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Massey L, Gilroy J, Kowal E, Doolan D, Clough A. Aboriginal families living with MJD in remote Australia: questions of access and equity. Int J Equity Health 2024; 23:187. [PMID: 39294722 PMCID: PMC11409620 DOI: 10.1186/s12939-024-02228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/09/2024] [Indexed: 09/21/2024] Open
Abstract
Managing genetic disease using medically assisted reproductive technology is increasingly promoted as a feasible option, given revolutionary advances in genomics. Far less attention has been directed to the issue of whether there is equitable access to this option. Context and circumstance determine equitable access; however, reporting has drawn overwhelmingly from affluent Anglo-western populations in developed countries. The experiences of poorer, less educated subpopulations within affluent countries and populations in less developed countries are underreported. The ability of consumers to understand the opportunities and risks of medically assisted reproductive technology is likewise not well described in the literature despite significant technological complexity and evidence that genetic disease may be overrepresented within some disadvantaged population groups.Equity is achieved by identifying barriers and allocating appropriate resources to enable understanding and access. In the case of utilising medically assisted technology, social and power relationships, regulations, and the presumptions of authority figures and policymakers reduce equitable access. Physical or cultural marginalisation from mainstream health services may result in reduced access to genetic and prenatal testing, in-vitro fertilisation and genetic screening of embryos necessary for medically assisted reproduction. Cost and regulatory frameworks can likewise limit opportunities to engage with services. Moreover, the quality of the information provided to prospective users of the technology and how it is received governs understanding of prevention and inhibits adequately informed choice.Best practice care and adequately informed choice can only be achieved by conscientiously attending to these accessibility issues. Deep engagement with at-risk people and critical reflection on mainstream accepted standpoints is required. This paper outlines issues associated with engaging with medically assisted reproduction encountered by Aboriginal families living with Machado-Joseph Disease in some of the most remote areas of Australia. It is the right of these families to access such technologies regardless of where they live. Current barriers to access raise important questions for service providers with implications for practice as new technologies increasingly become part of standard medical care.
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Affiliation(s)
- Libby Massey
- Division of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia.
- MJD Foundation, Alyangula, NT, Australia.
| | - John Gilroy
- The Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Emma Kowal
- Alfred Deakin Institute, Deakin University, Melbourne, Australia
| | - Denise Doolan
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
| | - Alan Clough
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia
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2
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Patton K, Wong EK, Cirino AL, Dobson LJ, Harris S. Reproductive decision-making and the utilization of preimplantation genetic testing among individuals with inherited aortic or vascular disease. J Genet Couns 2024; 33:592-604. [PMID: 37533143 DOI: 10.1002/jgc4.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
Preimplantation genetic testing for monogenic disorders (PGT-M) is a reproductive technology used in conjunction with in-vitro fertilization (IVF) to reduce the risk of passing on a known genetic condition from parent to child. There is limited research describing the experience and emotional impact of PGT-M among individuals with inherited aortic or vascular disease (IAVD). Our qualitative study aims to explore the factors that influence reproductive decision-making and the uptake of PGT-M within this population. Individuals diagnosed with IAVD who have considered PGT-M, and/or their reproductive partner, were recruited using internal clinical databases and advocacy organizations. Virtual semi-structured interviews were conducted using an interview guide that included questions related to participants' lived experience of their condition, risk perception, reproductive history, familiarity with PGT-M/IVF, and financial/psychosocial considerations. A total of 17 interviews were completed (13 affected individuals, 4 unaffected partners) and analyzed using thematic analysis. Emergent themes included: (1) the lived experience and perceived severity of disease; (2) need for comprehensive, balanced, and timely information; (3) and impact of personal values and circumstances. When discussing the impact of lived experience on reproductive decision-making, participants identified the physical and emotional impact of disease and variability of disease as factors influencing the uptake of PGT-M. Many described PGT-M as the only reproductive option presented to them by providers. Even so, participants expressed gaps in their understanding of PGT-M, particularly regarding cost/insurance coverage and the experience of IVF. Finally, participants recognized that the decision to pursue PGT-M primarily requires introspection and evaluation of one's values, but that cost remains a significant consideration. The findings from our study highlight the complexity of reproductive decision-making for individuals with IAVD and provide insight into their psychological and informational needs when engaging in this process. Providers can use these findings to tailor their discussions about reproductive decision-making with this patient cohort.
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Affiliation(s)
- Kaleigh Patton
- Genetic Counseling Program, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Division of Cancer Genetics & Prevention, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eugene K Wong
- Cardiology Division, Cardiovascular Genetics Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allison L Cirino
- Genetic Counseling Program, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lori J Dobson
- Genetic Counseling Program, MGH Institute of Health Professions, Boston, Massachusetts, USA
- Center for Fetal Medicine and Reproductive Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephanie Harris
- Cardiology Division, Cardiovascular Genetics Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Dean M, Hintz EA, Baker J, Reblin M, Quinn GP, Haskins C, Vadaparampil ST. Shared Decision-Making Experiences of Couples with Inherited Cancer Risk Regarding Family Building. JOURNAL OF HEALTH COMMUNICATION 2023:1-10. [PMID: 37078713 DOI: 10.1080/10810730.2023.2202630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Patients with hereditary cancer predisposition syndromes have a high likelihood of passing germline mutations to future offspring. Patients at risk for inherited cancer may not have started and/or completed building their families; thus, they must decide about having children and consider the possibility of passing on their germline mutation. Utilizing the Shared Decision Making (SDM) Model, this study explores family building decision-making communication processes in opposite-sex couples with inherited cancer risk (ICR). Fifteen couples completed two recorded, analogue discussions and dyadic interviews at two time points. Participants were recruited through social media and snowball sampling. The constant comparison method was utilized to thematically analyze the data. When couples discussed family building options (FBOs), several themes were identified: FBO risks, FBO considerations, genetic-related FBO logistics, and life FBOs logistics. When deliberating family building decisions, couples shared easy conversational topics (e.g. FBO options and potential child's cancer risk due to a genetic variant) and difficult/conflict-inducing topics (e.g. preparing for possibilities, parenting, emotions, finances, and timing). Last, couples self-reported primary and secondary FBOs. The findings of this study capture couples' decision-making communication process while considering their experiences. Clinicians and practitioners can utilize these findings to support couples' family building decisions considering their ICR.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Elizabeth A Hintz
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| | - Jonathan Baker
- Department of Communication, University of South Florida, Tampa, Florida, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
| | - Gwendolyn P Quinn
- Department of OB-GYN, Grossman School of Medicine, New York University, New York, USA
| | - Carolyn Haskins
- Department of Genetic Counseling, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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4
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Severijns Y, Heijmans MWF, de Die-Smulders CEM, Bijlsma EK, Corsten-Janssen N, Joosten SJR, van Kuijk SMJ, Lichtenbelt KD, Ottenheim CPE, Stuurman KE, Tan-Sindhunata GMB, de Vries H, van Osch LADM. The effects of an online decision aid to support the reproductive decision-making process of genetically at risk couples-A pilot study. J Genet Couns 2023; 32:153-165. [PMID: 36056622 PMCID: PMC10087273 DOI: 10.1002/jgc4.1631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022]
Abstract
Couples at risk of transmitting a genetic disease to their offspring may experience doubts about their reproductive options. This study examines the effects of an online decision aid (DA) on the (joint) reproductive decision-making process of couples (not pregnant at time of inclusion) at risk of transmitting a genetic disease to their offspring. The primary outcome is decisional conflict, and secondary outcomes are knowledge, realistic expectations, deliberation, joint informed decision-making, and decisional self-efficacy. These outcomes were measured with a pretest-posttest design: before use (T0), after use (T1), and 2 weeks after use (T2) of the decision aid (DA). Usability of the DA was assessed at T1. Paired sample t-tests were used to compute differences between baseline and subsequent measurements. The comparisons of T0-T1 and T0-T2 indicate a significant reduction in mean decisional conflict scores with stronger effects for participants with high baseline decisional conflict scores. Furthermore, use of the DA led to increased knowledge, improved realistic expectations, and increased levels of deliberation, with higher increase in participants with low baseline scores. Decision self-efficacy only improved for participants with lower baseline scores. Participants indicated that the information in the DA was comprehensible and clearly organized. These first results indicate that this online DA is an appropriate tool to support couples at risk of transmitting a genetic disease and a desire to have (a) child(ren) in their reproductive decision-making process.
