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Siermann M, Valcke O, Vermeesch JR, Raivio T, Tšuiko O, Borry P. "Are we not going too far?": Socio-ethical considerations of preimplantation genetic testing using polygenic risk scores according to healthcare professionals. Soc Sci Med 2024; 343:116599. [PMID: 38244362 DOI: 10.1016/j.socscimed.2024.116599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
The recent introduction of polygenic risk scores within preimplantation genetic testing (PGT-P) has been met with many concerns. To get more insights into the perspectives of relevant stakeholders on the socio-ethical aspects of PGT-P, an interview study with 31 healthcare professionals involved in reproductive medicine and genetics in Europe and North-America was performed. Healthcare professionals in our study were concerned that PGT-P was going too far in terms of selection, with regards to both medical conditions and non-medical traits. Healthcare professionals were worried about the ethical 'slippery slope' of PGT-P, the increasing medicalization of reproductive health, the commercial context of PGT-P, and potential stigmatization and discrimination. There were also concerns that the availability and the 'technological imperative' of PGT-P could lead to pressure and a sense of responsibility for parents to use PGT-P. Additionally, it could cause new anxieties about the child's health before the child has even been born. Since PGT-P provides polygenic risk scores before birth, the autonomy of the child has to be considered. These socio-ethical concerns heighten existing debates regarding reproductive genetic technologies and show that the specifics of PGT-P make this screening option especially ethically controversial.
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Affiliation(s)
- Maria Siermann
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 - Box 7001, 3000, Leuven, Belgium; Department of Physiology, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8 (P.O. Box 63), 00014, Helsinki, Finland.
| | - Ophelia Valcke
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 - Box 7001, 3000, Leuven, Belgium
| | - Joris Robert Vermeesch
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, ON1 Herestraat 49 - Bus 606, 3000, Leuven, Belgium
| | - Taneli Raivio
- Department of Physiology, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8 (P.O. Box 63), 00014, Helsinki, Finland
| | - Olga Tšuiko
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, ON1 Herestraat 49 - Bus 606, 3000, Leuven, Belgium; Reproductive Genetics Unit, Center for Human Genetics, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 - Box 7001, 3000, Leuven, Belgium
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Siermann M, Valcke O, Vermeesch JR, Raivio T, Tšuiko O, Borry P. Limitations, concerns and potential: attitudes of healthcare professionals toward preimplantation genetic testing using polygenic risk scores. Eur J Hum Genet 2023; 31:1133-1138. [PMID: 36935419 PMCID: PMC10545753 DOI: 10.1038/s41431-023-01333-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/08/2023] [Accepted: 03/07/2023] [Indexed: 03/21/2023] Open
Abstract
Preimplantation genetic testing using polygenic risk scores (PGT-P) has recently been introduced. However, PGT-P has been met with many ethical concerns. It is therefore important to get insights into the perspectives of stakeholders regarding PGT-P. We performed a qualitative interview study on the views of healthcare professionals toward PGT-P. We conducted in-depth semi-structured interviews with 31 healthcare professionals working in the field of preimplantation genetic testing. The interviews explored the attitudes of healthcare professionals toward the technology of PGT-P, e.g., the validity, utility, limitations and potential benefits of PGT-P. We found that most healthcare professionals were concerned about the prematurity of introducing PGT-P into clinical practice. They had various ethical considerations, such as concerns related to validity and utility of PGT-P, limited embryos and options, and difficulties for prospective parents regarding comprehension and informed decision-making. Positive aspects were also identified, e.g., regarding reproductive autonomy and potential health benefits. Overall, most healthcare professionals considered that clinical implementation of PGT-P is premature. More comprehensive, longitudinal and inclusive studies are needed first, though these might not improve PGT-P enough to responsibly implement it. Healthcare professionals were also concerned that PGT-P could cause anxiety and create difficult choices for prospective parents. These perspectives and ethical considerations are crucial to consider for future guidelines and recommendations regarding PGT-P.
