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Siranosian J, Lewis C, Hill M, Ormond KE. Exploring prenatal testing preferences among US pregnant individuals: A discrete choice experiment. J Genet Couns 2024; 33:699-708. [PMID: 37646199 DOI: 10.1002/jgc4.1777] [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: 11/04/2022] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
Although there are numerous benefits to diagnostic prenatal testing, such as fetal exome sequencing, there are also consequences, including the possibility of receiving variants of uncertain significance or identifying secondary findings. In this study, we utilized a survey-based discrete choice experiment to elicit the preferences of pregnant people in Northern California for hypothetical prenatal genomic tests. Pregnant individuals were invited to complete the survey through advertisements on social media. Five test attributes were studied: likelihood of getting a result, time taken to receive results, who explains results, reporting of uncertain results, and reporting of secondary findings. The survey also gathered information about the participants' demographics, current and past pregnancies, and tolerance of uncertainty using the IUS-12 scale. Participants were eligible if they were female, currently 24 or more weeks pregnant, and able to read/write enough English or Spanish to complete an online survey. Overall, participants (n = 56) preferred the option of having a prenatal test over not having a prenatal test (p < 0.01) and had substantially higher preferences for tests with the highest likelihood of getting a result (p < 0.01). There were also positive preferences for tests that reported secondary findings (p = 0.01) and those where results were returned by a genetic specialist (vs. their prenatal provider) (p = 0.04). These findings can be used to guide conversations between pregnant individuals and genetics specialists, such as genetic counselors, as they weigh the pros and cons of diagnostic prenatal testing options.
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Affiliation(s)
- Jennifer Siranosian
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Celine Lewis
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kelly E Ormond
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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2
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Tozduman B, Sözmen MK. Assessing the job preferences of senior medical students for mandatory service: a discrete choice experiment. Prim Health Care Res Dev 2024; 25:e31. [PMID: 38818776 PMCID: PMC11362681 DOI: 10.1017/s1463423624000252] [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] [Indexed: 06/01/2024] Open
Abstract
AIM To investigate the job preferences of senior medical students for mandatory service as general practitioners using discrete choice experiment. INTRODUCTION Health workforce is directly associated with health service coverage and health outcomes. However, there is a global shortage of healthcare workers (HCWs) in rural areas. Discrete choice experiments can guide the policy and decision-makers to increase recruitment and retention of HCWs in remote and rural areas by determining their job preferences. The aim of this study is to investigate job preferences of senior medical students for mandatory service as general practitioners. METHODS This cross-sectional survey was conducted among 144 medical students. To estimate students' preferences for different levels of job attributes, a mixed logit model was utilised. Simulations of job uptake rates and willingness to pay (WTP) estimates were computed. FINDINGS All attributes had an impact on the job preferences of students with the following order of priority: salary, workload, proximity to family/friends, working environment, facility and developmental status. For a normal workload and a workplace closed to family/friends which were the most valued attributes after salary, WTPs were 2818.8 Turkish lira (TRY) ($398.7) and 2287.5 TRY ($323.6), respectively. The preference weights of various job characteristics were modified by gender, the presence of a HCW parent and willingness to perform mandatory service. To recruit young physicians where they are most needed, monetary incentives appear to be the most efficient intervention. Non-pecuniary job characteristics also affected job preferences. Packages of both monetary and non-monetary incentives tailored to individual characteristics would be the most efficient approach.
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Affiliation(s)
- Buşra Tozduman
- Dokuz Eylul University, Faculty of Medicine, Department of Public Health, Epidemiology Subsection, Izmir, Turkey
| | - Melih Kaan Sözmen
- Izmir Katip Çelebi University, Faculty of Medicine, Department of Public Health, Izmir, Turkey
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA02115, USA
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3
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Lea JK, Stevens BK, Mulligan S, Hashmi SS, Lunstroth R, Choates MG. Non-invasive prenatal screening: Testing motivations and decision making in the low-risk population. J Genet Couns 2024. [PMID: 38778790 DOI: 10.1002/jgc4.1921] [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: 03/15/2023] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
Non-invasive prenatal screening provides a risk assessment for aneuploidies by utilizing cell-free DNA (cfDNA). It is recommended that cell-free DNA screening (cfDNA screening) be offered to all pregnant people regardless of a priori risk for aneuploidy. In the absence of an increased risk, alternative motives for electing cfDNA screening and different levels of informed decision making may arise. Therefore, our study aimed to characterize low-risk patients' motivations for cfDNA screening election, determine how often informed decisions are being made, and compare motivations between informed and uninformed decision makers. A survey that included a modified, validated measure of informed choice (MMIC) and questions to assess patients' motivations for cfDNA screening was offered at four MFM clinics following genetic counseling. It was found that 44% of participants (n = 100) made an uninformed decision about testing. Participants with private insurers were 4.25 times more likely to make an informed decision (95% CI = 1.10-16.37). Informed decision makers scored avoiding invasive procedures higher (p = 0.007) and ranked doing what family/friends desire lower (p = 0.005) than uninformed decision makers. While most participants scored receiving information about genetic conditions highest, 12% of participants reported fetal sex disclosure as a priority. However, this was not found to be associated with uninformed decision making. This study ultimately established that following genetic counseling, a low-risk population shared motivations with high-risk populations which highlights the importance of complete pre-test counseling for all. Future research should investigate the effect of modifying variables, such as socioeconomic status, on the performance of informed choice measures and critically evaluate the parameters that determine informed choice.
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Affiliation(s)
- Jenna K Lea
- UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Neurology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Blair K Stevens
- UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Shannon Mulligan
- UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Syed S Hashmi
- UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Rebecca Lunstroth
- McGovern Center for Humanities & Ethics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Meagan G Choates
- UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth, Houston, Texas, USA
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Perrot A, Clarke A, Vassy C, Horn R. Women's preferences for NIPT as a first-line test in England and France: Challenges for genetic counseling practices. J Genet Couns 2023. [PMID: 37975159 DOI: 10.1002/jgc4.1839] [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: 05/29/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
Non-invasive prenatal testing (NIPT) is provided in the private and public sectors worldwide as a first- or second-tier test. In England and France, NIPT is fully funded and offered as a contingent strategy with different probability cut-offs (1:150 and 1:1000). These different approaches to define the target population for NIPT have implications for how women experience their antenatal care. The paper explores and compares the perceptions and difficulties of women in England and France who took NIPT as a second-tier screening test. It is based on a semi-structured qualitative interview study with 17 women in England and France conducted between September 2021 and May 2022. The interviews were cross-analyzed using thematic analysis. Our findings show that most women express a preference for the offer of NIPT as a first-line screening test. Some issues with the contingent model, related to the access to information and termination of pregnancy (TOP), the disparities of NIPT uptake, and risks of generating anxiety with combined first-trimester screening (cFTS), could be addressed by a universal strategy for T21, T13, and T18. Nevertheless, this strategy could present some challenges for genetic counseling due to: women's understanding and expectations of NIPT; adequate information and counseling about the scope and limits of NIPT; concerns about the routinization of NIPT in the first-line offer; limitations and uncertainties associated with the provision of expanded NIPT in France; the remaining importance of other screening tests; and associated costs.
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Affiliation(s)
| | - Angus Clarke
- Institute of Medical Genetics, Cardiff University, Cardiff, UK
| | - Carine Vassy
- Institute of Interdisciplinary Research on Social Issues, University of Sorbonne Paris Nord, Bobigny, France
| | - Ruth Horn
- Ethox Centre, University of Oxford, Oxford, UK
- Ethics in Medicine, University of Augsburg, Augsburg, Germany
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Fang MT, Germani F, Spitale G, Wäscher S, Kunz L, Biller-Andorno N. Women's experiences with non-invasive prenatal testing in Switzerland: a qualitative analysis. BMC Med Ethics 2023; 24:85. [PMID: 37872496 PMCID: PMC10594794 DOI: 10.1186/s12910-023-00964-3] [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: 06/13/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Prenatal genetic testing, in particular non-invasive prenatal testing (NIPT), as well as screening for risks associated with pregnancy, and counseling, play pivotal roles in reproductive healthcare, offering valuable information about the health of the fetus to expectant parents. This study aims to delve into the perspectives and experiences of women considering genetic testing and screening during pregnancy, focusing on their decision-making processes and the implications for informed consent. METHODS A nationwide qualitative study was conducted in Switzerland, involving in-depth interviews with women who were 1 to 2 years post-partum, covered by basic compulsory Swiss insurance, including women with a migration background. Thematic analysis was employed to identify key themes and patterns in the data. RESULTS The findings underscore the significance of effective communication during prenatal counseling, suggesting that healthcare providers could not only convey technical information but also support women in their decision-making processes. Women need comprehensive information about genetic testing and its implications, as well as the reasons for screening during pregnancy, as there might be a need to bridge knowledge gaps and clarify misconceptions. Furthermore, the study highlights the multifaceted nature of decision-making, with women considering factors such as uncertainty, values, emotional responses, and societal support systems. The concept of acceptance emerged as a crucial theme, with some women expressing their readiness to love and accept their child, regardless of genetic anomalies or disabilities. CONCLUSION This study offers valuable insights into the perspectives and needs of women regarding prenatal genetic testing, screening, and counseling in Switzerland. It underscores the importance of enhancing the clinical interaction and informed consent process by providing comprehensive information, addressing misconceptions, and supporting women in decision-making about pregnancy management and the management of the child's health, following prenatal genetic testing, including NIPT. These findings can inform healthcare providers and policymakers in improving the quality of prenatal counseling, ensuring informed consent, and supporting women in making well-informed and meaningful decisions about genetic testing, and on the use of screening during pregnancy.
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Affiliation(s)
- Mirriam Tyebally Fang
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Federico Germani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Giovanni Spitale
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Sebastian Wäscher
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Ladina Kunz
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland.
