded into three categories, showed they recognized families' needs for psychological support, family decision making, and protection and privacy and suggested that nurses had undergone a profound shift in understanding about these issues. Although indicating that a single seminar was insufficient, the study findings will be useful to develop educational materials on genetics for both students and nurses.
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Affiliation(s)
- Kyoko Murakami
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Saeko Kutsunugi
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kumiko Tsujino
- Faculty of Health Sciences, The University of Ryukus', Okinawa, Japan
| | - Teresa E Stone
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.,Visiting Professor, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Misae Ito
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kazuko Iida
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Stefanovic V. The importance of pre- and post-test counseling for prenatal cell-free DNA screening for common fetal aneuploidies. Expert Rev Mol Diagn 2019; 19:201-215. [PMID: 30657716 DOI: 10.1080/14737159.2019.1571912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Prenatal cell-free DNA screening for common fetal aneuploidies has rapidly changed the paradigm of prenatal care. Despite its advantages compared to conventional screening methods, its unexpectedly rapid implementation in clinical practice has generated several ethical and medical issues and misconceptions. Aggressive commercial marketing of cell-free DNA screening and media dissemination of misleading information have added confusion. Areas covered: This review provides an extensive update and will focus on the importance of pre-and post-test counseling for prenatal cell-free DNA screening not previously discussed extensively in the available literature. Additionally, we report cell-free DNA screening implementation in the largest obstetrical tertiary unit in Finland which is one of few countries that provides all prenatal screening methods free of charge for all women and has a very high uptake of first-trimester screening. This is not a systematical review, but rather a narrative overview which includes the most relevant and recent original publications and reviews covering this issue. Expert opinion: Despite being the most accurate method for screening of common fetal aneuploidies, the knowledge and counseling should be substantially improved. Cell-free DNA screening is not a replacement for diagnostic testing and its use in prenatal testing is complex and limited.
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Affiliation(s)
- Vedran Stefanovic
- a Department of Obstetrics and Gynecology , Fetomaternal Medical Center, Helsinki University and Helsinki University Hospital , Helsinki , Finland
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Cernat A, De Freitas C, Majid U, Trivedi F, Higgins C, Vanstone M. Facilitating informed choice about non-invasive prenatal testing (NIPT): a systematic review and qualitative meta-synthesis of women's experiences. BMC Pregnancy Childbirth 2019; 19:27. [PMID: 30642270 PMCID: PMC6332899 DOI: 10.1186/s12884-018-2168-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/28/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Non-invasive prenatal testing (NIPT) can be used to accurately detect fetal chromosomal anomalies early in pregnancy by assessing cell-free fetal DNA present in maternal blood. The rapid diffusion of NIPT, as well as the ease and simplicity of the test raises concerns around informed decision-making and the potential for routinization. Introducing NIPT in a way that facilitates informed and autonomous decisions is imperative to the ethical application of this technology. We approach this imperative by systematically reviewing and synthesizing primary qualitative research on women's experiences with and preferences for informed decision-making around NIPT. METHODS We searched multiple bibliographic databases including Ovid MEDLINE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and ISI Web of Science Social Sciences Citation Index (SSCI). Our review was guided by integrative qualitative meta-synthesis, and we used a staged coding process similar to that of grounded theory to conduct our analysis. RESULTS Thirty empirical primary qualitative research studies were eligible for inclusion. Women preferred to learn about NIPT from their clinicians, but they expressed dissatisfaction with the quality and quantity of information provided during counselling and often sought information from a variety of other sources. Women generally had a good understanding of test characteristics, and the factors of accuracy, physical risk, and test timing were the critical information elements that they used to make informed decisions around NIPT. Women often described NIPT as easy or just another blood test, highlighting threats to informed decision-making such as routinization or a pressure to test. CONCLUSIONS Women's unique circumstances modulate the information that they value and require most in the context of making an informed decision. Widened availability of trustworthy information about NIPT as well as careful attention to the facilitation of counselling may help facilitate informed decision-making. TRIAL REGISTRATION PROSPERO 2018 CRD42018086261 .
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Affiliation(s)
- Alexandra Cernat
- Honours Life Sciences BSc Program, McMaster University, Hamilton, ON Canada
| | - Chante De Freitas
- Health Sciences Education Program, McMaster University, Hamilton, ON Canada
| | - Umair Majid
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON Canada
| | - Forum Trivedi
- Honours Life Sciences BSc Program, McMaster University, Hamilton, ON Canada
| | | | - Meredith Vanstone
- Department of Family Medicine, McMaster University, DBHSC 5003E, 100 Main St W, Hamilton, ON L8P 1H6 Canada
- Centre for Health Economic and Policy Analysis, McMaster University, Hamilton, ON Canada
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17
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Ngan OMY, Yi H, Ahmed S. Service provision of non-invasive prenatal testing for Down syndrome in public and private healthcare sectors: a qualitative study with obstetric providers. BMC Health Serv Res 2018; 18:731. [PMID: 30241520 PMCID: PMC6150999 DOI: 10.1186/s12913-018-3540-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/14/2018] [Indexed: 01/09/2023] Open
Abstract
Background Cell-free fetal DNA sequencing based non-invasive prenatal testing (NIPT) for Down syndrome (DS) has become widely available. In Hong Kong, obstetric providers in the public sector refer women identified at high risk of having a child with Down syndrome to obstetric providers in the private sector for NIPT. Little is known about how the NIPT has been adopted in the public sector where DS screening is provided for free of charge. The study aimed to identify the factors influencing providers’ role enactment, such as consultation and referral, in the service provision of NIPT for DS in public and private healthcare sectors. Methods In-depth interviews were conducted with 20 obstetric providers offering NIPT in Hong Kong. Thematic narrative analysis was used to identify (i) the factors considered by participants when referring women for NIPT for Down syndrome in public and private healthcare sectors and (ii) their perceptions of the need to integrate NIPT into the current public antenatal service. Results Participants raised concerns about the lack of transparent referral guideline between public and private sectors for NIPT. Public obstetric providers reported little obligation to provide women with much information about risks and benefits of NIPT as it was not provided by public sectors. Some private providers assumed that women referred from the public sector had already received sufficient information about NIPT. The providers were also concerned about potential application of NIPT for further detection without regulation. Conclusions Although the providers had good knowledge of clinical advantages of NIPT over conventional screening, they were uncertain about how to introduce NIPT to women. Guidelines are necessary to enable better coordination of public and private sectors services to enable women to make informed choices about the uptake of NIPT.