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Affiliation(s)
- Maria Siermann
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Ophelia Valcke
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Joris Robert Vermeesch
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Taneli Raivio
- Department of Physiology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Olga Tšuiko
- Laboratory for Cytogenetics and Genome Research, Department of Human Genetics, KU Leuven, Leuven, Belgium
- Reproductive Genetics Unit, Center for Human Genetics, UZ Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Siermann M, Claesen Z, Pasquier L, Raivio T, Tšuiko O, Vermeesch JR, Borry P. A systematic review of the views of healthcare professionals on the scope of preimplantation genetic testing. J Community Genet 2022; 13:1-11. [PMID: 35028914 DOI: 10.1007/s12687-021-00573-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022] Open
Abstract
Preimplantation genetic testing (PGT) involves testing embryos created through in vitro fertilization for the presence of hereditary genetic disorders and chromosome abnormalities. PGT for monogenic conditions (PGT-M) is generally performed for childhood-onset, lethal disorders, but is increasingly accepted for certain adult-onset conditions, conditions with available treatment options or conditions with lower penetrance. Furthermore, the development of PGT for polygenic conditions (PGT-P) makes ethical questions regarding PGT indications imperative. A systematic review was therefore performed to gather and analyse studies on the perspectives of healthcare professionals on the appropriate scope of PGT, with the aim of getting insights into the concerns about the scope of PGT now and in the near future. PRISMA guidelines were followed. Twelve qualitative articles were included. The main themes extracted were the scope of PGT and decision-making about PGT. Defining 'a serious genetic condition' was seen as complex, but severity, high penetrance and absence of treatability and patients' experience were seen as relevant indications to determine the appropriateness of PGT. In navigating the decision-making processes with patients, professionals experienced friction between setting limits and respecting patients' autonomy. Such friction and ethical dilemmas around seriousness, informed decision-making and preventative medicine show that while expanding the list of possible PGT indications and the development of PGT-P could augment patients' reproductive autonomy, it could also lead to an increased reproductive 'burden' for patients. These insights are crucial for establishing guidelines that help healthcare professionals navigate ethical tensions associated with PGT.
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Affiliation(s)
- Maria Siermann
- Centre for Biomedical Ethics and Law, KU Leuven, 3000, Leuven, Belgium.
| | - Zoë Claesen
- Centre for Biomedical Ethics and Law, KU Leuven, 3000, Leuven, Belgium
| | - Laurent Pasquier
- Centre for Biomedical Ethics and Law, KU Leuven, 3000, Leuven, Belgium
| | - Taneli Raivio
- Department of Physiology, University of Helsinki, 00014, Helsinki, Finland
| | - Olga Tšuiko
- Center for Human Genetics, University Hospitals Leuven, 3000, Leuven, Belgium.,Laboratory for Cytogenetics and Genome Research, KU Leuven, 3000, Leuven, Belgium
| | | | - Pascal Borry
- Centre for Biomedical Ethics and Law, KU Leuven, 3000, Leuven, Belgium
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Chan K, Petros M. Simple Test, Complex System: Multifaceted Views of Newborn Screening Science, Technology, and Policy. Glob Pediatr Health 2019; 6:2333794X19894812. [PMID: 31903414 PMCID: PMC6926981 DOI: 10.1177/2333794x19894812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/08/2019] [Accepted: 11/22/2019] [Indexed: 01/27/2023] Open
Abstract
Newborn screening (NBS) is a public health service provided for all babies born in the United States and in most countries of the developed world. A series of tests are applied to the blood taken from newborn babies to detect genetic and metabolic disorders that can be treated if identified early. With early treatment and therapy, the affected babies can usually live a normal, healthy life. Timing for sampling, testing, and reporting is vital for NBS to function as an effective system. In order to be an effective system, the evolution of science, technology, and policy gradually had to come into a synchronous partnership, where the discovery of new genetic disorders led to timely development of technology for screening, which is supported by policy and implemented into practice. The timely "dance" of these partnerships in an era of personalized health and medicine forms the integrated approach supporting NBS. This review will include a brief history of scientific development, policymaking, and the economic consideration in the expansion of the NBS.
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Affiliation(s)
- Kee Chan
- University of Illinois, Chicago, IL, USA
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Bioethics and public policies in neonatal screening in the United States, United Kingdom, and Colombia. BIOMEDICA 2019; 39:132-146. [PMID: 31021553 DOI: 10.7705/biomedica.v39i1.3906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Indexed: 11/21/2022]
Abstract
Introduction: Thinking about how neonatal screening should be done requires explaining the relevance of the bioethical factors involved.