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Shorey S, Lalor J, Pereira TLB, Jarašiūnaitė-Fedosejeva G, Downe S. Decision-making and future pregnancies after a positive fetal anomaly screen: A scoping review. J Clin Nurs 2023; 32:5534-5549. [PMID: 36707923 DOI: 10.1111/jocn.16628] [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: 07/13/2022] [Revised: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/29/2023]
Abstract
AIMS AND OBJECTIVES To examine and consolidate literature on the experiences and decision-making of parents following a screen positive result for a potential fetal anomaly and/or diagnosis of an actual anomaly in a previous pregnancy. BACKGROUND Prenatal screening consists of any diagnostic modality that is aimed at acquiring information about a fetus or an embryo; however, the entire process is highly stressful for parents, especially if there was a previous screen positive result, but no abnormality was detected in the final result. METHODS Eight electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Theses and Dissertations and ClinicalTrials.gov) were searched from each database's inception until February 2022. This scoping review was guided by Arksey and O'Malley's framework and was reported in accordance with the PRISMA-ScR checklist. Braun and Clarke's thematic analysis framework was utilised. RESULTS Thirty-one studies were eligible for inclusion. Two main themes (reliving the fear while maintaining hope, and bridging the past and future pregnancies) and six subthemes were identified. CONCLUSIONS A fetal anomaly diagnosis in pregnancy had a mixed impact on the attitudes of parents toward a future pregnancy. Some parents were fearful of reliving a traumatic experience, while others were determined to have a healthy child and grow their family. Parents generally expressed a greater preference for non-invasive over invasive prenatal testing due to the procedural risks involved. RELEVANCE TO CLINICAL PRACTICE There is a need for healthcare professionals to provide psychosocial and emotional support to parents so that they can achieve resolution for their previous pregnancy. Healthcare professionals' ability to provide informational support also enables these parents to make informed decision and understand their reproductive outcomes. Additionally, healthcare administration and policymakers should reconsider current neonatal or pregnancy loss bereavement guidelines to improve the inclusivity of fathers. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Travis Lanz-Brian Pereira
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Soo Downe
- THRIVE Centre, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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7
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Nguyen HM, Lindsay C, Baradaran M, Guertin JR, Nshimyumukiza L, Soukkhaphone B, Reinharz D. Development of a discrete choice experiment questionnaire to elicit preferences by pregnant women and policymakers for the expansion of non-invasive prenatal screening. PLoS One 2023; 18:e0287653. [PMID: 37352239 PMCID: PMC10289448 DOI: 10.1371/journal.pone.0287653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 06/10/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE An instrument for measuring intervention preferences applicable to both patients and policymakers would make it possible to better confront the needs of the supply and demand sides of the health care system. This study aimed to develop a discrete choice experiments (DCE) questionnaire to elicit the preferences of patients and policymakers. The instrument was specifically developed to estimate preferences for new conditions to be added to a screening program for fetal chromosomal anomalies. METHODS A DCE development study was conducted. The methods employed included a literature review, a qualitative study (based on individual semi-structured interviews, consultations, and a focus group discussion) with pregnant women and policymakers, and a pilot project with 33 pregnant women to validate the first version of the instrument and test the feasibility of its administration. RESULTS An initial list of 10 attributes was built based on a literature review and the qualitative research components of the study. Five attributes were built based on the responses provided by the participants from both groups. Eight attributes were consensually retained. A pilot project performed on 33 pregnant women led to a final instrument containing seven attributes: 'conditions to be screened', 'test performance', 'moment at gestational age to obtain the test result', 'degree of test result certainty to the severity of the disability', 'test sufficiency', 'information provided from test result', and 'cost related to the test'. CONCLUSION It is possible to reach a consensus on the construction of a DCE instrument intended to be administered to pregnant women and policymakers. However, complete validation of the consensual instrument is limited because there are too few voting members of health technology assessment agencies committees to statistically ascertain the relevance of the attributes and their levels.
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Affiliation(s)
- Hung Manh Nguyen
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
| | - Carmen Lindsay
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Mohammad Baradaran
- Département de Génie Électrique et de Génie Informatique, Université Laval, Québec, Canada
| | - Jason Robert Guertin
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Leon Nshimyumukiza
- Institut national D’excellence en Santé et en Services Sociaux, Québec, Canada
- Faculté des Sciences Infirmières, Université Laval, Québec, Canada
| | | | - Daniel Reinharz
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada
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8
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Zary N, Tan Z, Liu T, Chan SN, Sheng J, Wong TH, Huang J, Zhang CJP, Ming WK. Preference of Virtual Reality Games in Psychological Pressure and Depression Treatment: Discrete Choice Experiment. JMIR Serious Games 2023; 11:e34586. [PMID: 36645698 PMCID: PMC9947866 DOI: 10.2196/34586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/11/2022] [Accepted: 06/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Virtual reality (VR) can be used to build many different scenes aimed at reducing study-related stress. However, only few academic experiments on university students for preference testing have been performed. OBJECTIVE This study aims to assess the preference of VR games for stress and depression treatment using a discrete choice experiment (DCE). METHODS A total of 5 different attributes were selected based on the depression therapy parameters and attributes related to VR: (1) treatment modality; (2) therapy duration; (3) perceived remission rate; (4) probability of adverse events; and the (5) monthly cost of adding treatment to a discrete choice experiment. By comparing different attributes and levels, we could draw some conclusions about the depression therapy testing preference for university students; 1 university student was responsible for VR scene development and 1 for participant recruitment. RESULTS The utility value of different attributes for "0% Probability of adverse events" was higher than others (99.22), and the utility value of VR treatment as the most popular treatment method compared with counseling and medicine treatment was 80.95. Three parameter aspects (different treatments for depression) were statistically significant (P<.001), including "0%" and "50%" of "Probability of adverse events" and "¥500" (a currency exchange rate of ¥1 [Chinese yuan]=US $0.15 is applicable) of "The monthly cost of treatment." Most individuals preferred 12 months as the therapy duration, and the odds ratio of "12 months" was 1.095 (95% CI 0.945-1.270) when compared with the reference level (6 months). Meanwhile, the cheapest price (¥500) of depression therapy was the optimum choice for most students. CONCLUSIONS People placed great preference on VR technology psychological intervention methods, which indicates that VR may have a potential market in the treatment of psychological problems. However, adverse events and treatment costs need to be considered. This study can be used to guide policies that are relevant to the development of the application of VR technology in the field of psychological pressure and depression treatment.
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Affiliation(s)
| | - Zijian Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Taoran Liu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Sze Ngai Chan
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jie Sheng
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tak-Hap Wong
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Jian Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Casper J P Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China (Hong Kong)
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9
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Daniels SL, Morgan J, Lee MJ, Wickramasekera N, Moug S, Wilson TR, Brown SR, Wyld L. Surgeon preference for treatment allocation in older people facing major gastrointestinal surgery: an application of the discrete choice experiment methodology. Colorectal Dis 2023; 25:102-110. [PMID: 36161457 PMCID: PMC10087205 DOI: 10.1111/codi.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/30/2022] [Accepted: 07/31/2022] [Indexed: 02/02/2023]
Abstract
AIM Variation in major gastrointestinal surgery rates in the older population suggests heterogeneity in surgical management. A higher prevalence of comorbidities, frailty and cognitive impairments in the older population may account for some variation. The aim of this study was to determine surgeon preference for major surgery versus conservative management in hypothetical patient scenarios based on key attributes. METHOD A survey was designed according to the discrete choice methodology guided by a separate qualitative study. Questions were designed to test for associations between key attributes (age, comorbidity, urgency of presentation, pathology, functional and cognitive status) and treatment preference for major gastrointestinal surgery versus conservative management. The survey consisting of 18 hypothetical scenarios was disseminated electronically to UK gastrointestinal surgeons. Binomial logistic regression was used to identify associations between the attributes and treatment preference. RESULTS In total, 103 responses were received after 256 visits to the questionnaire site (response rate 40.2%). Participants answered 1847 out of the 1854 scenarios (99.6%). There was a preference for major surgery in 1112/1847 (60.2%) of all scenarios. Severe comorbidities (OR 0.001, 95% CI 0.000-0.030; P = 0.000), severe cognitive impairment (OR 0.001, 95% CI 0.000-0.033; P = 0.000) and age 85 years and above (OR 0.028, 95% CI 0.005-0.168; P = 0.000) were all significant in the decision not to offer major gastrointestinal surgery. CONCLUSION This study has demonstrated variation in surgical treatment preference according to key attributes in hypothetical scenarios. The development of fitness-stratified guidelines may help to reduce variation in surgical practice in the older population.
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Affiliation(s)
- Sarah L Daniels
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK
| | - Matthew J Lee
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Susan Moug
- Royal Alexandra Hospital, Glasgow, UK.,University of Glasgow, Glasgow, UK
| | - Tim R Wilson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK
| | - Steven R Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Doncaster and Bassetlaw NHS Foundation Trust, Doncaster, UK
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10
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Buchanan J, Hill M, Vass CM, Hammond J, Riedijk S, Klapwijk JE, Harding E, Lou S, Vogel I, Hui L, Ingvoldstad-Malmgren C, Soller MJ, Ormond KE, Choolani M, Zheng Q, Chitty LS, Lewis C. Factor's that impact on women's decision-making around prenatal genomic tests: An international discrete choice survey. Prenat Diagn 2022; 42:934-946. [PMID: 35476801 PMCID: PMC9325352 DOI: 10.1002/pd.6159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We conducted a survey-based discrete-choice experiment (DCE) to understand the test features that drive women's preferences for prenatal genomic testing, and explore variation across countries. METHODS Five test attributes were identified as being important for decision-making through a literature review, qualitative interviews and quantitative scoring exercise. Twelve scenarios were constructed in which respondents choose between two invasive tests or no test. Women from eight countries who delivered a baby in the previous 24 months completed a DCE presenting these scenarios. Choices were modeled using conditional logit regression analysis. RESULTS Surveys from 1239 women (Australia: n = 178; China: n = 179; Denmark: n = 88; Netherlands: n = 177; Singapore: n = 90; Sweden: n = 178; UK: n = 174; USA: n = 175) were analyzed. The key attribute affecting preferences was a test with the highest diagnostic yield (p < 0.01). Women preferred tests with short turnaround times (p < 0.01), and tests reporting variants of uncertain significance (VUS; p < 0.01) and secondary findings (SFs; p < 0.01). Several country-specific differences were identified, including time to get a result, who explains the result, and the return of VUS and SFs. CONCLUSION Most women want maximum information from prenatal genomic tests, but our findings highlight country-based differences. Global consensus on how to return uncertain results is not necessarily realistic or desirable.
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Affiliation(s)
- James Buchanan
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Caroline M Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK.,RTI Health Solutions, Manchester, UK
| | - Jennifer Hammond
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sam Riedijk
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Eleanor Harding
- BSc Paediatrics and Child Health, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stina Lou
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Hui
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, Northern Health, Epping, Victoria, Australia
| | - Charlotta Ingvoldstad-Malmgren
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden.,Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Maria Johansson Soller
- Department of Clinical Genetics, Karolinska Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kelly E Ormond
- Department of Genetics and Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA.,Department of Health Sciences and Technology, Health Ethics and Policy Lab, ETH Zurich, Zurich, Switzerland
| | - Mahesh Choolani
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qian Zheng
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK
| | - Lyn S Chitty
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,Genetic and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Celine Lewis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, UK.,Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
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11
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Dap M, Caffin L, Perdriolle-Galet E, Bonnet C, Morel O. Is Cell-free fetal DNA testing a safe option for women in a high-risk population after combined first-trimester testing? J Gynecol Obstet Hum Reprod 2022; 51:102329. [PMID: 35114410 DOI: 10.1016/j.jogoh.2022.102329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Our study aimed to examine the relevance of cell-free fetal DNA (cfDNA) testing on the screening of chromosomal defects and the issue of pregnancies in patients with a risk over 1:50 after the first-trimester combined test. METHODS This is a retrospective monocentric study. We included all consecutive patients with a singleton pregnancy between January 2015 and December 2020 attending our fetal medicine centre because the estimated risk for trisomy 21 after the first-trimester combined screening was over 1:50. The patients could either choose to have invasive testing or cell-free DNA testing. We collected data about the patient, the tests results (cfDNA, karyotype) and the pregnancy outcome (born alive, medical termination, miscarriage or intrauterine fetal death). RESULTS We included 98 patients with an estimated risk for trisomy 21 over 1:50. We found a total of 14 major chromosomal abnormalities (14/98; 14.3%), of which: thirteen trisomies 21 and one triploidy 69, XXY. A cfDNA testing was chosen by 34 (34/98; 34.7%) patients. Among the pathological results of invasive testing, 5 (5/64; 7.8%) couldn't be targeted by cfDNA testing. Two of them were placental mosaicism, one a triploidy 69, XXY, and two defects inherited from a parent and considered benign. There was no miscarriage linked to an invasive test in the population study. CONCLUSION In our monocentric cohort, a third of the patients choose cfDNA in a case of a risk over 1:50 after combined testing. Even if this cohort is too small to draw definitive conclusions, cfDNA could be safe in a high-risk population after combined testing. None of the chromosomal abnormalities found at the karyotype and non-detectable by cfDNA was a loss of information that impacted pregnancy follow-up. Further study could explore the input of Genome-Wide cfDNA and chromosomal micro-array in this population.