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Affiliation(s)
- Yil Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands.,GROW School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maartje W F Heijmans
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Christine E M de Die-Smulders
- GROW School for Oncology & Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Nicole Corsten-Janssen
- University of Groningen, University Medical Center Groningen Groningen, Department of Genetics, Groningen, The Netherlands
| | - Sara J R Joosten
- Department of Clinical Genetics, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Klaske D Lichtenbelt
- Department of Genetics, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Kyra E Stuurman
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Hein de Vries
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Liesbeth A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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Hershberger PE, Gallo AM, Adlam K, Driessnack M, Grotevant HD, Klock SC, Pasch L, Gruss V. Development of the Tool to Empower Parental Telling and Talking (TELL Tool): A digital decision aid intervention about children's origins from donated gametes or embryos. Digit Health 2023; 9:20552076231194934. [PMID: 37654721 PMCID: PMC10467186 DOI: 10.1177/20552076231194934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Objective This study aimed to create and develop a well-designed, theoretically driven, evidence-based, digital, decision Tool to Empower Parental Telling and Talking (TELL Tool) prototype. Methods This developmental study used an inclusive, systematic, and iterative process to formulate a prototype TELL Tool: the first digital decision aid for parents who have children 1 to 16 years of age and used donated gametes or embryos to establish their families. Recommendations from the International Patient Decision Aids Standards Collaboration and from experts in decision aid development, digital health interventions, design thinking, and instructional design guided the process. Results The extensive developmental process incorporated researchers, clinicians, parents, children, and other stakeholders, including donor-conceived adults. We determined the scope and target audience of the decision aid and formed a steering group. During design work, we used the decision-making process model as the guiding framework for selecting content. Parents' views and decisional needs were incorporated into the prototype through empirical research and review, appraisal, and synthesis of the literature. Clinicians' perspectives and insights were also incorporated. We used the experiential learning theory to guide the delivery of the content through a digital distribution plan. Following creation of initial content, including storyboards and scripts, an early prototype was redrafted and redesigned based on feedback from the steering group. A final TELL Tool prototype was then developed for alpha testing. Conclusions Detailing our early developmental processes provides transparency that can benefit the donor-conceived community as well as clinicians and researchers, especially those designing digital decision aids. Future research to evaluate the efficacy of the TELL Tool is planned.
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Affiliation(s)
- Patricia E. Hershberger
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Agatha M. Gallo
- Department of Human Development Nursing, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Kirby Adlam
- Department of Human Development Nursing, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Martha Driessnack
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Harold D. Grotevant
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Susan C. Klock
- Departments of Obstetrics and Gynecology and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauri Pasch
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Valerie Gruss
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Drackley A, Brew C, Wlodaver A, Spencer S, Leuer K, Rathbun P, Charrow J, Wieneke X, Lee Yap K, Ing A. Utility and Outcomes of the 2019 American College of Medical Genetics and Genomics-Clinical Genome Resource Guidelines for Interpretation of Copy Number Variants with Borderline Classifications at an Academic Clinical Diagnostic Laboratory. J Mol Diagn 2022; 24:1100-1111. [PMID: 35868509 DOI: 10.1016/j.jmoldx.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
In 2019, American College of Medical Genetics and Genomics and the Clinical Genome Resource published updated technical standards for the interpretation and reporting of copy number variants (CNVs), introducing a semiquantitative classification system that aims to foster greater standardization and consistency between laboratories. Evaluation of these guidelines' performance will inform laboratories about the impact of their implementation into clinical practice. A total of 145 difficult-to-classify CNVs, originally assessed by an academic molecular diagnostic laboratory, were re-interpreted/classified according to the American College of Medical Genetics and Genomics-Clinical Genome Resource guidelines. Classifications between interpretation systems were then compared. The concordance rate was 60.7%, and significantly more variants of uncertain significance were obtained when using the guidelines (n = 98) versus the laboratory's classification system (n = 49; P < 0.001). The concordance rate was presumably impacted by the intentionally unclear nature of the selected variants. The difference in variant of uncertain significance rate was largely due to laboratory-specific practices for variant interpretation and reporting, as well as differences in utilization of general population data. Laboratory-specific policies and practices may need to be addressed for true standardization to be achieved. Challenges to consistent guideline utilization are centered around the general lack of high-quality curated data available for CNV interpretations and the inherent subjectivity in the selection of evidence criteria and application of evidence points. Multiple aspects of the guidelines were highlighted as potential opportunities for subsequent refinements to further improve classification standardization.
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Affiliation(s)
- Andy Drackley
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Center for Genomics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Casey Brew
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Center for Genomics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alissa Wlodaver
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Center for Genomics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sara Spencer
- Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katrin Leuer
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Center for Genomics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pamela Rathbun
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Center for Genomics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joel Charrow
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xuwen Wieneke
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Center for Genomics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kai Lee Yap
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Center for Genomics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Alexander Ing
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Center for Genomics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Decision-making and experiences of preimplantation genetic diagnosis in inherited heart diseases: a qualitative study. Eur J Hum Genet 2022; 30:187-193. [PMID: 34545210 PMCID: PMC8821668 DOI: 10.1038/s41431-021-00963-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023] Open
Abstract
Preimplantation genetic diagnosis (PGD) ensures a disease-causing variant is not passed to the next generation, including for inherited heart diseases. PGD is known to cause significant emotional burden, but little is known about how parents experience PGD to select against inherited heart disease. We aim to understand how people with inherited heart disease, and their partners, experience and make decisions about PGD. Participants were recruited from a specialised inherited heart disease clinic. Qualitative semi-structured interviews were conducted with adult participants who had considered PGD. A semi-structured interview schedule explored overall experiences and reasons for undergoing PGD. Broad topics included experience of disease, reproductive history, psychosocial and financial considerations. Interviews were recorded, transcribed verbatim and thematically analysed using a framework method. Twenty participants were included (15 with inherited cardiomyopathy, 3 with inherited arrhythmia syndrome and 2 partners). In contemplating PGD, participants considered 3 main issues: past experience of disease e.g. sudden cardiac death, sport restrictions and clinical heterogeneity; intergenerational responsibilities; and practical considerations such as finances and maternal age. Among those who chose to undergo PGD (n = 7/18), past experience of a significant cardiac event, such as family history of sudden cardiac death, was important in the decision process. The decision to undergo PGD for inherited heart disease is complex and influenced by individual values and experience of disease. We highlight key areas where further discussion may assist in PGD decision processes.
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Decisional needs of patients considering preimplantation genetic testing: a systematic review. Reprod Biomed Online 2021; 44:839-852. [DOI: 10.1016/j.rbmo.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022]
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Lee I, Alur-Gupta S, Gallop R, Dokras A. Utilization of preimplantation genetic testing for monogenic disorders. Fertil Steril 2021; 114:854-860. [PMID: 33040985 DOI: 10.1016/j.fertnstert.2020.05.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the rate of utilization, factors influencing the decision-making process, and patient satisfaction with preimplantation genetic diagnosis for monogenic disorders (PGT-M). DESIGN Survey study. SETTING Academic center. PATIENT(S) Genetically at-risk patients seen for PGT-M consultation between January 2010 and 2018. INTERVENTION(S) Electronic survey including demographics, genetic history, consultation experience, decision-making process, and satisfaction with PGT-M process. MAIN OUTCOME MEASURE(S) Rate of utilization of PGT-M, importance of decision-making factors, and satisfaction with PGT-M process. RESULT(S) Among survey respondents (n = 49), the rate of utilization of PGT-M after consultation was 89.8%. Ninety-three percent of participants decided whether to pursue PGT-M within 3 months of consultation. Factors that were considered most important to this decision-making process included information provided at consultation, accuracy of test results after PGT-M, avoidance of suffering of an affected child, and ability to avoid termination of an affected pregnancy. Key barriers to utilization included financial burden and overall complexity of the in vitro fertilization (IVF)/PGT-M process. Of those utilizing PGT-M (n = 44), 72.1% had at least one live birth or were pregnant during the study period. Satisfaction with PGT-M was high, and most couples would use IVF/PGT-M for a future pregnancy (84.1%). Participants with a live birth were more satisfied with the PGT-M process than those who had no live birth. CONCLUSION(S) Most patients seeking consultation for PGT-M were likely to pursue this technology despite financial burden and complexity of the process. Exploring factors that influence patient decision-making regarding PGT-M is important for tailoring the consultation and optimizing the overall experience.
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Affiliation(s)
- Iris Lee
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Snigdha Alur-Gupta
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Robert Gallop
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania Hospital, Philadelphia, Pennsylvania.