Objective: To understand the relationship between bioethical considerations and the way neonatal screening is done and to identify its relevance in the Colombian legislation.
Materials and methods: A comparative study of public policies in the United States and the United Kingdom was done, as they exemplify extreme cases of neonatal screening. The influence of bioethical principles was interpreted based on similarities and differences. With this information, locally affected bioethical considerations were identified in the Colombian legislation on neonatal screening.
Results: In the United Kingdom, paternal autonomy prevails allowing parents to deny obligatory beneficence. In the USA, beneficence prevails and a significant number of anomalies must be screened for. This increases the likelihood of false positives and causes a high opportunity cost. Both countries have similarities which are also partially accepted in Colombia, such as the demand for equity of access. Others, such as specialized professional advice or the right to refuse screening, are not considered in the Colombian legislation on neonatal screening. Additionally, there are circumstances in Colombia such as different perspectives on what respecting justice means and how to apply that in choosing which abnormalities are screened for and lack of harmony between norms that prevents efficacious detection.
Conclusion: Bioethical considerations explain the differences between countries and sometimes prevail in the development of public policies on neonatal screening. Their inclusion in high-level norms in Colombia for effective screening is proposed.
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Boardman FK, Hale R, Young PJ. Newborn screening for haemophilia: The views of families and adults living with haemophilia in the UK. Haemophilia 2019; 25:276-282. [PMID: 30817064 PMCID: PMC6487806 DOI: 10.1111/hae.13706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/26/2019] [Accepted: 01/27/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION As genomic sequencing become more efficient and cost-effective, the number of conditions identified through newborn screening globally is set to dramatically increase. Haemophilia is a candidate condition; however, very little is known about the attitudes of the haemophilia community towards screening. AIM This study aimed to outline the perspectives of adults with haemophilia and their families towards newborn screening. METHODS A paper and online survey on screening were distributed to every family known to the Haemophilia Society UK. Data collection occurred between January and June 2018. In total, 327 participants completed the survey: 76% were a relative of a person with haemophilia and 24% had haemophilia themselves; 83% were living with haemophilia A and 17% with haemophilia B. RESULTS The vast majority supported newborn screening (77%) and preferred it to other forms of screening (preconception or prenatal). Participants supported newborn screening primarily because they viewed it as a means to facilitate early support and treatment, facilitate informed decisions about future pregnancies and prevent the "diagnostic odyssey." The 23% who did not support the screen did not associate these particular benefits with newborn screening. CONCLUSION Haemophilia emerged from this analysis as a condition that the vast majority of participants considered a "liveable" disability and one best suited to newborn screening programmes that could improve support to affected families rather than reduce the birth rate of affected children.
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Affiliation(s)
- Felicity K Boardman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Hale
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Philip J Young
- School of Life Sciences, University of Warwick, Coventry, UK
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Jansen ME, Lister KJ, van Kranen HJ, Cornel MC. Policy Making in Newborn Screening Needs a Structured and Transparent Approach. Front Public Health 2017; 5:53. [PMID: 28377917 PMCID: PMC5359248 DOI: 10.3389/fpubh.2017.00053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/01/2017] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Newborn bloodspot screening (NBS) programs have expanded significantly in the past years and are expected to expand further with the emergence of genetic technologies. Historically, NBS expansion has often occurred following ad hoc consideration of conditions, instead of a structured and transparent approach. In this review, we explore issues pertinent to NBS policy making, through the lens of the policy cycle: (a) agenda setting, (b) policy advice, (c) policy decision, (d) implementation, and (e) evaluation. METHODS A literature search was conducted to gather information on the elements specific to NBS and its policy making process. RESULTS The review highlighted two approaches to nominate a condition: a structured approach through horizon scanning; and an ad hoc process. For assessment of a condition, there was unanimous support for a robust process based on criteria. While the need to assess harms and benefits was a repeated theme in the articles, there is no agreed-upon threshold for benefit in decision-making. Furthermore, the literature was consistent in its recommendation for an overarching, independent, multidisciplinary group providing recommendations to government. An implementation plan focusing on the different levels on which NBS operates and the information needed on each level is essential for successful implementation. Continuously monitoring, and improving a program is vital, particularly following the implementation of screening for a new condition. An advisory committee could advise on implementation, development, review, modification, and cessation of (parts of) NBS. CONCLUSION The results highlight that there are a wave of issues facing NBS programs that policy makers must take into account when developing policy processes. What conditions to screen, and the technologies used in NBS, are both up for debate.