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Affiliation(s)
- Matthieu Dap
- Obstetrics and fetal medicine Unit, CHRU of Nancy, Nancy, France; Department of fetopathology and placental pathology, CHRU of Nancy, Nancy, France.
| | - Lucie Caffin
- Obstetrics and fetal medicine Unit, CHRU of Nancy, Nancy, France
| | | | - Céline Bonnet
- Department of Genetics, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Olivier Morel
- Obstetrics and fetal medicine Unit, CHRU of Nancy, Nancy, France; Inserm, Diagnostic and Interventional Adaptive Imaging, University of Lorraine, Nancy, France
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12
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Hammond J, Klapwijk JE, Riedijk S, Lou S, Ormond KE, Vogel I, Hui L, Sziepe EJ, Buchanan J, Ingvoldstad-Malmgren C, Soller MJ, Harding E, Hill M, Lewis C. Assessing women’s preferences towards tests that may reveal uncertain results from prenatal genomic testing: Development of attributes for a discrete choice experiment, using a mixed-methods design. PLoS One 2022; 17:e0261898. [PMID: 35089945 PMCID: PMC8797177 DOI: 10.1371/journal.pone.0261898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022] Open
Abstract
Prenatal DNA tests, such as chromosomal microarray analysis or exome sequencing, increase the likelihood of receiving a diagnosis when fetal structural anomalies are identified. However, some parents will receive uncertain results such as variants of uncertain significance and secondary findings. We aimed to develop a set of attributes and associated levels for a discrete-choice experiment (DCE) that will examine parents’ preferences for tests that may reveal uncertain test results. A two phase mixed-methods approach was used to develop attributes for the DCE. In Phase 1, a “long list” of candidate attributes were identified via two approaches: 1) a systematic review of the literature around parental experiences of uncertainty following prenatal testing; 2) 16 semi-structured interviews with parents who had experienced uncertainty during pregnancy and 25 health professionals who return uncertain prenatal results. In Phase 2, a quantitative scoring exercise with parents prioritised the candidate attributes. Clinically appropriate levels for each attribute were then developed. A final set of five attributes and levels were identified: likelihood of getting a result, reporting of variants of uncertain significance, reporting of secondary findings, time taken to receive results, and who tells you about your result. These attributes will be used in an international DCE study to investigate preferences and differences across countries. This research will inform best practice for professionals supporting parents to manage uncertainty in the prenatal setting.
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Affiliation(s)
- Jennifer Hammond
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, United Kingdom
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - Sam Riedijk
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Stina Lou
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kelly E. Ormond
- Department of Genetics and Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, United States America
| | - Ida Vogel
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Northern Health, Epping, VIC, Australia
| | - Emma-Jane Sziepe
- Reproductive Epidemiology, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - James Buchanan
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, United Kindom
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, England, United Kindom
| | - Charlotta Ingvoldstad-Malmgren
- Department of Clinical Genetics, Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Maria Johansson Soller
- Department of Clinical Genetics, Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Eleanor Harding
- BSc Paediatrics and Child Health, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melissa Hill
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, United Kingdom
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Celine Lewis
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital, London, United Kingdom
- * E-mail:
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13
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Fleming PS, Colonio-Salazar F, Waylen A, Sherriff M, Burden D, O Neill C, Ness A, Sandy J, Ireland T. Factors affecting willingness to pay for NHS-based orthodontic treatment. Br Dent J 2022:10.1038/s41415-022-3878-6. [PMID: 35091691 DOI: 10.1038/s41415-022-3878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Objective To assess factors affecting willingness to pay for orthodontic treatment.Methods An online discrete choice experiment and willingness to pay study was conducted on a convenience sample of 250 participants aged 16 and above over a four-month period. Participants completed a series of stated-preference tasks, in which they viewed choice sets with two orthodontic treatment options involving different combinations of attributes: family income; cost to patient; cause of problem; prevention of future problems; age; severity of the problem; and self-esteem/confidence.Results Family income, cost to patient, cause of the problem, age and self-esteem/confidence were the most important attributes influencing participants' decisions to have orthodontic treatment. Participants felt that free NHS-based orthodontic provision should be prioritised for those under 18, regardless of family income, for those with developmental anomalies, particularly where self-esteem and confidence are affected, with younger participants (aged 16-24 years) strongly preferring full NHS funding for those under 18 years old (p = 0.007, 95% CI: 0.57-0.09) who dislike smiling in public, especially where self-esteem and confidence are impaired (p = 0.002, 95% CI: 0.16-0.71). Participants with high annual income had the highest preference for the NHS to fund treatment regardless of income (p = 0.02, 95% CI: 0.13-1.47) and placed an onus on addressing developmental anomalies (p = 0.004, 95% CI: 0.22-1.15). In total, 159 (63.6%) of those who would undergo treatment were willing to pay for it, with the majority (88%) open to paying up to £2,000 and only three participants stating the NHS should not contribute towards the cost of orthodontic treatment.Conclusions Based on this pilot study, key factors influencing the decision to undergo treatment included family income, cost, the aetiology of malocclusion, age and self-esteem/confidence. It was felt that free NHS-based treatment should be given priority where self-esteem and confidence are impaired among young people. Further research to inform the priorities underpinning the provision of dental care and orthodontic treatment within the NHS is required.
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Affiliation(s)
- Padhraig S Fleming
- Professor of Orthodontics, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | | | - Andrea Waylen
- Senior Lecturer in Social Sciences, School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Martyn Sherriff
- Visiting Professor, Dental Material Science, University of Bristol, Bristol, UK
| | - Donald Burden
- Professor of Orthodontics, Queen´s University Belfast, Belfast, UK
| | - Ciaran O Neill
- Professor of Orthodontics, Queen´s University Belfast, Belfast, UK
| | - Andy Ness
- Professor of Epidemiology, Bristol Dental School, Bristol, UK
| | - Jonathan Sandy
- Professor of Orthodontics, Child Dental Health, Bristol Dental School, Bristol, UK
| | - Tony Ireland
- Professor of Orthodontics, Bristol Dental School, University of Bristol, Bristol, UK
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14
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Toft CLF, Diemer T, Ingerslev HJ, Pedersen IS, Adrian SW, Kesmodel US. Patients' choices and opinions on chorionic villous sampling and non-invasive alternatives for prenatal testing following preimplantation genetic testing for hereditary disorders: A cross-sectional questionnaire study. Prenat Diagn 2022; 42:212-225. [PMID: 34997771 DOI: 10.1002/pd.6088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate choices of and reasoning behind chorionic villous sampling and opinions on non-invasive prenatal testing among women and men achieving pregnancy following preimplantation genetic testing (PGT) for hereditary disorders. METHODS A questionnaire was electronically submitted to patients who had achieved a clinical pregnancy following PGT at the Center for Preimplantation Genetic Testing, Aalborg University Hospital, Denmark, between 2017 and 2020. RESULTS Chorionic villous sampling was declined by approximately half of the patients. The primary reason for declining was the perceived risk of miscarriage due to the procedure. Nine out of 10 patients responded that they would have opted for a non-invasive prenatal test if it had been offered. Some patients were not aware that the nuchal translucency scan offered to all pregnant women in the early second trimester only rarely provides information on the hereditary disorder for which PGT was performed. CONCLUSION Improved counseling on the array of prenatal tests and screenings available might be required to assist patients in making better informed decisions regarding prenatal testing. Non-invasive prenatal testing is welcomed by the patients and will likely increase the number of patients opting for confirmatory prenatal testing following PGT for hereditary disorders.
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Affiliation(s)
- Christian L F Toft
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tue Diemer
- Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Hans J Ingerslev
- Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Fertility Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Inge S Pedersen
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stine W Adrian
- Department of Culture and Learning, Aalborg University, Aalborg, Denmark
| | - Ulrik S Kesmodel
- Center for Preimplantation Genetic Testing, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark.,Fertility Unit, Aalborg University Hospital, Aalborg, Denmark
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15
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Toft CLF, Ingerslev HJ, Kesmodel US, Hatt L, Singh R, Ravn K, Nicolaisen BH, Christensen IB, Kølvraa M, Jeppesen LD, Schelde P, Vogel I, Uldbjerg N, Farlie R, Sommer S, Østergård MLV, Jensen AN, Mogensen H, Kjartansdóttir KR, Degn B, Okkels H, Ernst A, Pedersen IS. Cell-based non-invasive prenatal testing for monogenic disorders: confirmation of unaffected fetuses following preimplantation genetic testing. J Assist Reprod Genet 2021; 38:1959-1970. [PMID: 33677749 PMCID: PMC8417213 DOI: 10.1007/s10815-021-02104-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/04/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Proof of concept of the use of cell-based non-invasive prenatal testing (cbNIPT) as an alternative to chorionic villus sampling (CVS) following preimplantation genetic testing for monogenic disorders (PGT-M). METHOD PGT-M was performed by combined testing of short tandem repeat (STR) markers and direct mutation detection, followed by transfer of an unaffected embryo. Patients who opted for follow-up of PGT-M by CVS had blood sampled, from which potential fetal extravillous throphoblast cells were isolated. The cell origin and mutational status were determined by combined testing of STR markers and direct mutation detection using the same setup as during PGT. The cbNIPT results with respect to the mutational status were compared to those of genetic testing of the CVS. RESULTS Eight patients had blood collected between gestational weeks 10 and 13, from which 33 potential fetal cell samples were isolated. Twenty-seven out of 33 isolated cell samples were successfully tested (82%), of which 24 were of fetal origin (89%). This corresponds to a median of 2.5 successfully tested fetal cell samples per case (range 1-6). All fetal cell samples had a genetic profile identical to that of the transferred embryo confirming a pregnancy with an unaffected fetus, in accordance with the CVS results. CONCLUSION These findings show that although measures are needed to enhance the test success rate and the number of cells identified, cbNIPT is a promising alternative to CVS. TRIAL REGISTRATION NUMBER N-20180001.