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Affiliation(s)
- Olivia Miu Yung Ngan
- CUHK Centre for Bioethics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #09-01W, Singapore, 117549, Singapore.
| | - Shenaz Ahmed
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9NL, UK
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van Bruggen MJ, Henneman L, Timmermans DRM. Women's decision making regarding prenatal screening for fetal aneuploidy: A qualitative comparison between 2003 and 2016. Midwifery 2018; 64:93-100. [PMID: 29990629 DOI: 10.1016/j.midw.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Situational factors of prenatal screening have changed in recent decades. To explore the effect of a changing context on women's decision making, differences and similarities in the decision-making process of pregnant women regarding prenatal screening for fetal aneuploidy between two periods in time were studied. DESIGN A qualitative comparison was made between a dataset of 22 semi-structured interviews with pregnant women from 2003 and a newly collected dataset with 19 semi-structured interviews from 2016. FINDINGS Overall, women reported similar considerations in their decision-making process in 2003 and 2016, suggesting that decision making has not essentially changed. In 2016, women were still making a deliberate decision, however for some women costs and societal views as to what is acceptable did appear to impact the decision-making process. Moreover, new screening possibilities (e.g. improved test characteristics and including more conditions to be screened) seemed to impact the decision outcome. CONCLUSIONS Since most women based their decisions mainly on their personal values and personal experiences rather than on situational factors, the results suggest that the changing context with regard to prenatal screening had no major effect on women's decision making. It therefore seems unlikely that future changes in the field of prenatal screening will drastically change the decision-making process of pregnant women as long as informed and deliberate decision making is safeguarded.
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Affiliation(s)
- Metje J van Bruggen
- Department of Clinical Genetics, Section of Community Genetics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Daniëlle R M Timmermans
- Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands; Department of Public and Occupational Health, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
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Chan WV, Johnson JA, Wilson RD, Metcalfe A. Obstetrical provider knowledge and attitudes towards cell-free DNA screening: results of a cross-sectional national survey. BMC Pregnancy Childbirth 2018; 18:40. [PMID: 29361931 PMCID: PMC5781306 DOI: 10.1186/s12884-018-1662-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/08/2018] [Indexed: 01/05/2023] Open
Abstract
Background Cell-free DNA (cfDNA) screening has recently acquired tremendous attention, promising patients and healthcare providers a more accurate prenatal screen for aneuploidy than other current screening modalities. It is unclear how much knowledge regarding cfDNA screening obstetrical providers possess which has important implications for the quality and content of the informed consent patients receive. Methods A survey was designed to assess obstetrical provider knowledge and attitudes towards cfDNA screening and distributed online through the Society of Obstetricians & Gynecologists of Canada (SOGC). Chi-squared tests were used to detect differences in knowledge and attitudes between groups. Results 207 respondents completed the survey, composed of 60.6% Obstetricians/Gynecologists (OB/GYN), 15.4% Maternal Fetal Medicine (MFM) specialists, 16.5% General Practitioners (GP), and 7.5% Midwives (MW). MFM demonstrated a significant trend of being most knowledgeable about cfDNA screening followed by OB/GYN, GP, and lastly MW in almost all aspects of cfDNA screening. All groups demonstrated an overall positive attitude towards cfDNA screening; however, OB/GYN and MFM demonstrated a significantly more positive attitude than GP and MW. Despite not yet being a diagnostic test, 19.4% of GP would offer termination of pregnancy immediately following a positive cfDNA screen result compared to none of the MFM and only few OB/GYN or MW. Conclusions We have demonstrated that different types of obstetrical providers possess varying amounts of knowledge regarding cfDNA screening with MFM currently having greater knowledge to all other groups. All obstetrical providers must have adequate prenatal screening understanding so that we can embrace the benefits of this novel and promising technology while protecting the integrity of the informed consent process. Electronic supplementary material The online version of this article (10.1186/s12884-018-1662-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wilson V Chan
- Department of Obstetrics and Gynecology, University of Calgary, 4th Floor North Tower - Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada.
| | - Jo-Ann Johnson
- Department of Obstetrics and Gynecology, University of Calgary, 4th Floor North Tower - Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - R Douglas Wilson
- Department of Obstetrics and Gynecology, University of Calgary, 4th Floor North Tower - Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, University of Calgary, 4th Floor North Tower - Foothills Medical Centre, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada
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