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10
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Hughes T, Bracewell-Milnes T, Saso S, Jones BP, Almeida PA, Maclaren K, Norman-Taylor J, Johnson M, Nikolaou D. A review on the motivations, decision-making factors, attitudes and experiences of couples using pre-implantation genetic testing for inherited conditions. Hum Reprod Update 2021; 27:944-966. [PMID: 33969393 DOI: 10.1093/humupd/dmab013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In pre-implantation genetic testing (PGT), fertile couples undergo IVF with genetic testing of embryos to avoid conceptions with a genetic condition. There is an exponentially increasing uptake with over 600 applications listed by the Human Fertilisation and Embryology Authority in the UK. The psychological aspects of the decision-making process and the experience of PGT, however, are relatively underevaluated, with the potential to leave patients unsupported in their journeys. OBJECTIVE AND RATIONALE In this review, we aim to comprehensively report on every aspect of couples' experiences of PGT. We consider what motivates users, the practical and ethical decisions involved and how couples navigate the decision-making process. Additionally, we report on the social and psychological impact on couples who are actively undergoing or have completed the PGT process. SEARCH METHODS A systematic search of English peer-reviewed journals of three computerized databases was undertaken following PRISMA guidelines. Studies that examined the motivations, attitudes, decision-making factors and experiences of patients who have been actively engaged in the PGT process were included. No restrictions were placed on study design or date of publication. Studies examining patients using PGT in a hypothetical context or solely using PGT for aneuploidy were excluded. Qualitative data were extracted using thematic analysis. OUTCOMES The main outcomes were patient motivations, deciding factors and attitudes, as well as the patient experience of coming to a decision and going through PGT.Patients were primarily motivated by the desire to have a healthy child and to avoid termination of pregnancy. Those with a sick child or previous experience of termination were more likely to use PGT. Patients also felt compelled to make use of the technology available, either from a moral responsibility to do so or to avoid feelings of guilt if not. The main factors considered when deciding to use PGT were the need for IVF and the acceptability of the technology, the financial cost of the procedure and one's ethical standpoint on the creation and manipulation of embryos. There was a general consensus that PGT should be applied to lethal or severe childhood disease but less agreement on use for adult onset or variable expression conditions. There was an agreement that it should not be used to select for aesthetic traits and a frustration with the views of PGT in society. We report that couples find it difficult to consider all of the benefits and costs of PGT, resulting in ambivalence and prolonged indecision. After deciding on PGT use, we found that patients find the process extremely impractical and psychologically demanding. WIDER IMPLICATIONS This review aimed to summarize the current knowledge on how patients decide to use and experience PGT and to make suggestions to incorporate the findings into clinical practice. We cannot stress enough the importance of holistic evaluation of patients and thorough counselling prior to and during PGT use from a multidisciplinary team that includes geneticists, IVF clinicians, psychologists and also patient support groups. Large prospective studies using a validated psychological tool at various stages of the PGT process would provide an invaluable database for professionals to better aid patients in their decision-making and to improve the patient experience.
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Affiliation(s)
- Tara Hughes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Timothy Bracewell-Milnes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin P Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Paula A Almeida
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Katherine Maclaren
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Julian Norman-Taylor
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Mark Johnson
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - Dimitrios Nikolaou
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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11
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Severijns Y, de Die-Smulders CEM, Gültzow T, de Vries H, van Osch LADM. Hereditary diseases and child wish: exploring motives, considerations, and the (joint) decision-making process of genetically at-risk couples. J Community Genet 2021; 12:325-335. [PMID: 33611773 PMCID: PMC8241960 DOI: 10.1007/s12687-021-00510-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
Couples who are at risk of transmitting a genetic disease to their offspring may face difficult challenges regarding reproductive decision-making. Deciding if, and how, to purse their child wish can be a demanding process. This study aims to describe the reproductive joint decision-making process of genetically at-risk couples. A qualitative study was conducted with 16 couples (N=31) at risk of transmitting a genetic disease to their offspring and who received genetic counseling. Most couples were not aware of all available reproductive options in the Netherlands. A variety of motives was reported with almost all couples expressing a preference towards a reproductive option in which the child is genetically related to both parents. Only a few couples considered other options such as the use of donor gametes, adoption, and foster parenting. All couples indicated that they had multiple conversations to reach a mutually supported reproductive decision. Several carriers reported feelings of guilt and in some couples, the woman appeared to have a greater impact in the decision-making process as she should carry a pregnancy and should undergo medical treatments. This study provides insight in the extensive decision-making process of genetically at-risk couples and the role of both partners in this process. These findings can guide the development of genetic counseling (e.g., increase awareness of available reproductive options) and decision support for these couples.
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Affiliation(s)
- Y Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. .,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - C E M de Die-Smulders
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - T Gültzow
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - H de Vries
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - L A D M van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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12
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Bracewell-Milnes T, Saso S, Jones B, Cato S, Parikh R, Thum MY, Johnson M, Almeida P, Norman-Taylor J, Nikolaou D. A systematic review exploring the patient decision-making factors and attitudes towards pre-implantation genetic testing for aneuploidy and gender selection. Acta Obstet Gynecol Scand 2020; 100:17-29. [PMID: 32862440 DOI: 10.1111/aogs.13973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pre-implantation genetic testing for aneuploidy (PGT-A) is in high demand worldwide, with ongoing debate among medical societies as to which patient groups it should be offered. The psychological aspects for patients regarding its use, lag behind the genomic technological advances, leaving couples with limited decision-making support. The development of this technology also leads to the possibility for its utilization in gender selection. Despite the controversy surrounding these issues, very few studies have investigated the psychological aspects of patients using PGT-A. MATERIAL AND METHODS This systematic review provides an up-to-date analysis of the psychosocial aspects surrounding PGT for aneuploidy and sex selection, as well as decision-making factors. A systematic search of English peer-reviewed journals of three computerized databases were undertaken following PRISMA guidelines. The qualitative data were extracted using thematic analysis. PROSPERO Registration number: CRD42019126439. RESULTS The main outcome measures were patients' motivations, decision-making factors, attitudes and experiences surrounding the use of PGT for aneuploidy and sex selection. Ten studies were included, four for PGT-A and six for sex selection. Attitudes towards PGT-A were positive, with the main motivating factors being decreasing miscarriage rate, reducing the risk of termination of pregnancy and reducing the time to pregnancy. Consistently raised concerns regarding PGT-A were the financial burden and moral beliefs. The vast majority of patients felt sufficiently knowledgeable to make the decision; however, studies did reveal that a minority mis-interpreted certain potential benefits of PGT-A. Studies investigating PGT for sex selection predominantly reported the main motivation was to achieve gender balance within the family dynamic, with most studies finding no difference between couples using PGT for gender selection to have male or female offspring. CONCLUSIONS Although this systematic review was limited by the small number of studies investigating this topic, a significant minority of patients appeared to misunderstand certain benefits and limitations of PGT-A. Fertility clinics must ensure they provide adequate counseling to all patients using PGT-A. With the use of PGT-A on the rise globally, there is a need to develop decision support tools for couples who have an increasing number of genetic testing options becoming available to them.
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Affiliation(s)
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | | | - Riya Parikh
- Biomedical Sciences, St George's, University of London, London, UK
| | | | - Mark Johnson
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Paula Almeida
- Assisted Conception Unit, Chelsea and Westminster Hospital, London, UK
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13
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Al-Kharusi K, Bruwer Z, Wessels TM. The experience of Preimplantation Genetic Testing (PGT) among Muslim couples in Oman in the Middle East. J Genet Couns 2020; 30:121-131. [PMID: 32578356 DOI: 10.1002/jgc4.1300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 05/05/2020] [Indexed: 11/06/2022]
Abstract
Preimplantation genetic testing (PGT) is an alternative reproductive technology integrated with in vitro fertilization (IVF). It is a well-established technique offering a reproductive option for families at a high risk of transmitting a genetic disorder, allowing them to avoid making a decision about termination of an affected pregnancy (TOP). In Arab communities and particularly in Oman, where TOP is not favored under the majority of implemented Muslim law, termination of pregnancy for fetal indications is not always possible. As these communities are in favor of consanguineous marriage, they are at increased risk of serious and lethal autosomal recessive conditions, and as a result, PGT is a feasible option as a TOP decision can be avoided. However, undergoing PGT is relatively new in the Arab Muslim countries and Omani patients have only recently had access to the service. This qualitative study utilized a phenomenological approach to explore the experience of Omani families who had selected to undergo PGT as a means of reducing the risk of having a child affected with a genetic disorder. Fourteen participants from eight families who underwent PGT were interviewed. Data collected were analyzed using thematic analysis. The research identified four main themes: Anxiously waiting 'Taraqub'; Unforeseen; Secrecy; and Me and My Partner. The findings of the research have provided insight into the PGT experiences of Omani families. Unique cultural and religious perspectives should be considered when counseling Omani Muslim couples.