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Affiliation(s)
- Marleen E Jansen
- Section Community Genetics, Department of Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Institute for Public Health Genomics, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Karla J Lister
- Screening Policy Section, Office of Population Health Genomics, Department of Health, Government of Western Australia , Perth, WA , Australia
| | - Henk J van Kranen
- Institute for Public Health Genomics, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands; Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Martina C Cornel
- Section Community Genetics, Department of Clinical Genetics, Amsterdam Public Health Research Institute , Amsterdam , Netherlands
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Jansen ME, Metternick-Jones SC, Lister KJ. International differences in the evaluation of conditions for newborn bloodspot screening: a review of scientific literature and policy documents. Eur J Hum Genet 2016; 25:10-16. [PMID: 27848945 PMCID: PMC5159762 DOI: 10.1038/ejhg.2016.126] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/16/2016] [Accepted: 08/24/2016] [Indexed: 12/11/2022] Open
Abstract
Despite international adoption of newborn bloodspot screening (DBS), no two countries' screening programs are the same. This article aims to understand what factors influence DBS decision-making criteria and how conditions are assessed against them. In doing so, it offers unique insights into the international landscape of DBS. A systematic review on DBS criteria in scientific literature was first undertaken. Through this, five topics were identified for consideration when analyzing DBS decision-making. Using these five topics as a template, a side-by-side comparison was conducted on DBS in policy documents of eight countries. Programs are using different approaches to explore the same policy issues, including: the beneficiary of DBS, definition of criteria, the way conditions are assessed, level of evidence required, and recommendations after assessment. These differences have the potential to result in increased disparity across DBS internationally. Ultimately, governments need to decide on their role and develop an approach to DBS decision-making in line with this role. The analyses presented in this article highlight that despite programs' commonalities, no one 'DBS decision-making solution' exists. Understanding the different approaches to decision-making within the literature and policy settings, provides an objective starting point for structured decision-making approaches for DBS programs.
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Affiliation(s)
- Marleen E Jansen
- Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Genetics and Cell Biology, Institute for Public Health Genomics, School for Oncology and Developmental Biology (GROW), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Selina C Metternick-Jones
- Department of Health, Screening Policy Section, Office of Population Health Genomics, Government of Western Australia, Perth, Australia
| | - Karla J Lister
- Department of Health, Screening Policy Section, Office of Population Health Genomics, Government of Western Australia, Perth, Australia
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Abstract
The current standard model for identifying carriers of high-risk mutations in cancer-susceptibility genes (CSGs) generally involves a process that is not amenable to population-based testing: access to genetic tests is typically regulated by health-care providers on the basis of a labour-intensive assessment of an individual's personal and family history of cancer, with face-to-face genetic counselling performed before mutation testing. Several studies have shown that application of these selection criteria results in a substantial proportion of mutation carriers being missed. Population-based genetic testing has been proposed as an alternative approach to determining cancer susceptibility, and aims for a more-comprehensive detection of mutation carriers. Herein, we review the existing data on population-based genetic testing, and consider some of the barriers, pitfalls, and challenges related to the possible expansion of this approach. We consider mechanisms by which population-based genetic testing for cancer susceptibility could be delivered, and suggest how such genetic testing might be integrated into existing and emerging health-care structures. The existing models of genetic testing (including issues relating to informed consent) will very likely require considerable alteration if the potential benefits of population-based genetic testing are to be fully realized.