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Affiliation(s)
- Christian Liebst Frisk Toft
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | | | - Ulrik Schiøler Kesmodel
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Fertility Unit, Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | | | | | | | | | | | - Ida Vogel
- Department of Clinical Genetic, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Richard Farlie
- Department of Obstetrics and Gynecology, Viborg Regional Hospital, Viborg, Denmark
| | - Steffen Sommer
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | | | - Ann Nygaard Jensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Mogensen
- Department of Obstetrics and Gynecology, Kolding Regional Hospital, Kolding, Denmark
| | - Kristín Rós Kjartansdóttir
- Molecular Genetics Laboratory, Department of Clinical Genetics, University Hospital Copenhagen, Copenhagen, Denmark
| | - Birte Degn
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Okkels
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Anja Ernst
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Inge Søkilde Pedersen
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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16
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The Impact of Reproductive Issues on Preferences of Women with Relapsing Multiple Sclerosis for Disease-Modifying Treatments. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:583-597. [PMID: 32588337 DOI: 10.1007/s40271-020-00429-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Relapsing-remitting multiple sclerosis (RRMS) is an incurable disease characterised by relapses (periods of function loss) followed by full or partial recovery, and potential permanent disability over time. Many disease-modifying treatments (DMTs) exist that help reduce relapses and slow disease progression. Most are contraindicated during conception/pregnancy and some require a discontinuation period before trying to conceive. Although around three-quarters of people with RRMS are women, there is limited knowledge about how reproductive issues impact DMT preference. OBJECTIVE The aim of this study was to measure the preferences for DMTs of women with RRMS who are considering pregnancy. DESIGN An online discrete choice experiment (DCE). METHODS Participants chose between two hypothetical DMTs characterised by a set of attributes, then indicated if they preferred their choice to no treatment. Attributes were identified from interviews and focus groups with people with RRMS and MS professionals, as well as literature reviews, and included the probability of problems with pregnancy, discontinuation of DMTs, and breastfeeding safety. In each DCE task, participants were asked to imagine making decisions in three scenarios: now; when trying to conceive; and when pregnant. ANALYSIS Two mixed logit models were estimated, one to assess the statistical significance between scenarios and one in maximum acceptable risk space to allow comparison of the magnitudes of parameters between scenarios. SAMPLE Women with RRMS who were considering having a child in the future, recruited from a UK MS patient register. RESULTS Sixty respondents completed the survey. Participants preferred no treatment in 12.6% of choices in the 'now' scenario, rising significantly to 37.6% in the 'trying to conceive' scenario and 60.3% in the 'pregnant' scenario (Kruskal-Wallis p < 0.001). This pattern corresponds with results from models that included a no-treatment alternative-specific constant (ASC) capturing differences between taking and not taking a DMT not specified by the attributes. The ASC was lower in the trying to conceive scenario than in the now scenario, and lower still in the pregnant scenario, indicating an intrinsic preference for no treatment. Participants also placed relatively less preference on reducing relapses and avoiding disease progression in the trying to conceive and pregnant scenarios compared with a lower risk of problems with pregnancy. In the trying to conceive scenario, participants' preference for treatments with shorter washout periods increased. CONCLUSION Women with RRMS considering having a child prefer DMTs with more favourable reproduction-related attributes, even when not trying to conceive. Reproductive issues also influenced preferences for DMT attributes not directly related to pregnancy, with preferences dependent on the life circumstances in which choices were made. The design of the DCE highlights the benefits of considering the scenario in which participants make choices, as they may change over time.
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17
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Thomas GM, Rothman BK, Strange H, Latimer JE. Testing Times: The Social Life of Non-invasive Prenatal Testing. SCIENCE TECHNOLOGY AND SOCIETY 2021. [DOI: 10.1177/0971721820960262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-invasive prenatal testing (NIPT) is a genomic technology used to predict the chance of a foetus having a genetic condition. Despite the immediacy of this technology’s integration into clinical practice, there is a dearth of evidence outlining how both patients and professionals experience NIPT on the ground. In this article, we draw upon our collective empirical research—specifically on earlier screening technologies (BKR), Down syndrome screening (GT), genetic screening/testing (JL) and NIPT (HS)—to outline the most pressing and often controversial issues which, we argue, remain unresolved and vital to consider regarding NIPT. We begin with a brief introduction to NIPT as a prenatal technology and the bodies of literature which unpack its ‘social life’. In what follows, BKR discusses NIPT within the context of her research on ‘the tentative pregnancy’ and diagnostic testing in the USA. In the following sections, GT, HS and JL identify different, but related, concerns with respect to NIPT, particularly around routinisation, commercialisation, choice, abortion, and configurations of disability and ‘normalcy’.
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Affiliation(s)
- Gareth M. Thomas
- Gareth Thomas (corresponding author), School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT, UK
| | - Barbara Katz Rothman
- Barbara Katz Rothman, The Graduate Center, City University of New York (CUNY), 365 Fifth Avenue, New York, NY 10016, USA
| | - Heather Strange
- Heather Strange, School of Medicine, Cardiff University, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK
| | - Joanna E. Latimer
- Joanna Latimer, Department of Sociology, University of York, Heslington, York, North Yorkshire, YO10 5DD, UK
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18
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Buczyńska A, Sidorkiewicz I, Ławicki S, Krętowski A, Zbucka-Krętowska M. The Significance of Apolipoprotein E Measurement in the Screening of Fetal Down Syndrome. J Clin Med 2020; 9:jcm9123995. [PMID: 33321701 PMCID: PMC7764604 DOI: 10.3390/jcm9123995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/22/2022] Open
Abstract
Prenatal screening for Down syndrome (DS) is based on both noninvasive and invasive methods. Noninvasive, cell-free fetal DNA genetic tests are expensive, whereas biochemical methods remain imprecise. Amniocentesis is the most frequently used invasive diagnosis procedure, characterized by 99.8% diagnostic efficiency and less than 1% risk of miscarriage. The aim of this study was to evaluate the screening value of apolipoprotein E (ApoE) as a potential noninvasive biomarker for prenatal DS assessment. This study was conducted on a group of female patients who decided to undergo routine amniocentesis between the 15th and 18th week of pregnancy at the Department of Reproduction and Gynecological Endocrinology of the Medical University of Bialystok, Poland. For the purpose of this study, 20 women with DS fetuses were selected as the study group, and 20 healthy pregnant women with euploid fetus karyotypes as the control group. The plasma levels of ApoE were significantly higher in the study group compared to healthy subjects (p < 0.05). The area under the receiver operating characteristic (ROC) curve was 0.978 (p < 0.001), with the cut-off set to 1.37 mg/mL, which was characterized by 80% of sensitivity and 100% of specificity. The high sensitivity and specificity demonstrate the screening utility of maternal ApoE concentration in prenatal fetal DS screening.
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Affiliation(s)
- Angelika Buczyńska
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.B.); (I.S.); (A.K.)
| | - Iwona Sidorkiewicz
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.B.); (I.S.); (A.K.)
| | - Sławomir Ławicki
- Department of Population Medicine and Civilization Diseases Prevention, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Adam Krętowski
- Clinical Research Centre, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.B.); (I.S.); (A.K.)
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland
| | - Monika Zbucka-Krętowska
- Department of Gynecological Endocrinology and Adolescent Gynecology, Medical University of Bialystok, 15-276 Bialystok, Poland
- Correspondence: ; Tel.: +48-85-746-8336
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19
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Wu L, Wu Y, Zou S, Sun C, Chen J, Li X, Lin Z, Guan L, Zeng Q, Zhao S, Liang J, Chen R, Hu Z, Au K, Xie D, Xiao X, Ming WK. Eliciting women's preference for prenatal testing in China: a discrete choice experiment. BMC Pregnancy Childbirth 2020; 20:604. [PMID: 33032548 PMCID: PMC7542883 DOI: 10.1186/s12884-020-03270-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background Pregnancy tests can be used for the early diagnosis of fetal problems and can prevent abnormal birth in pregnancies. Yet, testing preferences among Chinese women are poorly investigated. Methods We developed a Discrete Choice Experiment with 5 attributes: test procedure, detection rate, miscarriage rate, time to wait for result, and test cost. By studying the choices that the women make in the hypothetical scenarios and comparing the attributes and levels, we can analyze the women’s preference of prenatal testing in China. Results Ninety-two women completed the study. Respondents considered the test procedure as the most important attribute, followed by detection rate, miscarriage rate, wait time for result, and test cost, respectively. The estimated preference weight for the non-invasive procedure was 0.928 (P < 0.0001). All other attributes being equal, the odds of choosing a non-invasive testing procedure over an invasive one was 2.53 (95% confidence interval, 2.42–2.64; P < 0.001). Participants were willing to pay up to RMB$28,810 (approximately US$4610) for a non-invasive test, RMB$6061(US$970) to reduce the miscarriage rate by 1% and up to RMB$3356 (US$537) to increase the detection rate by 1%. Compared to other DCE (Discrete Choice Experiment) studies regarding Down’s syndrome screening, women in our study place relatively less emphasis on test safety. Conclusions The present study has shown that Chinese women place more emphasis on detection rate than test safety. Chinese women place great preference on noninvasive prenatal testing, which indicate a popular need of incorporating noninvasive prenatal testing into the health insurance coverage in China. This study provided valuable evidence for the decision makers in the Chinese government.
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Affiliation(s)
- Liangzhi Wu
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,The Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Yanxin Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shiqian Zou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Cong Sun
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Junyu Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xueyan Li
- School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Zihang Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lizhi Guan
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qing Zeng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Sihan Zhao
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingtong Liang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rui Chen
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zhiwen Hu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kingyan Au
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daipeng Xie
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaomin Xiao
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wai-Kit Ming
- The Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China. .,Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China. .,School of Medicine, Jinan University, Guangzhou, Guangdong, China. .,Harvard Medical School, Harvard University, Boston, MA, USA.
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Munro S, Sou J, Zhang W, Mohammadi T, Trenaman L, Langlois S, Anis AH. Attitudes toward prenatal screening for chromosomal abnormalities: A focus group study. Women Birth 2019; 32:364-371. [DOI: 10.1016/j.wombi.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/16/2022]
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21
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Trapero-Bertran M, Rodríguez-Martín B, López-Bastida J. What attributes should be included in a discrete choice experiment related to health technologies? A systematic literature review. PLoS One 2019; 14:e0219905. [PMID: 31318926 PMCID: PMC6639002 DOI: 10.1371/journal.pone.0219905] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/04/2019] [Indexed: 01/12/2023] Open
Abstract
Discrete choice experiments (DCEs) are a way to assess priority-setting in health care provision. This approach allows for the evaluation of individuals’ preferences as a means of adding criteria to traditional quality-adjusted life year analysis. The aim of this systematic literature review was to identify attributes for designing a DCE in order to then develop and validate a framework that supports decision-making on health technologies. Our systematic literature review replicated the methods and search terms used by de Bekker-Grob et al. 2012 and Clark et al. 2014. The Medline database was searched for articles dated between 2008 and 2015. The search was limited to studies in English that reflected general preferences and were choice-based, published as full-text articles and related to health technologies. This study included 72 papers, 52% of which focused on DCEs on drug treatments. The average number of attributes used in all included DCE studies was 5.74 (SD 1.98). The most frequently used attributes in these DCEs were improvements in health (78%), side effects (57%) and cost of treatment (53%). Other, less frequently used attributes included waiting time for treatment or duration of treatment (25%), severity of disease (7%) and value for money (4%). The attributes identified might inform future DCE surveys designed to study societal preferences regarding health technologies in order to better inform decisions in health technology assessment.