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Affiliation(s)
- Khalsa Al-Kharusi
- Genetics and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Oman
| | - Zandre Bruwer
- Genetics and Developmental Medicine Clinic, Sultan Qaboos University Hospital, Muscat, Oman
| | - Tina-Marié Wessels
- Division of Human Genetics, Department of Pathology Faculty of Medicine, University of Cape Town, Cape Town, South Africa
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14
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De Krom G, Severijns Y, Vlieg WL, Arens YHJM, Van Golde RJT, De Die-Smulders CEM, Van Osch LADM. Motives and considerations regarding PGT in couples carrying a structural chromosomal abnormality: a qualitative exploration. J Assist Reprod Genet 2020; 37:1719-1727. [PMID: 32418135 PMCID: PMC7376769 DOI: 10.1007/s10815-020-01810-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/06/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose This study aims to describe the motives and considerations of couples carrying a structural chromosomal abnormality deciding on preimplantation genetic testing (PGT). Methods A qualitative exploratory study was conducted using semi-structured dyadic interviews with 13 couples (N = 26) carrying a structural chromosomal abnormality. All couples had an informative consultation in our PGT centre in the Netherlands. Results Almost all couples considered PGT or natural conception combined with prenatal diagnosis (PND) as the only two reproductive options. Among several considerations mentioned, the majority indicated that the wish to increase the chance of a successful pregnancy was the most important motive to opt for PGT. All couples who opted for PGT had first tried to conceive spontaneously and entered the PGT programme because of their adverse experiences during these attempts (infertility, recurrent miscarriage, termination of pregnancy, birth of an affected child). Couples that refrained from PGT were of advanced maternal age and expressed the long trajectory of PGT as the main reason to refrain. If conceiving spontaneously would not lead to an ongoing pregnancy, these couples also indicated that they would use PGT. Conclusion This study shows that couples carrying a structural chromosomal abnormality consider PGT and spontaneous conception with PND as relevant reproductive options. They are looking for the option that is in their opinion the fastest way to establish a successful pregnancy. Information on the perceived pros and cons of PGT or spontaneous conception in these couples can help to optimize counselling and psychological support during the decision-making process.
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Affiliation(s)
- G De Krom
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre +, Maastricht, The Netherlands.,School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - Y Severijns
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - W L Vlieg
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Y H J M Arens
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - R J T Van Golde
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre +, Maastricht, The Netherlands.,School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - C E M De Die-Smulders
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - L A D M Van Osch
- Department of Health Promotion/CAPHRI, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre +, Maastricht, The Netherlands
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15
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Hormone therapy decision-making processes: Transgender youth and parents. J Adolesc 2020; 79:136-147. [DOI: 10.1016/j.adolescence.2019.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/22/2019] [Accepted: 12/30/2019] [Indexed: 01/18/2023]
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16
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Pastore LM, Cordeiro Mitchell CN, Rubin LR, Nicoloro-SantaBarbara J, Genoff Garzon MC, Lobel M. Patients' preimplantation genetic testing decision-making experience: an opinion on related psychological frameworks. Hum Reprod Open 2019; 2019:hoz019. [PMID: 31598567 PMCID: PMC6777985 DOI: 10.1093/hropen/hoz019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022] Open
Abstract
The process of deciding whether to pursue preimplantation genetic testing (PGT) of an embryo is highly stressful for individuals and couples and has adverse emotional consequences (e.g. distress and uncertainty). PGT influences patients’ lives in both positive and negative ways and is experienced at an individual level, as a dyadic unit, as a family member and as part of the society. Here, we argue that providing a conceptual framework with which to understand the `experience of decision making’ about PGT for monogenic disease (PGT-M) testing specifically, as well as the factors contributing to `decisional distress’ and `uncertainty’ that patients endure as a result—apart from what decision they make—is crucial to optimizing patient counseling, satisfaction and outcomes in the field of ART. Derived from psychological theory, the framework proposed here identifies three categories of contributing factors to decisional distress and uncertainty in considering PGT-M; namely, ‘intraindividual’, ‘interpersonal’ and ‘situational’ factors. We reviewed evidence from the PGT literature to inform our framework. Well-accepted theories of stress and health decision making were also reviewed for their relevance to PGT-M decision making, focusing on potential distress and uncertainty. Our novel conceptual framework can be used to inform clinical practice, to advance research and to aid the development of interventions for individuals and couples who are deciding whether or not to use PGT-M. Alleviating emotional distress and uncertainty can improve patients’ well-being during their reproductive journey.
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Affiliation(s)
- L M Pastore
- Department of Obstetrics, Gynecology and Reproductive Medicine, Stony Brook Medicine, Stony Brook, NY, USA
| | - C N Cordeiro Mitchell
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L R Rubin
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | | | - M C Genoff Garzon
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - M Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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17
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Hershberger PE, Driessnack M, Kavanaugh K, Klock SC. Oocyte donation disclosure decisions: a longitudinal follow-up at middle childhood. HUM FERTIL 2019; 24:31-45. [PMID: 30724630 DOI: 10.1080/14647273.2019.1567945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Few studies have captured oocyte donation (OD) parents' decision processes about intended and actual disclosure over time. Likewise, OD children's perceptions about their family composition during middle childhood are underexplored. To address these gaps, a longitudinally followed cohort of OD recipient families was invited to participate in a qualitative, follow-up study. With an 86% response rate after 12 years, families were composed of oocyte recipient mothers (n = 6) and biological fathers (n = 6) representing 12 donor-oocyte conceived children (10.33 ± 1.23 years; mean ± SD). Of the 12 children, two that were aware and two that were unaware of their conceptual origins completed conversational interviews. Only one family in the initial cohort had disclosed OD to their children by the 12-year follow-up, despite 43% of parents intending to disclose and another 43% undecided about disclosure during pregnancy. Four parental disclosure patterns emerged at 12 years: (i) wanting to disclose; (ii) conflicted about disclosure; (iii) not planning to disclose; and (iv) having disclosed. Children that were unaware of their conceptual origins displayed no knowledge of their method of conception. There is a need for family-centric interventions to assist 'wanting to disclose' parents in their disclosure process and 'conflicted about disclosure' parents in their decision-making process post-OD treatment.
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Affiliation(s)
- Patricia E Hershberger
- Department of Health Systems Science, College of Nursing, Chicago, IL, USA.,Department of Obstetrics and Gynecology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Martha Driessnack
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Karen Kavanaugh
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Susan C Klock
- Departments of Obstetrics and Gynecology and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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18
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Boardman FK, Hale R. "I didn't take it too seriously because I'd just never heard of it": Experiential knowledge and genetic screening for thalassaemia in the UK. J Genet Couns 2019; 28:141-154. [PMID: 30629758 PMCID: PMC7814888 DOI: 10.1002/jgc4.1042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 01/25/2023]
Abstract
Members of the public face particular challenges when undergoing reproductive genetic screening. Lack of family history with genetic disease has been identified as a key barrier affecting screening uptake and responses to genetic risk. This study explores this obstacle using beta thalassaemia as a case study. Fifteen in-depth qualitative interviews were conducted exploring the reproductive views and decisions of people at risk of transmitting thalassaemia. Eleven participants had thalassaemia themselves and/or were members of an affected family. Four participants were identified as thalassaemia carriers through genetic screening programmes with no family history. Notable differences were observed between these two groups. For thalassaemic individuals and families, past experience clarified and facilitated their sense of reproductive responsibility, however carriers struggled to relate to, and incorporate the information into their lives. It was witnessing their child becoming symptomatic-rather than receiving a diagnosis or genetic risk information per se that had the most substantial influence on carriers' subsequent views and decisions. Educational resources used to support genetic screening programmes would benefit from an engagement with the experiential accounts of life with genetic disease in order to more effectively bridge the chasm in knowledge and understanding between affected families and the general public, towards whom expansive genetic screening is aimed.