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van El CG, Rigter T, Reuser AJJ, van der Ploeg AT, Weinreich SS, Cornel MC. Newborn screening for pompe disease? a qualitative study exploring professional views. BMC Pediatr 2014; 14:203. [PMID: 25124044 PMCID: PMC4139142 DOI: 10.1186/1471-2431-14-203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Developments in enzyme replacement therapy have kindled discussions on adding Pompe disease, characterized by progressive muscle weakness and wasting, to neonatal screening. Pompe disease does not fit traditional screening criteria as it is a broad-spectrum phenotype disorder that may occur in lethal form in early infancy or manifest in less severe forms from infancy to late adulthood. Current screening tests cannot differentiate between these forms. Normally, expanding screening is discussed among experts in advisory bodies. While advisory reports usually mention the procedures and outcome of deliberations, little is known of the importance attached to different arguments and the actual weighing processes involved. In this research we aim to explore the views of a wide range of relevant professionals to gain more insight into the process of weighing pros and cons of neonatal screening for Pompe disease, as an example of the dilemmas involved in screening for broad-spectrum phenotype disorders. Methods We conducted 24 semi-structured interviews with medical, lab, insurance and screening professionals, and executive staff of patient organisations. They were asked about their first reaction to neonatal screening for Pompe disease, after which benefits and harms and requirements for screening were explored in more detail. Results Advantages included health gain by timely intervention, avoiding a diagnostic quest, having a reproductive choice and gaining more knowledge about the natural course and treatment. Being prepared was mentioned as an advantage for the later manifesting cases. Disadvantages included treatment costs and uncertainties about its effect, the timing of treatment in later manifesting cases, the psychological burden for the patient-in-waiting and the family. Also the downsides of having prior knowledge as well as having to consider a reproductive option were mentioned as disadvantages. Conclusion When weighing pros and cons, interviewees attach different importance to different arguments, based on personal and professional views. Professionals expect benefits from neonatal screening for Pompe disease, especially for early-onset cases. Some interviewees valued screening in later manifesting cases as well, while stressing the need for adequate support of pre-symptomatic patients and their families. Others considered the psychological burden and uncertainties regarding treatment as reasons not to screen.
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Affiliation(s)
- Carla G van El
- Department of Clinical Genetics/EMGO Institute for Health and Care Research, Section Community Genetics, VU University Medical Center, Van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands.
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Zizzo N, Di Pietro N, Green C, Reynolds J, Bell E, Racine E. Comments and reflections on ethics in screening for biomarkers of prenatal alcohol exposure. Alcohol Clin Exp Res 2013; 37:1451-5. [PMID: 23550996 DOI: 10.1111/acer.12115] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/30/2013] [Indexed: 12/01/2022]
Abstract
Early identification of and intervention for fetal alcohol spectrum disorder (FASD) has been shown to optimize outcomes for affected individuals. Detecting biomarkers of prenatal alcohol exposure (PAE) in neonates may assist in the identification of children at risk of FASD enabling targeted early interventions. Despite these potential benefits, complicated ethical issues arise in screening for biomarkers of PAE and these must be addressed prior to the implementation of screening programs. Here, we identify and comment, based on a North American perspective, on concerns raised in the current ethical, social, and legal literature related to meconium screening for PAE. Major ethical concerns revolve around the targeting of populations for PAE screening, consent and respect for persons, stigma and participation rates, the cost-benefit analysis of a screening program, consequences of false-positive and false-negative test results, confidentiality and appropriate follow-up to positive screen results, and the use of screen results for criminal prosecution. We identify gaps in the literature on screening for PAE, most notably related to a lack of stakeholder perspectives (e.g., parents, healthcare providers) about screening and the ethical challenges it presents.
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Affiliation(s)
- Natalie Zizzo
- Neuroethics Research Unit , Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada
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Botler J, Camacho LAB, Cruz MMD. Avaliação das unidades de coleta do Programa de Triagem Neonatal no Estado do Rio de Janeiro. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2012. [DOI: 10.1590/s1519-38292012000400009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: avaliar estrutura e processo das unidades de coleta (UC) e incluindo coleta e transporte das amostras, e busca ativa do Programa de Triagem Neonatal do Estado do Rio de Janeiro (PTN-RJ). MÉTODOS: foram selecionadas 66 das 422 UC existentes, conforme tipo, localização e volume de amostras. Foram aplicados questionário semi-estruturado e roteiros para observação direta e análise documental. Foram gerados escores para estrutura e processo para cada UC. Foram calculadas medianas da pontuação, avaliada a consistência interna do instrumento, correlação de escores entre estrutura e processo. RESULTADOS: o escore mediano global (máximo de 100) foi de 69,1 (variação: 50,5-86,6) para estrutura e 63,9 (variação: 46,9-77,4) para processo. O desempenho das UC foi semelhante em estrutura. Maternidades e PSF tiveram desempenhos superiores em processo, e UCB inferiores. O coeficiente alfa de Cronbach indicou alta consistência dos instrumentos para avaliação de estrutura (alfa=0,93) e processo (alfa=0,81). Os escores de estrutura e processo apresentaram fraca correlação (coeficiente de Pearson = 0,44; Spearman = 0,42). Diferenças nos escores médios entre tipos de UC demonstraram considerável magnitude, porém sem significância estatística (p=0,387). CONCLUSÕES: o desempenho global em estrutura e processo foi satisfatório. As deficiências foram encontradas na capacitação de profissionais e suprimento de material para coleta e educativo.