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Affiliation(s)
- Marta Trapero-Bertran
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Beatriz Rodríguez-Martín
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
- Faculty of Health Sciences, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Julio López-Bastida
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
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22
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Vass CM, Georgsson S, Ulph F, Payne K. Preferences for aspects of antenatal and newborn screening: a systematic review. BMC Pregnancy Childbirth 2019; 19:131. [PMID: 30991967 PMCID: PMC6469127 DOI: 10.1186/s12884-019-2278-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries offer screening programmes to unborn and newborn babies (antenatal and newborn screening) to identify those at risk of certain conditions to aid earlier diagnosis and treatment. Technological advances have stimulated the development of screening programmes to include more conditions, subsequently changing the information required and potential benefit-risk trade-offs driving participation. Quantifying preferences for screening programmes can provide programme commissioners with data to understand potential demand, the drivers of this demand, information provision required to support the programmes and the extent to which preferences differ in a population. This study aimed to identify published studies eliciting preferences for antenatal and newborn screening programmes and provide an overview of key methods and findings. METHODS A systematic search of electronic databases for key terms identified eligible studies (discrete choice experiments (DCEs) or best-worst scaling (BWS) studies related to antenatal/newborn testing/screening published between 1990 and October 2018). Data were systematically extracted, tabulated and summarised in a narrative review. RESULTS A total of 19 studies using a DCE or BWS to elicit preferences for antenatal (n = 15; 79%) and newborn screening (n = 4; 21%) programmes were identified. Most of the studies were conducted in Europe (n = 12; 63%) but there were some examples from North America (n = 2; 11%) and Australia (n = 2; 11%). Attributes most commonly included were accuracy of screening (n = 15; 79%) and when screening occurred (n = 13; 68%). Other commonly occurring attributes included information content (n = 11; 58%) and risk of miscarriage (n = 10; 53%). Pregnant women (n = 11; 58%) and healthcare professionals (n = 11; 58%) were the most common study samples. Ten studies (53%) compared preferences across different respondents. Two studies (11%) made comparisons between countries. The most popular analytical model was a standard conditional logit model (n = 11; 58%) and one study investigated preference heterogeneity with latent class analysis. CONCLUSION There is an existing literature identifying stated preferences for antenatal and newborn screening but the incorporation of more sophisticated design and analytical methods to investigate preference heterogeneity could extend the relevance of the findings to inform commissioning of new screening programmes.
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Affiliation(s)
- Caroline M. Vass
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | | | - Fiona Ulph
- Division of Psychology & Mental Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
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23
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Goh ESY, Miller FA, Marshall DA, Ungar WJ. Genetic counselors' preferences for coverage of preimplantation genetic diagnosis: A discrete choice experiment. Clin Genet 2019; 95:684-692. [PMID: 30859557 DOI: 10.1111/cge.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
Preimplantation genetic diagnosis (PGD) allows couples to test for a genetically affected embryo prior to implantation. Patient access to this ethically complex and expensive technology differs markedly across jurisdictions, with differences in private/public insurance coverage and variations in patient inclusion and diagnostic criteria. The objective of the study was to identify trade-offs regarding PGD coverage decisions amongst genetic counselors. To quantify stated preferences for PGD coverage, we conducted a discrete choice experiment with Canadian genetic counselors (GC) considering attributes regarding the scope of testing (PGD indication, risk of the condition and number of cycles covered) and patient inclusion criteria (fertility status and family history). Multinomial logit regression was used to estimate trade-offs amongst attributes using part-worth utilities and importance scores. The completed response rate was 41% with 126 GC completing the survey. Risk of the genetic condition was the most important attribute. Overall, GC were more responsive to the scope of testing criteria including the condition's risk (importance score of 42%) and PGD indication (31%) rather than family history (11%) and fertility status (8%). Based on this study's attributes and levels, condition characteristics are prioritized even above patient characteristics for PGD coverage.
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Affiliation(s)
- Elaine Suk-Ying Goh
- Trillium Health Partners, Department of Laboratory Medicine and Genetics, Mississauga, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children (Sickkids) Research Institute, Toronto, Ontario, Canada
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24
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Seror V, L’Haridon O, Bussières L, Malan V, Fries N, Vekemans M, Salomon LJ, Ville Y. Women's Attitudes Toward Invasive and Noninvasive Testing When Facing a High Risk of Fetal Down Syndrome. JAMA Netw Open 2019; 2:e191062. [PMID: 30924894 PMCID: PMC6450316 DOI: 10.1001/jamanetworkopen.2019.1062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Noninvasive prenatal testing (NIPT) using cell-free DNA in maternal blood is increasingly common compared with invasive testing (IT) in routine antenatal detection of Down syndrome (DS). OBJECTIVE To assess attitudes and decision making in pregnant women facing a risk of fetal DS greater than 1 in 250 as established by combined first trimester screening at 11 to 14 weeks of gestation. DESIGN, SETTING, AND PARTICIPANTS Survey study in which data were collected from pregnant women at high risk of fetal DS participating in a randomized clinical trial. Data were collected from April 8, 2014, to April 7, 2016, in 57 prenatal diagnosis centers in France. Data were analyzed in 2018. INTERVENTIONS Data on attitudes were collected prior to offering randomization between NIPT and IT, whereas data on decision making and test results were collected as part of the clinical trial. MAIN OUTCOME AND MEASURES The primary outcome related to attitudes. A hierarchical cluster analysis was conducted to identify clusters with contrasting attitudes. Logistic regression analyses were used to identify factors associated with attitudes. RESULTS All 2436 consecutive women to whom the study was proposed (mean [SD] age, 36.3 [5.0] years) answered the questionnaire: 515 (21.1%) expressed preference toward IT with complete karyotyping, whereas 1843 (75.7%) favored NIPT with almost certain but limited information. Hierarchical cluster analysis yielded 4 different clusters that mainly differed in attitudes toward risk taking and extent of information seeking. Factors likely associated with attitudes driven by risk aversion were mostly age and religious beliefs (adjusted odds ratio [aOR], 1.03; 95% CI, 1.00-1.05; P = .03 and aOR, 1.62; 95% CI, 1.29-2.04; P < .001, respectively), whereas higher nuchal translucency measurements by ultrasonography were associated with attitudes driven by ambiguity aversion (aOR, 1.67; 95% CI, 1.27-2.20; P < .001). For attitudes involving both risk and ambiguity aversion at different extents, lower education was associated with highly valuing all possibilities of getting information on pregnancy, whereas higher education was associated with highly valuing information on fetal DS as a primary concern (aOR, 0.54; 95% CI, 0.44-0.67; P < .001 and aOR, 1.44; 95% CI, 1.20-1.74; P < .001, respectively). In all, decision making was in line with attitudes. CONCLUSIONS AND RELEVANCE Aversion to risk of fetal loss related to IT and aversion to ambiguity generated by incomplete information from NIPT played a major role in shaping attitudes and decision making. Informed decision making should require pregnant women at high risk of DS to receive extensive information on targeted abnormalities by both tests.
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Affiliation(s)
- Valerie Seror
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | | | - Laurence Bussières
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Valérie Malan
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Nicolas Fries
- Department of Obstetrics and Gynecology, CHU de Montpellier, Montpellier, France
- Collège Français d'Echographie Fœtale, Chateaubriand, France
| | - Michel Vekemans
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Laurent J. Salomon
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Groupe de Recherche en Obstétrique et Gynécologie, Paris, France
- Collège Français d'Echographie Fœtale, Chateaubriand, France
| | - Yves Ville
- Department of Obstetrics and Gynecology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
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25
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Smith SK, Cai A, Wong M, Sousa MS, Peate M, Welsh A, Meiser B, Kaur R, Halliday J, Lewis S, Trevena L, Yanes T, Barlow-Stewart K, Barclay M. Improving women's knowledge about prenatal screening in the era of non-invasive prenatal testing for Down syndrome - development and acceptability of a low literacy decision aid. BMC Pregnancy Childbirth 2018; 18:499. [PMID: 30558569 PMCID: PMC6296052 DOI: 10.1186/s12884-018-2135-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023] Open
Abstract
Background Access to information about prenatal screening is important particularly in light of new techniques such as non-invasive prenatal testing (NIPT). This study aimed to develop and examine the acceptability of a low literacy decision aid (DA) about Down syndrome screening among pregnant women with varying education levels and GPs. Methods We developed a DA booklet providing information about first-trimester combined testing, maternal serum screening, and NIPT. GPs and women participated in a telephone interview to examine the acceptability of the DA and measure screening knowledge before and after reading the DA. The knowledge measure was designed to assess whether women had understood the gist of the information presented in the decision aid. It comprised conceptual questions (e.g. screening tells you the chance of having a baby with Down syndrome) and numeric questions (e.g. the accuracy of different screening tests). Results Twenty-nine women and 18 GPs participated. Regardless of education level, most women found the booklet ‘very’ clearly presented (n = 22, 76%), and ‘very’ informative (n = 23, 80%). Overall, women’s conceptual and numeric knowledge improved after exposure to the DA, from 4% having adequate knowledge to 69%. Women’s knowledge of NIPT also improved after receiving the decision aid, irrespective of education. Most GPs found it ‘very’ clearly presented (n = 13, 72%), and that it would ‘very much’ facilitate decision-making (n = 16, 89%). Conclusions The DA was found to be acceptable to women as well as GPs. A comprehensive evaluation of the efficacy of the decision aid compared to standard information is an important next step. Strategies are needed on how to implement the tool in practice. Electronic supplementary material The online version of this article (10.1186/s12884-018-2135-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sian Karen Smith
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.
| | - Antonia Cai
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Michelle Wong
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Mariana S Sousa
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.,Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University, Ingham, Sydney, Australia.,South Western Sydney Local Health District, Institute for Applied Medical Research, Sydney, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Alec Welsh
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Rajneesh Kaur
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tatiane Yanes
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | | | - Margot Barclay
- Women's Services, Liverpool Hospital, Sydney, Australia.,Western Sydney University, Parramatta, Sydney, Australia
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26
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Haidar H, Dupras C, Ravitsky V. Non-Invasive Prenatal Testing: Review of Ethical, Legal and Social Implications. BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044264ar] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Non-invasive prenatal testing (NIPT) using cell-free fetal DNA (cffDNA) from maternal blood has recently entered clinical practice in many countries, including Canada. This test can be performed early during pregnancy to detect Down syndrome and other conditions. While NIPT promises numerous benefits, it also has challenging ethical, legal and social implications (ELSI). This paper reviews concerns currently found in the literature on the ELSI of NIPT. We make four observations. First, NIPT seems to exacerbate some of the already existing concerns raised by other prenatal tests (amniocentesis and maternal serum screening) such as threats to women’s reproductive autonomy and the potential for discrimination and stigmatization of disabled individuals and their families. This may be due to the likely upcoming large scale implementation and routinization of NIPT. Second, the distinction between NIPT as a screening test (as it is currently recommended) and as a diagnostic test (potentially in the future), has certain implications for the ELSI discussion. Third, we observed a progressive shift in the literature from initially including mostly conceptual analysis to an increasing number of empirical studies. This demonstrates the contribution of empirical bioethics approaches as the technology is being implemented into clinical use. Finally, we noted an increasing interest in equity and justice concerns regarding access to NIPT as it becomes more widely implemented.