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19
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Hokke S, Hackworth NJ, Quin N, Bennetts SK, Win HY, Nicholson JM, Zion L, Lucke J, Keyzer P, Crawford SB. Ethical issues in using the internet to engage participants in family and child research: A scoping review. PLoS One 2018; 13:e0204572. [PMID: 30261041 PMCID: PMC6160098 DOI: 10.1371/journal.pone.0204572] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 09/11/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The internet is an increasingly popular tool in family and child research that is argued to pose new ethical challenges, yet few studies have systematically assessed the ethical issues of engaging parents and children in research online. This scoping review aims to identify and integrate evidence on the ethical issues reported when recruiting, retaining and tracing families and children in research online, and to identify ethical guidelines for internet research. METHODS Academic literature was searched using electronic academic databases (Scopus, PsycINFO, Embase, ERIC, CINAHL and Informit) and handsearching reference lists for articles published in English between January 2006 and February 2016. Grey literature was searched using Google to identify relevant ethical guidelines. RESULTS Sixty-five academic articles were included after screening 3,537 titles and abstracts and 205 full-text articles. Most articles reported using the internet to recruit participants (88%) with few reporting online retention (12%) or tracing (10%). Forty percent commented on ethical issues; the majority did not discuss ethics beyond general consent or approval procedures. Some ethical concerns were specific to engaging minors online, including parental consent, age verification and children's vulnerability. Other concerns applied when engaging any research participant online, including privacy and confidentiality, informed consent and disparities in internet access. Five professional guidelines and 10 university guidelines on internet research ethics were identified. Few academic articles (5%) reported using these guidelines. CONCLUSIONS Engaging families and children in research online introduces unique challenges requiring careful consideration. While researchers regarded themselves as responsible for ensuring research is conducted ethically, lack of use of available guidelines and limited academic literature suggests internet research is occurring without suitable guidance. We recommend broad dissemination of ethical guidelines and encourage researchers to report the methodological and ethical issues of using the internet to engage families and children in research.
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Affiliation(s)
- Stacey Hokke
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Naomi J. Hackworth
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Parenting Research Centre, Melbourne, Victoria, Australia
| | - Nina Quin
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon K. Bennetts
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Hnin Yee Win
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Jan M. Nicholson
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lawrie Zion
- Department of Communications and Media, La Trobe University, Melbourne, Victoria, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Patrick Keyzer
- La Trobe Law School, La Trobe University, Melbourne, Victoria, Australia
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20
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Lamb B, Johnson E, Francis L, Fagan M, Riches N, Canada I, Wilson A, Mathiesen A, Sabatello M, Gurtcheff S, Johnstone E, Rothwell E. Pre-implantation genetic testing: decisional factors to accept or decline among in vitro fertilization patients. J Assist Reprod Genet 2018; 35:1605-1612. [PMID: 30074131 PMCID: PMC6133803 DOI: 10.1007/s10815-018-1278-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/24/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Embryo testing to improve pregnancy outcomes among individuals who are seeking assisted reproduction technologies is increasing. The purpose of this study was to assess decisional factors through in-depth interviews for why women would accept or decline preimplantation genetic testing for aneuploidy (PGT-A) with in vitro fertilization (IVF). METHODS Semi-structured telephone interviews were conducted with 37 women who were offered PGT-A with IVF during the summer 2017. Interviews lasted on average 40 min and were audio-recorded, transcribed, and analyzed using a content analysis. RESULTS Results identified a number of decisional factors related to values about conception, disability, and pregnancy termination, past pregnancy experiences, optimism toward technology, and cost. Other key issues that were identified include the use of expanded carrier screening prior to IVF, maternal age, and limited education about PGT-A due to the complexity about education for IVF alone. CONCLUSION There is a need to develop decision support tools for the increasing choices of genetic testing options for patients seeking IVF. Including patients' values, past pregnancy experiences and attitudes toward science into the decision-making process may help promote a more informed decision.
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Affiliation(s)
- Brandy Lamb
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | - Erin Johnson
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | - Leslie Francis
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | - Melinda Fagan
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | - Naomi Riches
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | - Isabella Canada
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | - Alena Wilson
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | - Amber Mathiesen
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | | | | | - Erica Johnstone
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA
| | - Erin Rothwell
- University of Utah, 10 South 2000 East, Salt Lake City, UT, USA.
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21
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Baldwin K. Conceptualising women's motivations for social egg freezing and experience of reproductive delay. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:859-873. [PMID: 29602235 DOI: 10.1111/1467-9566.12728] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As the average age of motherhood in many Western countries continues to rise, the spectacle of the older mother and the trend towards delayed childbearing has been the subject of much public debate and interest. Concurrent to this trend has been the development and use of a new form of fertility preservation - social egg freezing - a technology which by its very nature is meant to enable reproductive delay. Whilst previous studies have been able to provide insights into the complex and often interrelating structural, economic, and relational factors shaping the timing of motherhood, and in some cases women's use of social egg freezing, fewer studies have clearly demonstrated the way these factors themselves, as well as the accounts of individual women, can be seen as being shaped by ideological and discursive forces. Drawing on interviews with 31 users of social egg freezing this article will demonstrate how women's accounts of reproductive delay and use of egg freezing technology can be seen as being shaped by neoliberal rationality, heteronormativity, discourses of 'appropriate parenting' and gendered ideologies of parenthood.
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Affiliation(s)
- Kylie Baldwin
- Centre for Reproduction Research, De Montfort University, UK
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22
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Decision-Making Process Regarding Fertility Among Reproductive-Age Women With Cancer in Taiwan. Cancer Nurs 2017; 40:394-402. [PMID: 27753649 DOI: 10.1097/ncc.0000000000000439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Previous studies indicate that women with cancer experience infertility after cancer-related treatment. With the rapid progress in fertility science, women face diverse and uncertain choices regarding pregnancy. OBJECTIVE The aim of this study is to understand the decision-making process regarding fertility choices among reproductive-age women with cancer in Taiwan. METHODS Grounded theory methodology guided data collection using in-depth interviews with 18 women diagnosed and treated for cancer. Verbatim transcriptions were analyzed using constant comparative analysis and open, axial, and selective coding. RESULTS The core category that describes the decision-making process regarding fertility among reproductive-age women with cancer is "searching for balance in life and creating value in life." The decision process was divided into 3 phases: needing to have children before treatment, struggling with self-living during cancer treatment, and returning to life after treatment. The style of cancer participants' decision making in pregnancy was divided into 3 patterns: action taking, hesitation, and persistence. CONCLUSIONS Decision making regarding fertility among women with cancer was affected by the need for children before treatment and their experience during treatment. IMPLICATIONS FOR PRACTICE Health providers should be aware of and understand the needs of women with cancer to balance their need for children with their perception of their cancer prognosis and its effects on fertility, and help them with pregnancy planning if desired.
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23
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Hershberger PE, Kavanaugh K. Comparing appropriateness and equivalence of email interviews to phone interviews in qualitative research on reproductive decisions. Appl Nurs Res 2017; 37:50-54. [PMID: 28985920 DOI: 10.1016/j.apnr.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 07/11/2017] [Accepted: 07/30/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite an increasing use of qualitative email interviews by nurse researchers, there is little understanding about the appropriateness and equivalence of email interviews to other qualitative data collection methods, especially on sensitive topics research. PURPOSE The purpose is to describe our procedures for completing asynchronous, email interviews and to evaluate the appropriateness and equivalency of email interviews to phone interviews in two qualitative research studies that examined reproductive decisions. METHODS Content analysis guided the methodological appraisal of appropriateness and equivalency of in-depth, asynchronous email interviews to single phone interviews. Appropriateness was determined by: (a) participants' willingness to engage in email or phone interviews, (b) completing data collection in a timely period, and (c) participants' satisfaction with the interview. Equivalency was evaluated by: (a) completeness of the interview data, and (b) insight obtained from the data. RESULTS Of the combined sample in the two studies (N=71), 31% of participants chose to participate via an email interview over a phone interview. The time needed to complete the email interviews averaged 27 to 28days and the number of investigator probe-participant response interchanges was 4 to 5cycles on average. In contrast, the phone interviews averaged 59 to 61min in duration. Most participants in both the email and phone interviews reported they were satisfied or very satisfied with their ability to express their true feelings throughout the interview. Regarding equivalence, 100% of the email and phone interviews provided insight into decision processes. Although insightful, two of the email and one phone interview had short answers or, at times, underdeveloped responses. Participants' quotes and behaviors cited within four published articles, a novel evaluation of equivalency, revealed that 20% to 37.5% of the citations about decision processes were from email participants, which is consistent with the percent of email participants. CONCLUSIONS In-depth, asynchronous email interviews were appropriate and garnered rich, insightful data that augmented the phone interviews. Awareness of the procedures, appropriateness, and nuances when carrying out email interviews on sensitive topics may provide nurse researchers with the ability to obtain thick, rich data that can best advance clinical practice and direct future research.
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Affiliation(s)
- Patricia E Hershberger
- College of Nursing and College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, United States.
| | - Karen Kavanaugh
- Children's Hospital of Wisconsin, Milwaukee, WI 53226, United States.