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Plass AMC, van El CG, Pieters T, Cornel MC. Neonatal screening for treatable and untreatable disorders: prospective parents' opinions. Pediatrics 2010; 125:e99-106. [PMID: 20026497 DOI: 10.1542/peds.2009-0269] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE In the Netherlands, in 2007, the national newborn screening program was expanded from 3 to 17 disorders that met the World Health Organization's Wilson and Jungner screening criteria, especially regarding treatability. The decision of whether to add diseases to the program is generally based on experts' advice, whereas the opinion of those whom it concerns--prospective parents--remains unknown. In this study, we investigated the opinion of prospective parents concerning newborn screening for disorders that are incurable yet treatable to some extent or even untreatable. METHODS A structured questionnaire that consisted of 3 parts in which similar questions were posed about treatable, less treatable, and untreatable childhood-onset disorders was posted on the Web site of a national pregnancy fair. RESULTS A total of 1631 prospective parents filled out the questionnaire, 259 of whom were excluded. In contrast to current policy, respondents showed a positive attitude toward inclusion of less treatable (88%) or untreatable childhood-onset disorders (73%) within the national newborn screening program. Respondents who already had children at the time of completing the questionnaire were even more in favor of screening for especially untreatable disorders. The most important reason mentioned was to prevent a long diagnostic quest. Obtaining information to enable reproductive choices in future pregnancies was hardly mentioned. CONCLUSIONS Prospective parents in the Dutch population seem interested in newborn screening for untreatable childhood-onset disorders; therefore, we argue that additional debate of pros and cons is needed among policy makers, health care professionals, and consumers.
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Affiliation(s)
- Anne Marie Catharina Plass
- Department of Clinical Genetics, Community Genetics, VU University Medical Center and EMGO Institute for Health and Care Research, Amsterdam, Netherlands.
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Gilbert R. Treatment for congenital toxoplasmosis: finding out what works. Mem Inst Oswaldo Cruz 2009; 104:305-11. [DOI: 10.1590/s0074-02762009000200026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 10/29/2008] [Indexed: 11/22/2022] Open
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Potter BK, Avard D, Entwistle V, Kennedy C, Chakraborty P, McGuire M, Wilson BJ. Ethical, legal, and social issues in health technology assessment for prenatal/preconceptional and newborn screening: a workshop report. Public Health Genomics 2008; 12:4-10. [PMID: 19023190 PMCID: PMC2790790 DOI: 10.1159/000153430] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 05/14/2008] [Indexed: 12/11/2022] Open
Abstract
Prenatal/preconceptional and newborn screening programs have been a focus of recent policy debates that have included attention to ethical, legal, and social issues (ELSIs). In parallel, there has been an ongoing discussion about whether and how ELSIs may be addressed in health technology assessment (HTA). We conducted a knowledge synthesis study to explore both guidance and current practice regarding the consideration of ELSIs in HTA for prenatal/preconceptional and newborn screening. As the concluding activity for this project, we held a Canadian workshop to discuss the issues with a diverse group of stakeholders. Based on key workshop themes integrated with our study results, we suggest that population-based genetic screening programs may present particular types of ELSIs and that a public health ethics perspective is potentially highly relevant when considering them. We also suggest that approaches to addressing ELSIs in HTA for prenatal/preconceptional and newborn screening may need to be flexible enough to respond to diversity in HTA organizations, cultural values, stakeholder communities, and contextual factors. Finally, we highlight a need for transparency in the way that HTA producers move from evidence to conclusions and the ways in which screening policy decisions are made.
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Affiliation(s)
- B K Potter
- Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, Ont. K1H 8M5, Canada.
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