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Affiliation(s)
- Hazar Haidar
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Charles Dupras
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Vardit Ravitsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
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27
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Cheng YKY, Leung WC, Leung TY, Choy KW, Chiu RWK, Lo TK, Kwok KY, Sahota DS. Women's preference for non-invasive prenatal DNA testing versus chromosomal microarray after screening for Down syndrome: a prospective study. BJOG 2018; 125:451-459. [DOI: 10.1111/1471-0528.15022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Affiliation(s)
- YKY Cheng
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
| | - WC Leung
- Department of Obstetrics and Gynaecology; Kwong Wah Hospital; Hong Kong China
| | - TY Leung
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
| | - KW Choy
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
| | - RWK Chiu
- Department of Chemical Pathology; The Chinese University of Hong Kong; Hong Kong China
| | - T-K Lo
- Department of Obstetrics and Gynaecology; Princess Margaret Hospital; Hong Kong China
| | - KY Kwok
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
| | - DS Sahota
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Hong Kong China
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28
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Martin L, Gitsels-van der Wal JT, de Boer MA, Vanstone M, Henneman L. Introduction of non-invasive prenatal testing as a first-tier aneuploidy screening test: A survey among Dutch midwives about their role as counsellors. Midwifery 2018; 56:1-8. [DOI: 10.1016/j.midw.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 12/20/2022]
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29
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Hens K. Chromosome Screening Using Noninvasive Prenatal Testing Beyond Trisomy-21: What to Screen for and Why It Matters. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017; 43:8-21. [DOI: 10.1093/jmp/jhx030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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30
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Salloum RG, Shenkman EA, Louviere JJ, Chambers DA. Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review. Implement Sci 2017; 12:140. [PMID: 29169397 PMCID: PMC5701380 DOI: 10.1186/s13012-017-0675-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/15/2017] [Indexed: 01/11/2023] Open
Abstract
Background One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE) is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science. Methods We conducted a systematic literature search (up to December 2016) of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s), healthcare setting, and implementation outcome. Results Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1) characterizing demand for therapies and treatment technologies (n = 32), (2) comparing implementation strategies (n = 22), (3) incentivizing workforce participation (n = 11), and (4) prioritizing interventions (n = 10). Stakeholders included providers (n = 27), patients (n = 25), caregivers (n = 5), and administrators (n = 2). The remaining studies (n = 16) engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators). The following implementation outcomes were discussed: acceptability (n = 75), appropriateness (n = 34), adoption (n = 19), feasibility (n = 16), and fidelity (n = 3). Conclusions The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the past decade. As DCEs are more widely used as a healthcare assessment tool, there is a wide range of applications for them in stakeholder engagement. The DCE approach could serve as a tool for engaging stakeholders in implementation science. Electronic supplementary material The online version of this article (10.1186/s13012-017-0675-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Jordan J Louviere
- Institute for Choice, School of Marketing, University of South Australia, Adelaide, SA, Australia
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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31
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Gokcen O, Mehmet D, Emine A, Mehmet A, Sinan BM. An Overview of Prenatal Screening/Diagnosis Programs for Down Syndrome in Turkey. INT J HUM GENET 2017. [DOI: 10.1080/09723757.2016.11886273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Orgul Gokcen
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey Hacettepe University Faculty of Medicine, Department of Medical Genetics, Ankara, Turkey
| | - Demirel Mehmet
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey Hacettepe University Faculty of Medicine, Department of Medical Genetics, Ankara, Turkey
| | - Aydin Emine
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey Hacettepe University Faculty of Medicine, Department of Medical Genetics, Ankara, Turkey
| | - Alikasifoglu Mehmet
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey Hacettepe University Faculty of Medicine, Department of Medical Genetics, Ankara, Turkey
| | - Beksac M. Sinan
- Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Ankara, Turkey Hacettepe University Faculty of Medicine, Department of Medical Genetics, Ankara, Turkey
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Richmond Z, Fleischer R, Chopra M, Pinner J, D'Souza M, Fridgant Y, Hyett J. The impact of non-invasive prenatal testing on anxiety in women considered at high or low risk for aneuploidy after combined first trimester screening. Prenat Diagn 2017; 37:975-982. [PMID: 28685502 DOI: 10.1002/pd.5110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/01/2017] [Accepted: 07/03/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study was to (1) examine the psychological impact of non-invasive prenatal testing (NIPT) in women with a high-risk (≥1 : 300) and low-risk (≤1 : 301) result on combined first trimester screening (cFTS) and (2) to examine factors influencing anxiety and decision-making in both risk populations. METHOD Questionnaires and structured interviews were administered to low (n = 50) and high (n = 63) risk women at the time of NIPT blood draw (point A) and again at least 1 week after receiving their NIPT result (point B). Anxiety levels were measured at these two time points using the State-Trait Anxiety Inventory. RESULTS Both high-risk and low-risk cFTS groups demonstrated similar intrinsic (trait) anxiety levels (36 ± 10 vs 35 ± 10; p = 0.70). High-risk women had significantly higher levels of state anxiety at point A than low-risk women (42 ± 11 vs 36 ± 11; p < 0.01). Both groups had a statistically significant reduction (p < 0.01), to similar final levels of state anxiety at point B (30 ± 11 vs 29 ± 8; p = 0.61). CONCLUSION Women receiving a high-risk result on cFTS have higher levels of state anxiety than their low-risk counterparts. Following a low-risk NIPT result, the anxiety levels in both populations are reduced to similar levels. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Zara Richmond
- Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ron Fleischer
- Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Maya Chopra
- Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Genetic Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Jason Pinner
- Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Genetic Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Mario D'Souza
- Sydney Local Health District Clinical Research Centre, Camperdown, NSW, Australia
| | - Yelena Fridgant
- Sydney Local Health District Clinical Research Centre, Camperdown, NSW, Australia
| | - Jonathan Hyett
- Fetal Medicine Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Harrison M, Milbers K, Hudson M, Bansback N. Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments. BMJ Open 2017; 7:e014719. [PMID: 28515194 PMCID: PMC5623426 DOI: 10.1136/bmjopen-2016-014719] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To review studies eliciting patient and healthcare provider preferences for healthcare interventions using discrete choice experiments (DCEs) to (1) review the methodology to evaluate similarities, differences, rigour of designs and whether comparisons are made at the aggregate level or account for individual heterogeneity; and (2) quantify the extent to which they demonstrate concordance of patient and healthcare provider preferences. METHODS A systematic review searching Medline, EMBASE, Econlit, PsycINFO and Web of Science for DCEs using patient and healthcare providers. INCLUSION CRITERIA peer-reviewed; complete empiric text in English from 1995 to 31July 2015; discussing a healthcare-related topic; DCE methodology; comparing patients and healthcare providers. DESIGN Systematic review. RESULTS We identified 38 papers exploring 16 interventions in 26 diseases/indications. Methods to analyse results, determine concordance between patient and physician values, and explore heterogeneity varied considerably between studies. The majority of studies we reviewed found more evidence of mixed concordance and discordance (n=28) or discordance of patient and healthcare provider preferences (n=12) than of concordant preferences (n=4). A synthesis of concordance suggested that healthcare providers rank structure and outcome attributes more highly than patients, while patients rank process attributes more highly than healthcare providers. CONCLUSIONS Discordant patient and healthcare provider preferences for different attributes of healthcare interventions are common. Concordance varies according to whether attributes are processes, structures or outcomes, and therefore determining preference concordance should consider all aspects jointly and not a binary outcome. DCE studies provide excellent opportunities to assess value concordance between patients and providers, but assessment of concordance was limited by a lack of consistency in the approaches used and consideration of heterogeneity of preferences. Future DCEs assessing concordance should fully report the framing of the questions and investigate the heterogeneity of preferences within groups and how these compare.
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Affiliation(s)
- Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
| | - Katherine Milbers
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montréal, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Canada
- Lady Davis Institute for Medical Research, Montréal, Canada
| | - Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Hill M, Oteng-Ntim E, Forya F, Petrou M, Morris S, Chitty LS. Preferences for prenatal diagnosis of sickle-cell disorder: A discrete choice experiment comparing potential service users and health-care providers. Health Expect 2017; 20:1289-1295. [PMID: 28504327 PMCID: PMC5689222 DOI: 10.1111/hex.12568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 01/29/2023] Open
Abstract
Background Non‐invasive prenatal diagnosis (NIPD) for sickle‐cell disorder (SCD) is moving closer to implementation and studies considering stakeholder preferences are required to underpin strategies for offering NIPD in clinical practice. Objective Determine service user and provider preferences for key attributes of prenatal diagnostic tests for SCD and examine views on NIPD. Method A questionnaire that includes a discrete choice experiment was used to determine the preferences of service users and providers for prenatal tests that varied across three attributes: accuracy, time of test and risk of miscarriage. Results Adults who were carriers of SCD or affected with the condition (N=67) were recruited from haemoglobinopathy clinics at two maternity units. Health professionals, predominately midwives, who offer antenatal care (N=62) were recruited from one maternity unit. No miscarriage risk was a key driver of decision making for both service users and providers. Service providers placed greater emphasis on accuracy than service users. Current uptake of invasive tests was 63%, whilst predicted uptake of NIPD was 93.8%. Many service users (55.4%) and providers (52.5%) think pressure to have prenatal testing will increase when NIPD for SCD becomes available. Conclusions There are clear differences between service users and health professionals’ preferences for prenatal tests for sickle‐cell disorder. The safety of NIPD is welcomed by parents and uptake is likely to be high. To promote informed choice, pretest counselling should be balanced and not exclusively focused on test safety. Counselling strategies that are sensitive to feelings of pressure to test will be essential.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Directorate of Women's Health, Guy's and St Thomas' Foundation Trust, London, UK.,King's College London, London, UK
| | - Frida Forya
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Women's Health, University College London, London, UK
| | - Mary Petrou
- Institute of Women's Health, University College London, London, UK.,Haemoglobinopathy Genetics Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
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Oxenford K, Daley R, Lewis C, Hill M, Chitty LS. Development and evaluation of training resources to prepare health professionals for counselling pregnant women about non-invasive prenatal testing for Down syndrome: a mixed methods study. BMC Pregnancy Childbirth 2017; 17:132. [PMID: 28449648 PMCID: PMC5408404 DOI: 10.1186/s12884-017-1315-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/24/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The availability of non-invasive prenatal testing (NIPT) for aneuploidies is expanding rapidly throughout the world. Training health professionals to offer NIPT in a way that supports informed choice is essential for implementation. The aim of this study was to develop and evaluate a training package for health professionals to support the introduction of NIPT into clinical practice. METHODS Training on NIPT was offered to health professionals, primarily midwives, involved in Down syndrome screening and testing in eight hospitals located in England and Scotland as part of a research study evaluating the implementation of NIPT in the UK National Health Service. Training was evaluated using a mixed methods approach that included quantitative questionnaires at three time points and post-training qualitative interviews. The questionnaires measured confidence, self-perceived knowledge and actual knowledge about NIPT for Down syndrome. Interviews explored opinions about the training and experiences of offering NIPT. RESULTS The training provided to the health professionals was found to positively impact on their confidence in discussing NIPT with women in their clinic, and both their perceived and actual knowledge and understanding of NIPT was improved. Knowledge remained weak in four areas; cell-free fetal DNA levels increase with gestation; turnaround time for NIPT results; cell-free fetal DNA is placental in origin; and NIPT false positive rate. CONCLUSIONS Training materials, including a lesson plan, PowerPoint presentation and written factsheet on NIPT, have been developed and evaluated for use in educating midwives and supporting the introduction of NIPT. Implementation of training should include a greater focus on the areas where knowledge remained low. Some groups of midwives will need additional training or support to optimise their confidence in discussing NIPT with women.