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Laney DA, Clarke V, Foley A, Hall EW, Gillespie SE, Holida M, Simmons M, Wadley A. The Impact of Fabry Disease on Reproductive Fitness. JIMD Rep 2017; 37:85-97. [PMID: 28324326 PMCID: PMC5740039 DOI: 10.1007/8904_2017_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/02/2017] [Accepted: 02/21/2017] [Indexed: 01/24/2023] Open
Abstract
Fabry disease (FD) is a pan-ethnic, X-linked, progressive lysosomal storage disorder caused by pathogenic mutations in the GLA gene. Published case reports and abstracts suggest that decreased reproductive fitness may occur in males with FD. In order to understand the impact of FD on reproductive fitness and increase the accuracy of reproductive genetic counseling, this study examines a large, multi-centered population of individuals with FD to determine if males have reduced reproductive fitness. Study data were collected on 376 patients through two, gender-specific surveys distributed across the United States and Canada. The number of biological live-born children among individuals with FD was compared to statistics from the general population. Information was also collected on reduced sperm count, depression, pain, use of assisted reproductive technology, and reproductive choice. On average, females affected by FD had more biological live-born children (1.8) than males affected by FD (1.1). However, males affected by FD had an increased mean number of biological children (1.1) compared to the mean number of biological children fathered by men in the United States (0.9). Sixteen of the 134 males with FD reported oligospermia, which suggests that an infertility work up may be indicated for males having difficulty impregnating their partners. In our large multicenter sample, males and females with FD do not exhibit reduced reproductive fitness; on average they have more biological children than the general population in the United States. This information should assist clinicians in providing accurate reproductive genetic counseling and treatment for individuals with FD.
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Affiliation(s)
- Dawn A. Laney
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Virginia Clarke
- Neurology Department, Massachusetts General Hospital, Boston, MA USA
| | - Allison Foley
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Eric W. Hall
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Scott E. Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Myrl Holida
- Division of Medical Genetics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA USA
| | - Morgan Simmons
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, 2165 North Decatur Road, Decatur, GA 30033 USA
| | - Alexandrea Wadley
- University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
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Experiences of Pre-Implantation Genetic Diagnosis (PGD) in Sweden: a Three-Year Follow-Up of Men and Women. J Genet Couns 2017; 26:1008-1016. [PMID: 28191608 PMCID: PMC5582074 DOI: 10.1007/s10897-017-0078-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/30/2017] [Indexed: 11/03/2022]
Abstract
Men and women with a hereditary genetic disease are faced with different options when they wish to become parents. One is pre-implantation genetic diagnosis (PGD) which is a combination of in vitro fertilization (IVF) and genetic analysis of the embryo before implantation. The present study focused on men and women's psychological experiences of PGD three years after applying for PGD. Nineteen women and seventeen men (i.e. seventeen couples and two women) participated. The interviews were analysed by thematic method. It is better to have tried was identified as a master theme, under which came three underlying sub-themes, which had the following headings: Practical experience of PGD, Psychological experience of PGD and Goals of PGD. The results show that men and women three years after PGD are still psychologically affected by their experience. The men and women raised concerns that their relationship had been affected, both positively and negatively, and feelings of anxiety and depression still remained. Healthcare services should recognize the heterogeneous nature of the group being studied and therefore the need for counselling can arise at different times and in relation to different areas, regardless of the outcome of the PGD.
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Scheitle CP, Ecklund EH. The influence of science popularizers on the public's view of religion and science: An experimental assessment. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2017; 26:25-39. [PMID: 26055875 DOI: 10.1177/0963662515588432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Research suggests that public figures can play an influential role in forming public opinion; yet, little research has experimentally tested the efficacy of public figures on the cognitive formation of boundaries. Using an experiment embedded within a nationally representative survey, we examine how two science popularizers, Francis Collins and Richard Dawkins, influence perceptions regarding the boundaries between religion and science. We find that learning of Dawkins does not influence people's perceptions of the religion-science relationship, while learning of Collins shifts respondents toward a collaborative view of religion and science. Findings suggest that figures with unexpected views might be more effective in changing conceptual boundaries.
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Winter C, Van Acker F, Bonduelle M, Van Berkel K, Belva F, Liebaers I, Nekkebroeck J. Depression, pregnancy-related anxiety and parental-antenatal attachment in couples using preimplantation genetic diagnosis. Hum Reprod 2016; 31:1288-99. [DOI: 10.1093/humrep/dew074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
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Hershberger PE, Sipsma H, Finnegan L, Hirshfeld-Cytron J. Reasons Why Young Women Accept or Decline Fertility Preservation After Cancer Diagnosis. J Obstet Gynecol Neonatal Nurs 2016; 45:123-34. [PMID: 26815806 PMCID: PMC4730896 DOI: 10.1016/j.jogn.2015.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To understand young women's reasons for accepting or declining fertility preservation after cancer diagnosis to aid in the development of theory regarding decision making in this context. DESIGN Qualitative descriptive. SETTING Participants' homes or other private location. PARTICIPANTS Twenty-seven young women (mean age, 29 years) diagnosed with cancer and eligible for fertility preservation. METHODS Recruitment was conducted via the Internet and in fertility centers. Participants completed demographic questionnaires and in-depth semi-structured interviews. Tenets of grounded theory guided an inductive and deductive analysis. RESULTS Young women's reasons for deciding whether to undergo fertility preservation were linked to four theoretical dimensions: Cognitive Appraisals, Emotional Responses, Moral Judgments, and Decision Partners. Women who declined fertility preservation described more reasons in the Cognitive Appraisals dimension, including financial cost and human risks, than women who accepted. In the Emotional Responses dimension, most women who accepted fertility preservation reported a strong desire for biological motherhood, whereas women who declined tended to report a strong desire for surviving cancer. Three participants who declined reported reasons linked to the Moral Judgments dimension, and most participants were influenced by Decision Partners, including husbands, boyfriends, parents, and clinicians. CONCLUSION The primary reason on which many but not all participants based decisions related to fertility preservation was whether the immediate emphasis of care should be placed on surviving cancer or securing options for future biological motherhood. Nurses and other clinicians should base education and counseling on the four theoretical dimensions to effectively support young women with cancer.
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Gebhart MB, Hines RS, Penman A, Holland AC. How do patient perceived determinants influence the decision-making process to accept or decline preimplantation genetic screening? Fertil Steril 2015; 105:188-93. [PMID: 26474735 DOI: 10.1016/j.fertnstert.2015.09.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Identify the determinants that influence the patient's decision-making process when deciding to accept or decline preimplantation genetic screening (PGS) in a given IVF cycle. DESIGN Pilot, retrospective, cross-sectional study that used a questionnaire containing a combination of quantitative and qualitative items. SETTING Private practice IVF clinic. PATIENT(S) Patients and partners initiating an IVF treatment cycle, both autologous and donor, between October 2012 and January 2015. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Identification of patient perceived determinants and the importance of each on the decision to accept or decline PGS. RESULT(S) Responses from the questionnaire (N = 117) were returned, and of these, 60% accepted PGS. The female response rate was 75% (N = 88) and the male response rate was 25% (N = 29). Ninety-eight percent were Christian (N = 112) and 88% college educated (N = 102) with 39% (N = 40) having some postgraduate education. Sixty-eight percent (N = 79) had no knowledge of PGS before the IVF cycle; however, after provider education, 92% (N = 108) correctly identified that PGS was elective and 93% (N = 109) reported sufficient knowledge to make an informed decision to accept or decline PGS. The additional cost of screening, the provider information and influence, and social support or acceptance from partner, family, and/or friends, were the three statistically significant variables affecting the decision. CONCLUSION(S) This is the first study, to the authors' knowledge, to identify and assess the determinants of the patient decision-making process when presented with the choice of PGS. Several factors contribute to the patient-perceived determinants when choosing to accept or decline PGS, including cost, religious and ethical beliefs and values, social and family support, provider influences, and the past reproductive experience of the patient.
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Affiliation(s)
| | - Randall S Hines
- Mississippi Reproductive Medicine, PLLC, Flowood, Mississippi
| | - Alan Penman
- Department of Medicine, Center of Biostatistics, The University of Mississippi Medical Center, Jackson, Mississippi
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Hershberger PE, Gallo AM, Molokie R, Thompson AA, Suarez ML, Yao Y, Wilkie DJ. Perception of young adults with sickle cell disease or sickle cell trait about participation in the CHOICES randomized controlled trial. J Adv Nurs 2015; 72:1430-40. [PMID: 26073718 DOI: 10.1111/jan.12702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/29/2022]
Abstract
AIMS To gain an in-depth understanding of the perceptions of young adults with sickle cell disease and sickle cell trait about parenthood and participating in the CHOICES randomized controlled trial that used computer-based, educational programmes. BACKGROUND In the USA, there is insufficient education to assure that all young adults with sickle cell disease or sickle cell trait understand genetic inheritance risks and reproductive options to make informed reproductive decisions. To address this educational need, we developed a computer-based, multimedia program (CHOICES) and reformatted usual care into a computer-based (e-Book) program. We then conducted a two-year randomized controlled trial that included a qualitative component that would deepen understanding of young adults' perceptions of parenthood and use of computer-based, educational programmes. DESIGN A qualitative descriptive approach completed after a randomized controlled trial. METHODS Sixty-eight men and women of childbearing age participated in semi-structured interviews at the completion of the randomized controlled trial from 2012-2013. Thematic content analysis guided the qualitative description. RESULTS/FINDINGS Three main themes were identified: (1) increasing knowledge and new ways of thinking and behaving; (2) rethinking parenting plans; and (3) appraising the program design and delivery. Most participants reported increased knowledge and rethinking of their parenting plans and were supportive of computer-based learning. Some participants expressed difficulty in determining individual transmission risks. CONCLUSION Participants perceived the computer programs as beneficial to their learning. Future development of an Internet-based educational programme is warranted, with emphasis on providing tailored education or memory boosters about individual transmission risks.
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Affiliation(s)
- Patricia E Hershberger
- University of Illinois at Chicago, College of Nursing, Illinois, USA.,University of Illinois at Chicago, College of Medicine, Illinois, USA
| | - Agatha M Gallo
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Robert Molokie
- University of Illinois at Chicago, College of Medicine, Illinois, USA.,University of Illinois at Chicago, College of Pharmacy, Illinois, USA.,University of Illinois Hospital and Health Sciences System Comprehensive Sickle Cell Center, Chicago, Illinois, USA
| | - Alexis A Thompson
- Northwestern University-Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Hematology/Oncology/Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois, USA
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Yingwei Yao
- University of Illinois at Chicago, College of Nursing, Illinois, USA
| | - Diana J Wilkie
- University of Illinois at Chicago, College of Nursing, Illinois, USA.,University of Illinois Hospital and Health Sciences System Comprehensive Sickle Cell Center, Chicago, Illinois, USA
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Winter C, Van Acker F, Bonduelle M, Desmyttere S, Nekkebroeck J. Psychosocial development of full term singletons, born after preimplantation genetic diagnosis (PGD) at preschool age and family functioning: a prospective case-controlled study and multi-informant approach. Hum Reprod 2015; 30:1122-36. [DOI: 10.1093/humrep/dev036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/06/2015] [Indexed: 11/13/2022] Open
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Cunningham J, Goldsmith L, Skirton H. The evidence base regarding the experiences of and attitudes to preimplantation genetic diagnosis in prospective parents. Midwifery 2015; 31:288-96. [DOI: 10.1016/j.midw.2014.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/19/2014] [Accepted: 09/27/2014] [Indexed: 11/16/2022]
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De Krom G, Arens YHJM, Coonen E, Van Ravenswaaij-Arts CMA, Meijer-Hoogeveen M, Evers JLH, Van Golde RJT, De Die-Smulders CEM. Recurrent miscarriage in translocation carriers: no differences in clinical characteristics between couples who accept and couples who decline PGD. Hum Reprod 2014; 30:484-9. [PMID: 25432924 DOI: 10.1093/humrep/deu314] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Do clinical characteristics of recurrent miscarriage couples with a chromosomal abnormality and who opt for PGD differ from couples that decline PGD after extensive genetic counselling? SUMMARY ANSWER No differences in clinical characteristics are identified between recurrent miscarriage couples carrying a structural chromosomal abnormality who opt for PGD compared with those that decline PGD after extensive genetic counselling. WHAT IS KNOWN ALREADY Couples who have experienced two or more miscarriages (recurrent miscarriage) are at increased recurrence risk if one of the partners carries a structural chromosomal abnormality. PGD can be offered to avoid (another) miscarriage or pregnancy termination when (invasive) prenatal diagnosis shows an abnormal result. To date, no reports are available that describe reproductive decision-making after genetic counselling on PGD in these specific couples. STUDY DESIGN, SIZE, DURATION Retrospective cohort study of 294 couples carrying a structural chromosomal abnormality seeking genetic counselling on PGD between 1996 and 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were recurrent miscarriage couples carrying a structural chromosomal abnormality. They had been referred for genetic counselling to the only national licensed PGD centre. Clinical characteristics analysed included couple associated characteristics, characteristics concerning reproductive history and external characteristics such as type of physician that referred the couple for genetic counselling and the clinical geneticist performing the counselling on PGD. MAIN RESULTS AND THE ROLE OF CHANCE Of 294 couples referred for counselling on PGD, 26 were not accepted because they did not meet the criteria for IVF-PGD. The remaining cohort of 268 couples consisted of two-thirds female and one-third male carriers. Main PGD indications were reciprocal translocations (83.9%) and Robertsonian translocations (16.7%). Following genetic counselling, 76.9% of included couples chose PGD as their reproductive option, the others declined PGD. Reproductive choice is not influenced by sex of the translocation carrier (P = 0.499), type of chromosomal abnormality (P = 0.346), number of previous miscarriages (P = 0.882), history of termination of pregnancy (TOP) because of an unbalanced fetal karyotype (P = 0.800), referring physician (P = 0.208) or geneticist who performed the counselling (P = 0.410). LIMITATIONS, REASONS FOR CAUTION This study only included recurrent miscarriage couples carrying a structural chromosomal abnormality, who were actually referred to a PGD clinic for genetic counselling. We lack information on couples who were not referred for PGD. Some of these patients may not have been informed on PGD at all, while others were not referred for counselling because they did not opt for PGD to start with. WIDER IMPLICATIONS OF THE FINDINGS This study shows that reproductive choices in couples with recurrent miscarriage on the basis of a structural chromosomal abnormality are not influenced by characteristics of the couple itself, nor by their obstetric history or external characteristics. These findings suggest that a couples' intrinsic attitude towards PGD treatment is a major factor influencing their reproductive choice. Future research will focus on these personal motives that seem to push reproductive decision-making following genetic counselling in a given direction.
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Affiliation(s)
- G De Krom
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - Y H J M Arens
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Coonen
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - M Meijer-Hoogeveen
- Department of Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J L H Evers
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - R J T Van Golde
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - C E M De Die-Smulders
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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Abstract
From a historical perspective, selective reproduction is nothing new. Infanticide, abandonment, and selective neglect of children have a long history, and the widespread deployment of sterilization and forced abortion in the twentieth century has been well documented. Yet in recent decades selective reproduction has been placed under the aegis of science and expertise in novel ways. New laboratory and clinical techniques allow for the selective fertilization of gametes, implantation of embryos, or abortion of fetuses. Although they will often overlap with assisted reproductive technologies (ARTs), what we term selective reproductive technologies (SRTs) are of a more specific nature: Rather than aiming to overcome infertility, they are used to prevent or allow the birth of certain kinds of children. This review highlights anthropological research into SRTs in different parts of the world, discussing how selective reproduction engages with issues of long-standing theoretical concern in anthropology, such as politics, kinship, gender, religion, globalization, and inequality.
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Affiliation(s)
- Tine M. Gammeltoft
- Department of Anthropology, University of Copenhagen, 1353 Copenhagen, Denmark;,
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, 1353 Copenhagen, Denmark;,
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Tur-Kaspa I, Jeelani R, Doraiswamy PM. Preimplantation genetic diagnosis for inherited neurological disorders. Nat Rev Neurol 2014; 10:417-24. [PMID: 24866878 DOI: 10.1038/nrneurol.2014.84] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Preimplantation genetic diagnosis (PGD) is an option for couples at risk of having offspring with an inherited debilitating or fatal neurological disorder who wish to conceive a healthy child. PGD has been carried out for conditions with various modes of inheritance, including spinal muscular atrophy, Huntington disease, fragile X syndrome, and chromosomal or mitochondrial disorders, and for susceptibility genes for cancers with nervous system involvement. Most couples at risk of transmitting a genetic mutation would opt for PGD over prenatal testing and possible termination of a pregnancy. The aim of this Perspectives article is to assist neurologists in counselling and treating patients who wish to explore the option of PGD to enable conception of an unaffected child. PGD can be accomplished for most disorders in which the genetic basis is known, and we argue that it is time for clinicians and neurological societies to consider the evidence and to formulate guidelines for the responsible integration of PGD into modern preventative neurology.