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Affiliation(s)
- Kerry Oxenford
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rebecca Daley
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Celine Lewis
- NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Lyn S Chitty
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK.,NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
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Ahmed S, Jafri H, Rashid Y, Mason G, Ehsan Y, Ahmed M. Attitudes towards non-invasive prenatal diagnosis among obstetricians in Pakistan, a developing, Islamic country. Prenat Diagn 2017; 37:289-295. [PMID: 28109006 DOI: 10.1002/pd.5008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/20/2016] [Accepted: 01/13/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Stakeholders' views are essential for informing implementation strategies for non-invasive prenatal testing (NIPT). Little is known about such views in developing countries. We explored attitudes towards NIPT among obstetricians in Pakistan, a developing, Islamic country. METHODS A 35-item questionnaire was distributed and collected at eight events (a national conference and seven workshops in five cities) for obstetric professionals on advances in fetal medicine. RESULTS Responses from 113 obstetrician show positive attitudes towards implementation of NIPT: 95% agreed prevention of genetic conditions was a necessity, and 97% agreed public hospitals should provide prenatal screening tests. However, participants also agreed the availability of NIPT would increase social pressure on women to have prenatal screening tests and to terminate an affected pregnancy (53% and 63%, respectively). Most participants would not offer NIPT for sex determination (55%), although 31% would. The most valued aspects of NIPT were its safety, followed by its utility and then accuracy. CONCLUSION Participants generally supported the implementation of NIPT but raised concerns about social implications. Therefore, national policy is needed to regulate the implementation of NIPT, and pretest information and post-test genetic counselling are needed to mitigate social pressure and support parents to make informed decisions. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Shenaz Ahmed
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, LS2 9NL, UK
| | | | | | | | | | - Mushtaq Ahmed
- Yorkshire Regional Genetics Service, Leeds NHS Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, LS7 4SA, UK
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Tamminga S, van Dussen L, Verweij EJJ, de Boer MA, Cornel MC, Henneman L. What do people want to know about NIPT? Content analysis of questions emailed to national NIPT information websites. Prenat Diagn 2017; 37:412-415. [PMID: 28124373 PMCID: PMC5413829 DOI: 10.1002/pd.5011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/06/2017] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
What's already known about this topic?
Several countries, including the Netherlands, have implemented non‐invasive prenatal testing (NIPT) in their national prenatal screening program Access to relevant online health information is important as it increases informed decision making What does this study add?
Visitors of national NIPT websites mostly request more information about testing beyond the currently available NIPT: a broader range of disorders (such as monogenic disorders) and increasing target group eligibility (such as low‐risk or twin pregnancies) © 2017 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Saskia Tamminga
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | | | - E J Joanne Verweij
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
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Georgsson S, Sahlin E, Iwarsson M, Nordenskjöld M, Gustavsson P, Iwarsson E. Knowledge and Attitudes Regarding Non-Invasive Prenatal Testing (NIPT) and Preferences for Risk Information among High School Students in Sweden. J Genet Couns 2016; 26:447-454. [PMID: 27480089 PMCID: PMC5415585 DOI: 10.1007/s10897-016-9997-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/12/2016] [Indexed: 01/24/2023]
Abstract
Non-invasive prenatal testing (NIPT) was recently introduced for prenatal testing of genetic disorders. Cell-free fetal DNA is present in maternal blood during pregnancy and enables detection of fetal chromosome aberrations in a maternal blood sample. The public perspective to this new, simple method has not been illuminated. The views of young people (i.e. future parents) are important to develop suitable counseling strategies regarding prenatal testing. The aim was to explore Swedish high school students’ attitudes, knowledge and preferences regarding NIPT. A questionnaire was completed by 305 students recruited from one high school in Stockholm, November and December 2014. Most students (80 %) considered prenatal testing as good. The majority (65 %) was positive or very positive towards NIPT and 62 % stated that they potentially would like to undergo the test if they or their partner was pregnant. The vast majority (94 %) requested further information about NIPT. Most students (61 %) preferred verbal information, whereas 20 % preferred information via the Internet. The majority of the high school students was positive towards prenatal testing and most was positive towards NIPT. Further, information was requested by the vast majority before making a decision about NIPT. Most of the students preferred verbal information and to a lesser extent information via the Internet. The attitudes, knowledge and preferences for risk information concerning NIPT in young adults are important, in order to increase knowledge on how to educate and inform future parents.
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Affiliation(s)
- Susanne Georgsson
- Sophiahemmet University, Box 5605, SE-114 86, Stockholm, Sweden. .,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, SE-171 77, Sweden.
| | - Ellika Sahlin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
| | - Moa Iwarsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
| | - Magnus Nordenskjöld
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
| | - Peter Gustavsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
| | - Erik Iwarsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, CMM (L8:02), SE-171 76, Stockholm, Sweden
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Farrell R, Agatisa P, Mercer M, Mitchum A, Coleridge M. Expanded indications for noninvasive prenatal genetic testing: Implications for the individual and the public. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jemep.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Barrett AN, Advani HV, Chitty LS, Su LL, Biswas A, Tan WC, Hill M, Choolani M. Evaluation of preferences of women and healthcare professionals in Singapore for implementation of noninvasive prenatal testing for Down syndrome. Singapore Med J 2016; 58:298-310. [PMID: 27357315 DOI: 10.11622/smedj.2016114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Invasive prenatal diagnosis (IPD) has long been used to prenatally diagnose Down syndrome (DS), but it is associated with a small risk of miscarriage. Noninvasive prenatal testing (NIPT) is a highly sensitive screening test using cell-free DNA in maternal blood for detection of DS without the risk of miscarriage, but it confers a small risk of false-positive and false-negative results. The implementation of these procedures into clinical practice requires an understanding of stakeholder preferences. METHODS A total of 69 health professionals (HPs) and 301 women took part in a discrete choice experiment (DCE) in which preferences for four prenatal test attributes - accuracy, time of results, risk of miscarriage and amount of information provided - were assessed. Conditional logit regression was used to analyse the data. Data on demographics and ranked preferences for test attributes was collected, and a direct choice question regarding NIPT, IPD or neither test was posed to participants. RESULTS The women showed a preference for test safety, whereas HPs prioritised test accuracy above all other attributes. When offered a direct choice of NIPT, IPD or neither test, women aged 35 years and older, those with previous miscarriage or who knew a child with DS were more likely to choose NIPT. Chinese women preferred NIPT, whereas Indian women preferred IPD. CONCLUSION Our data highlights the need for patient-specific counselling, taking into account previous experiences and cultural factors. Since women and HPs prioritise different test attributes, it is essential that HPs recognise these differences in order to provide non-biased counselling.
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Affiliation(s)
| | - Henna Vishal Advani
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, England, United Kingdom
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Wei Ching Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, England, United Kingdom
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore.,Department of Obstetrics and Gynaecology, National University Hospital, Singapore
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Sahlin E, Nordenskjöld M, Gustavsson P, Wincent J, Georgsson S, Iwarsson E. Positive Attitudes towards Non-Invasive Prenatal Testing (NIPT) in a Swedish Cohort of 1,003 Pregnant Women. PLoS One 2016; 11:e0156088. [PMID: 27195496 PMCID: PMC4872994 DOI: 10.1371/journal.pone.0156088] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/09/2016] [Indexed: 01/20/2023] Open
Abstract
Objective The clinical utilization of non-invasive prenatal testing (NIPT) for identification of fetal aneuploidies is expanding worldwide. The aim of this study was to gain an increased understanding of pregnant women’s awareness, attitudes, preferences for risk information and decision-making concerning prenatal examinations with emphasis on NIPT, before its introduction into Swedish healthcare. Method Pregnant women were recruited to fill in a questionnaire, including multiple-choice questions and Likert scales, at nine maternity clinics located in different areas of Stockholm, Sweden. Results In total, 1,003 women participated in the study (86% consent rate). The vast majority (90.7%) considered examinations aiming to detect fetal abnormalities to be good. Regarding NIPT, 59.8% stated that they had heard about the method previously, yet 74.0% would like to use the test if available. The main factor affecting the women’s decision to undergo prenatal chromosomal screening was worry about the baby’s health (82.5%), followed by the urge to have as much information as possible about the fetus (54.5%). Most women (79.9%) preferred to receive NIPT information orally. Conclusion The overwhelming majority of a cohort of 1,003 pregnant women considered prenatal examinations good. Moreover, the majority had a positive attitude towards NIPT and would like to use the test if available.
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Affiliation(s)
- Ellika Sahlin
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
- * E-mail:
| | - Magnus Nordenskjöld
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Peter Gustavsson
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Josephine Wincent
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Susanne Georgsson
- Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Iwarsson
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, CMM L8:02, Karolinska University Hospital, S-171 76, Stockholm, Sweden
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Lewis C, Hill M, Chitty LS. Women's Experiences and Preferences for Service Delivery of Non-Invasive Prenatal Testing for Aneuploidy in a Public Health Setting: A Mixed Methods Study. PLoS One 2016; 11:e0153147. [PMID: 27045195 PMCID: PMC4821600 DOI: 10.1371/journal.pone.0153147] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/24/2016] [Indexed: 12/21/2022] Open
Abstract
Non-invasive prenatal testing (NIPT) for aneuploidy is currently only available in the UK through the private sector outside of the research arena. As part of an implementation study in the UK National Health Service we conducted a mixed methods study to assess women’s experience of being offered NIPT using validated measures of decisional conflict, decisional regret and anxiety. Clinical service preferences were also explored. Women with a Down syndrome screening risk >1:1000 were invited to take part in the study and offered NIPT, NIPT and invasive testing (for women with a risk above 1:150) or no further testing. A cross-sectional survey and semi-structured interviews were conducted at two time points; at the time of testing and one month following receipt of results (or equivalent for NIPT decliners). In total, 845 questionnaires and 81 interviews were analysed. The main motivation to accept NIPT was for reassurance (30.8%). Decisional conflict occurred in a minimal number of cases (3.8%), however, none of the participants experienced decisional regret. Around a third (29.9%) of women had elevated anxiety at the time of testing, including intermediate risk women who traditionally would not be offered further testing (54.4% high risk; 20.1% medium risk), a finding supported through the qualitative interviews where prolonged or additional anxiety was found to occur in some medium risk cases. Women were overwhelmingly positive about the opportunity to have a test that was procedurally safe, accurate, reduced the need for invasive testing and identified cases of Down syndrome that might otherwise have been missed. Reassurance was identified as the main motivator for accepting NIPT, particularly amongst medium risk women, with high risk women inclined to accept NIPT to inform decisions around invasive testing. The current turnaround time for test result was identified as a key limitation. All the women interviewed thought NIPT should be adopted as part of NHS clinical practice, with the majority favouring NIPT offered as a first-line test. Our study highlights the potential that NIPT has to positively impact women’s experience of prenatal testing for aneuploidy.