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Affiliation(s)
- Ilan Tur-Kaspa
- Institute for Human Reproduction, 409 West Huron Street, Suite 500, Chicago, IL 60654, USA, and Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL 60637, USA
| | - Roohi Jeelani
- Department of Obstetrics and Gynecology, Wayne State University, 3390 John R. Street, Detroit, MI 48201, USA
| | - P Murali Doraiswamy
- Departments of Psychiatry and Medicine, and the Duke Institute for Brain Sciences, DUMC-3018 Duke Medical Center, 1000 Trent Drive, Suite 3550, Durham, NC 27710, USA
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Valdrez K, Silva S, Coelho T, Alves E. Awareness and motives for use and non-use of preimplantation genetic diagnosis in familial amyloid polyneuropathy mutation carriers. Prenat Diagn 2014; 34:886-92. [DOI: 10.1002/pd.4388] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/31/2014] [Accepted: 04/12/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Kátia Valdrez
- Department of Clinical Epidemiology, Predictive Medicine and Public Health; University of Porto Medical School; Porto Portugal
- Unidade Clínica de Paramiloidose; Centro Hospitalar do Porto; Porto Portugal
| | - Susana Silva
- Department of Clinical Epidemiology, Predictive Medicine and Public Health; University of Porto Medical School; Porto Portugal
- Institute of Public Health; University of Porto (ISPUP); Porto Portugal
| | - Teresa Coelho
- Unidade Clínica de Paramiloidose; Centro Hospitalar do Porto; Porto Portugal
| | - Elisabete Alves
- Department of Clinical Epidemiology, Predictive Medicine and Public Health; University of Porto Medical School; Porto Portugal
- Institute of Public Health; University of Porto (ISPUP); Porto Portugal
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Drazba KT, Kelley MA, Hershberger PE. A qualitative inquiry of the financial concerns of couples opting to use preimplantation genetic diagnosis to prevent the transmission of known genetic disorders. J Genet Couns 2014; 23:202-11. [PMID: 23949612 PMCID: PMC3925761 DOI: 10.1007/s10897-013-9638-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/30/2013] [Indexed: 11/27/2022]
Abstract
Preimplantation genetic diagnosis (PGD) is an innovative prenatal testing option because the determination of whether a genetic disorder or chromosomal abnormality is evident occurs prior to pregnancy. However, PGD is not covered financially under the majority of private and public health insurance institutions in the United States, leaving couples to decide whether PGD is financially feasible. The aim of this qualitative study was to understand the role of finances in the decision-making process among couples who were actively considering PGD. In-depth, semi-structured interviews were completed with 18 genetic high-risk couples (36 individual partners). Grounded theory guided the analysis, whereby three themes emerged: 1) Cost is salient, 2) Emotions surrounding affordability, and 3) Financial burden and sacrifice. Ultimately, couples determined that the opportunity to avoid passing on a genetic disorder to a future child was paramount to the cost of PGD, but expressed financial concerns and recognized financial access as a major barrier to PGD utilization.
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Affiliation(s)
- Kathryn T Drazba
- Population Science, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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Järvholm S, Broberg M, Thurin-Kjellberg A. The choice of Pre-implantation Genetic Diagnosis (PGD), a qualitative study among men and women. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2013.851372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Harper JC, Geraedts J, Borry P, Cornel MC, Dondorp W, Gianaroli L, Harton G, Milachich T, Kääriäinen H, Liebaers I, Morris M, Sequeiros J, Sermon K, Shenfield F, Skirton H, Soini S, Spits C, Veiga A, Vermeesch JR, Viville S, de Wert G, Macek M. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. European Society of Human Genetics and European Society of Human Reproduction and Embryology. Eur J Hum Genet 2013; 21 Suppl 2:S1-21. [PMID: 24225486 PMCID: PMC3831061 DOI: 10.1038/ejhg.2013.219] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation - ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and provide an update of selected topics that have evolved since 2005.
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Affiliation(s)
- Joyce C Harper
- UCL Centre for PG&D, Institute for Womens Health, University College London, London, UK
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Drazba KT, Kelley MA, Hershberger PE. A qualitative inquiry of the financial concerns of couples opting to use preimplantation genetic diagnosis to prevent the transmission of known genetic disorders. J Genet Couns 2013. [PMID: 23949612 DOI: 10.1007/s10897-013-9638-7.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Preimplantation genetic diagnosis (PGD) is an innovative prenatal testing option because the determination of whether a genetic disorder or chromosomal abnormality is evident occurs prior to pregnancy. However, PGD is not covered financially under the majority of private and public health insurance institutions in the United States, leaving couples to decide whether PGD is financially feasible. The aim of this qualitative study was to understand the role of finances in the decision-making process among couples who were actively considering PGD. In-depth, semi-structured interviews were completed with 18 genetic high-risk couples (36 individual partners). Grounded theory guided the analysis, whereby three themes emerged: 1) Cost is salient, 2) Emotions surrounding affordability, and 3) Financial burden and sacrifice. Ultimately, couples determined that the opportunity to avoid passing on a genetic disorder to a future child was paramount to the cost of PGD, but expressed financial concerns and recognized financial access as a major barrier to PGD utilization.
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Affiliation(s)
- Kathryn T Drazba
- Population Science, Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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41
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Affiliation(s)
- Ginny Mounce
- University of Oxford, Nuffield Department of Obstetrics and Gynaecology, Institute of Reproductive Sciences,
Oxford Business Park North, Oxford, UK
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Hershberger PE, Finnegan L, Pierce PF, Scoccia B. The decision-making process of young adult women with cancer who considered fertility cryopreservation. J Obstet Gynecol Neonatal Nurs 2013; 42:59-69. [PMID: 23167639 PMCID: PMC4164048 DOI: 10.1111/j.1552-6909.2012.01426.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To provide an in-depth description of the decision-making process that women who are diagnosed with cancer undergo as they decide whether to accept or decline fertility cryopreservation. DESIGN A qualitative, grounded theory approach. SETTING AND PARTICIPANTS Twenty-seven women (mean age = 29 years) who were diagnosed with cancer and were eligible for egg, embryo, or ovarian tissue cryopreservation were recruited from the Internet and two university centers. METHODS Each woman participated in a semistructured interview by phone (n = 21) or e-mail (n = 6). Data were analyzed using the constant-comparative method to inductively ascertain the women's decision-making process. NVivo 8 software was used to assist with data retrieval and analysis. RESULTS The decision-making process consists of four major phases that women experience to actively formulate a decision: identify, contemplate, resolve, and engage. In the identify phase, women acquire knowledge and experience a "double hit" scenario that is often devastating. Within the contemplate phase, five interrelated dimensions emerged including constructing and/or endorsing preferences and values and undergoing decisional debriefing sessions. A decision is reached in the resolve phase and carried out in the engage phase. Among the participants, 14 declined fertility cryopreservation and 13 accepted egg and/or embryo cryopreservation. CONCLUSION The descriptive theoretical framework clarifies the underlying processes that women with cancer undergo to decide about fertility cryopreservation. Quality of care for women with cancer can be improved by implementing appropriately timed information and tailored developmental and contextual counseling to support decision making.
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Hershberger PE, Finnegan L, Altfeld S, Lake S, Hirshfeld-Cytron J. Toward theoretical understanding of the fertility preservation decision-making process: examining information processing among young women with cancer. Res Theory Nurs Pract 2013; 27:257-75. [PMID: 24552086 PMCID: PMC4164111 DOI: 10.1891/1541-6577.27.4.257] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Young women with cancer now face the complex decision about whether to undergo fertility preservation. Yet little is known about how these women process information involved in making this decision. OBJECTIVE The purpose of this article is to expand theoretical understanding of the decision-making process by examining aspects of information processing among young women diagnosed with cancer. METHODS Using a grounded theory approach, 27 women with cancer participated in individual, semistructured interviews. Data were coded and analyzed using constant-comparison techniques that were guided by 5 dimensions within the Contemplate phase of the decision-making process framework. RESULTS In the first dimension, young women acquired information primarily from clinicians and Internet sources. Experiential information, often obtained from peers, occurred in the second dimension. Preferences and values were constructed in the third dimension as women acquired factual, moral, and ethical information. Women desired tailored, personalized information that was specific to their situation in the fourth dimension; however, women struggled with communicating these needs to clinicians. In the fifth dimension, women offered detailed descriptions of clinician behaviors that enhance or impede decisional debriefing. CONCLUSION Better understanding of theoretical underpinnings surrounding women's information processes can facilitate decision support and improve clinical care.
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Affiliation(s)
- Patricia E Hershberger
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, USA.
| | - Lorna Finnegan
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, USA
| | - Susan Altfeld
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, USA
| | - Sara Lake
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, USA
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