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Affiliation(s)
- Celine Lewis
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- * E-mail:
| | - Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3BH, United Kingdom
| | - Lyn S. Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3BH, United Kingdom
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Lau J, Yi H, Ahmed S. Decision-making for non-invasive prenatal testing for Down syndrome: Hong Kong Chinese women's preferences for individualvsrelational autonomy. Clin Genet 2016; 89:550-6. [DOI: 10.1111/cge.12743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/06/2016] [Accepted: 01/22/2016] [Indexed: 01/31/2023]
Affiliation(s)
- J.Y.C. Lau
- JC School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong SAR China
| | - H. Yi
- JC School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong SAR China
- CUHK Centre for Bioethics; The Chinese University of Hong Kong; Hong Kong SAR China
| | - S. Ahmed
- Leeds Institute of Health Sciences; University of Leeds; Leeds United Kingdom
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Pisnoli L, O’Connor A, Goldsmith L, Jackson L, Skirton H. Impact of fetal or child loss on parents’ perceptions of non-invasive prenatal diagnosis for autosomal recessive conditions. Midwifery 2016; 34:105-110. [DOI: 10.1016/j.midw.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/26/2015] [Indexed: 11/26/2022]
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Farrell RM, Agatisa PK, Mercer M, Coleridge MB. Online direct-to-consumer messages about non-invasive prenatal genetic testing. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2015; 1:88-97. [PMID: 29911190 PMCID: PMC6001346 DOI: 10.1016/j.rbms.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 06/08/2023]
Abstract
Non-invasive prenatal testing (NIPT) has been integrated into clinical care at a time when patients and healthcare providers increasingly utilize the internet to access health information. This study evaluated online direct-to-consumer information about NIPT produced by commercial laboratories accessible to both patients and healthcare providers. A coding checklist captured areas to describe content and assess concordance with clinical guidelines. We found that the information presented about NIPT is highly variable, both within a single website and broadly across all websites. Variability was noted in how NIPT is characterized, including test characteristics and indications. All laboratories offer NIPT to test for common sex chromosome aneuploidies, although there is a lack of consistency regarding the conditions offered and information provided about each. Although indicated for a subset of women at increased risk of aneuploidy, some laboratories describe the use of NIPT for all pregnant women. A subset of laboratories offers screening for microdeletions, although clinical practice guidelines do not yet recommend for general use for this indication. None of the online materials addressed the ethical issues associated with NIPT. This study highlights the need for clear, consistent, and evidence-based materials to educate patients and healthcare providers about the current and emerging applications of NIPT.
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Affiliation(s)
- Ruth M. Farrell
- Department of Obstetrics and Gynecology and Department of Bioethics, Cleveland Clinic Women’s Health Institute
- Department of Bioethics, Cleveland Clinic
- Genomic Medicine Institute, Cleveland Clinic Center for Personalized Genetic Healthcare
| | | | | | - Marissa B. Coleridge
- Genomic Medicine Institute, Cleveland Clinic Center for Personalized Genetic Healthcare
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47
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Hill M, Johnson JA, Langlois S, Lee H, Winsor S, Dineley B, Horniachek M, Lalatta F, Ronzoni L, Barrett AN, Advani HV, Choolani M, Rabinowitz R, Pajkrt E, van Schendel RV, Henneman L, Rommers W, Bilardo CM, Rendeiro P, Ribeiro MJ, Rocha J, Bay Lund IC, Petersen OB, Becher N, Vogel I, Stefánsdottir V, Ingvarsdottir S, Gottfredsdottir H, Morris S, Chitty LS. Preferences for prenatal tests for Down syndrome: an international comparison of the views of pregnant women and health professionals. Eur J Hum Genet 2015; 24:968-75. [PMID: 26577044 DOI: 10.1038/ejhg.2015.249] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/06/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
Abstract
Non-invasive prenatal testing is increasingly available worldwide and stakeholder viewpoints are essential to guide implementation. Here we compare the preferences of women and health professionals from nine different countries towards attributes of non-invasive and invasive prenatal tests for Down syndrome. A discrete choice experiment was used to obtain participants' stated preference for prenatal tests that varied according to four attributes: accuracy, time of test, risk of miscarriage, and type of information. Pregnant women and health professionals were recruited from Canada, Denmark, Iceland, Israel, Italy, the Netherlands, Portugal, Singapore, and the United Kingdom. A total of 2666 women's and 1245 health professionals' questionnaires were included in the analysis. Differences in preferences were seen between women and health professionals within and between countries. Overall, women placed greater emphasis on test safety and comprehensive information than health professionals, who emphasised accuracy and early testing. Differences between women's and health professionals' preferences are marked between countries. Varied approaches to implementation and service delivery are therefore needed and individual countries should develop guidelines appropriate for their own social and screening contexts.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo-Ann Johnson
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Lee
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Winsor
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Brigid Dineley
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Marisa Horniachek
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Faustina Lalatta
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luisa Ronzoni
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Angela N Barrett
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Henna V Advani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ron Rabinowitz
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Eva Pajkrt
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rachèl V van Schendel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Wieke Rommers
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - José Rocha
- CGC Genetics, Porto, Portugal.,IINFACTS, CESPU, Porto, Portugal
| | | | - Olav B Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Naja Becher
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Vigdis Stefánsdottir
- Department of Genetics and Molecular Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Sigrun Ingvarsdottir
- Landspitali, National University Hospital, Reykjavik, Iceland.,Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Helga Gottfredsdottir
- Landspitali, National University Hospital, Reykjavik, Iceland.,Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Stephen Morris
- Research Department of Applied Health Research, University College London, London, UK
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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48
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Higuchi EC, Sheldon JP, Zikmund-Fisher BJ, Yashar BM. Non-invasive prenatal screening for trisomy 21: Consumers' perspectives. Am J Med Genet A 2015; 170A:375-385. [PMID: 26553705 DOI: 10.1002/ajmg.a.37460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/22/2015] [Indexed: 11/05/2022]
Abstract
Non-invasive prenatal screening (NIPS) has the potential to dramatically increase the prenatal detection rate of Down syndrome because of improvements in safety and accuracy over existing tests. There is concern that NIPS could lead to more negative attitudes towards Down syndrome and less support for individuals with Down syndrome. To assess the impact of NIPS on support for prenatal testing, decision-making about testing, and beliefs or attitudes about Down syndrome, we performed an Internet-based experiment using adults (N = 1,789) recruited through Amazon Mechanical Turk. Participants were randomly assigned to read a mock news article about NIPS, a mock news article about amniocentesis, or no article. The content in the two articles varied only in their descriptions of the test characteristics. Participants then answered questions about their support for testing, hypothetical testing decision, and beliefs and attitudes about Down syndrome. Reading the mock NIPS news article predicted increased hypothetical test uptake. In addition, the NIPS article group also agreed more strongly that pregnant women, in general, should utilize prenatal testing. We also found that the more strongly participants supported prenatal testing for pregnant women, the less favorable their attitudes towards individuals with Down syndrome; providing some evidence that NIPS may indirectly result in more negative perceptions of individuals with this diagnosis.
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Affiliation(s)
- Emily C Higuchi
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Jane P Sheldon
- Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
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Tamminga S, van Schendel RV, Rommers W, Bilardo CM, Pajkrt E, Dondorp WJ, van Maarle M, Cornel MC, Henneman L. Changing to NIPT as a first-tier screening test and future perspectives: opinions of health professionals. Prenat Diagn 2015; 35:1316-23. [PMID: 26411372 DOI: 10.1002/pd.4697] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/04/2015] [Accepted: 09/20/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to investigate health professionals' opinions toward offering noninvasive prenatal testing (NIPT) as first-tier screening test regardless of pregnant women's risk, and toward a potential broader range of disorders. METHODS A questionnaire completed by obstetric health professionals (n = 240) after an in-service NIPT training in the West and North of the Netherlands. RESULTS The majority (72%) of respondents favored replacing first-trimester combined test (FCT) by NIPT, although 43% preferred to maintain nuchal translucency measurement. Many respondents believed that replacing FCT by NIPT would only have advantages (57%), would lead to more pregnant women opting for prenatal testing (69%), and would simplify counseling (47%). Differences in attitudes toward counseling between health professionals were observed. When considering NIPT to screen for broader range of disorders, the majority (92%) thought that this should include disorders characterized by neonatal death, whereas 52% of the respondents favored testing for fetomaternal risk factors. Overall, 46% thought screening should be offered as a fixed list of disorders. CONCLUSION Most health professionals favor NIPT instead of FCT but prefer to maintain nuchal translucency measurement. If NIPT becomes available as a first-tier screening test, attention remains necessary to ensure that pregnant women make well-informed decisions in line with the aim of prenatal screening.
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Affiliation(s)
- Saskia Tamminga
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Rachèl V van Schendel
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Wieke Rommers
- Department of Fetal Medicine and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Caterina M Bilardo
- Department of Fetal Medicine and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - Wybo J Dondorp
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Research Institutes GROW and CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Merel van Maarle
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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50
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Silcock C, Liao L, Hill M, Chitty LS. Will the introduction of non-invasive prenatal testing for Down's syndrome undermine informed choice? Health Expect 2015; 18:1658-71. [PMID: 26039796 PMCID: PMC5060845 DOI: 10.1111/hex.12159] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To investigate whether the introduction of non-invasive pre-natal testing for Down's syndrome (DS) has the potential to undermine informed choice. PARTICIPANTS Three hundred and ninety-three health professionals; 523 pregnant women. METHODS A cross-sectional questionnaire study across nine maternity units and three conferences in the UK designed to assess opinions regarding test delivery and how information should be communicated to women when offered Down's syndrome screening (DSS) or diagnosis using invasive (IDT) or non-invasive testing (NIPT). RESULTS Both pregnant women and health professionals in the NIPT and DSS groups were less likely than the IDT group to consider that testing should take place at a return visit or that obtaining written consent was necessary, and more likely to think testing should be carried out routinely. Compared to health professionals, pregnant women expressed a stronger preference for testing to occur on the same day as pre-test counselling (P = 0.000) and for invasive testing to be offered routinely (P = 0.000). They were also more likely to indicate written consent as necessary for DSS (P = 0.000) and NIPT (P < 0.05). CONCLUSIONS Health professionals and pregnant women view the consenting process differently across antenatal test types. These differences suggest that informed choice may be undermined with the introduction of NIPT for DS into clinical practice. To maintain high standards of care, effective professional training programmes and practice guidelines are needed which prioritize informed consent and take into account the views and needs of service users.
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Affiliation(s)
- Caroline Silcock
- University College London Hospitals NHS Foundation Trust & UCL Institute for Women's HealthLondonUK
| | - Lih‐Mei Liao
- University College London Hospitals NHS Foundation Trust & UCL Institute for Women's HealthLondonUK
| | - Melissa Hill
- UCL Institute of Child HealthGreat Ormond Street Hospital for Children NHS Trust, and Fetal Medicine Unit, University College London Hospitals NHS Foundation TrustLondonUK
| | - Lyn S. Chitty
- UCL Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Trust and Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK
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