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Craig KP, Riggan KA, Rubeck S, Meredith SH, Allyse MA, Michie M. Never "totally prepared": Support groups on helping families prepare for a child with a genetic condition. J Community Genet 2023:10.1007/s12687-023-00646-y. [PMID: 37046173 PMCID: PMC10092915 DOI: 10.1007/s12687-023-00646-y] [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: 12/12/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
A rapid increase in the reach and breadth of prenatal genetic screening and testing has led to an expanding need for prenatal support of families receiving this genetic information. As part of a larger study investigating prenatal preparation for a child with a genetic condition, we interviewed representatives of patient advocacy groups (PAGs) who support parents post-diagnosis. Groups supporting families with Down syndrome were often local or regional, while other groups were often national or international in scope. Groups varied in their willingness or ability to support families prior to making a pregnancy continuation decision, and participants reflected on ways they addressed these needs with individual counseling and referrals, if needed. Participants described supporting parents with information about conditions and a range of lived experiences for families, while referring families to healthcare professionals for technical questions and additional medical needs. PAGs also prioritized connecting parents experiencing a new diagnosis with other families for peer support and community-building, both in person and on social media. Participants discussed limitations, such as a lack of racially-concordant support, ability to offer resources in languages other than English, and a lack of funding to meet the expressed needs of families post-diagnosis. Overall, participants emphasized that the parenting experience of each child is unique, irrespective of a genetic diagnosis, an experience for which parents can never be "totally prepared."
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Affiliation(s)
- Kaitlynn P Craig
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA
| | - Sabina Rubeck
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Stephanie H Meredith
- Lettercase National Center for Prenatal and Postnatal Resources, University of Kentucky's Human Development Institute, Lexington, KY, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program & Department of Obstetrics & Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | - Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Why do French women refuse to have Down's syndrome screening by maternal serum testing? A mixed methods study. Midwifery 2022; 110:103351. [DOI: 10.1016/j.midw.2022.103351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 02/02/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022]
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Michie M. Is preparation a good reason for prenatal genetic testing? Ethical and critical questions. Birth Defects Res 2021; 112:332-338. [PMID: 32115901 DOI: 10.1002/bdr2.1651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/09/2022]
Abstract
As prenatal genetic testing technologies have become both easier and more accessible, women are increasingly choosing prenatal genetic testing for a reason that is largely unexamined in the clinical literature: preparation. This reasoning, offered not only from pregnant women but frequently from testing laboratories and health care providers, reflects long-held assumptions that prenatal genetic results-properly delivered and followed with information, clinical surveillance, and/or social supports-prepare families for a child with a genetic condition, and even improve health and social outcomes for children and families. But these assumptions remain unexamined, since there are no clear definitions or recommendations for prenatal preparation. Preparation may refer to several overlapping ways in which prenatal information may change parents' approach to the rest of the pregnancy, including: (a) clinical activities, including surveillance, interventions, and delivery planning; (b) social and informational support, such as interacting with patient support groups and gathering information about quality of life; and (c) psychological "coping" or adjustments to the reality of raising a child with a genetic condition. These meanings and activities intersect and influence one another and form a foundation for postnatal family adaptation, but they are rarely parsed out in studies examining the impact of prenatal diagnosis. Based on previous work delineating conceptual models as middle terms between theory and reality, we are building a conceptual model that incorporates an empirical understanding of meanings and actions encompassed by prenatal preparation. Comparing diverse families' expectations with the resources they are offered can identify (mis)matches between priorities and approaches.
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Affiliation(s)
- Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Bryant L. What is so complicated about prenatal testing for Down syndrome? A personal view. Hum Genet 2021; 141:1013-1015. [PMID: 34002259 PMCID: PMC8128085 DOI: 10.1007/s00439-021-02292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Louise Bryant
- School of Medicine, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9JT, UK.
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Gould JB. Epistemic Virtue, Prospective Parents and Disability Abortion. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:389-404. [PMID: 31372884 DOI: 10.1007/s11673-019-09933-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
Research shows that a high majority of parents receiving prenatal diagnosis of intellectual disability terminate pregnancy. They have reasons for rejecting a child with intellectual disabilities-these reasons are, most commonly, beliefs about quality of life for it or them. Without a negative evaluation of intellectual disability, their choice makes no sense. Disability-based abortion has been critiqued through virtue ethics for being inconsistent with admirable moral character. Parental selectivity conflicts with the virtue of acceptingness (the commitment to welcome whatever child comes naturally) and exhibits the vice of wilfulness (the project of picking and choosing what children one will take). In this paper I claim that, beyond failures of moral virtue, disability abortion often involves failures of epistemic virtue on the part of parents. I argue two things: parents believe something false, or at least contested, about life with intellectual disability-and they do so because they are not epistemically conscientious. I first explain why a central motivation for disability abortion-that it prevents harm to the child-is mistaken. I next give a brief account of intellectual virtue and culpable ignorance. I then indicate why many parents fail to be intellectually virtuous when choosing to terminate pregnancy. I focus on elimination of intellectual disability and have little to say about physical and sensory impairments.
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Affiliation(s)
- James B Gould
- Department of Philosophy, McHenry County College, 8900 Rt. 14, Crystal Lake, IL, 60110, USA.
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Pop-Tudose ME, Popescu-Spineni D, Armean P, Pop IV. Attitude, knowledge and informed choice towards prenatal screening for Down Syndrome: a cross-sectional study. BMC Pregnancy Childbirth 2018; 18:439. [PMID: 30419853 PMCID: PMC6233289 DOI: 10.1186/s12884-018-2077-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022] Open
Abstract
Background Down Syndrome screening test is a bridge between knowledge and uncertainty, safety and risk, unpredictability and desire to know in order to gain control. It may be accepted either not to have a baby with Down syndrome, or to prepare to have a baby with this condition. Every woman should understand that it is an option and should be encouraged to make their own decisions based on information and personal values. The implications and possible subsequent scenarios differentiate this type of test from the common biochemical tests performed during pregnancy, of paramount importance being the right to make informed choices. The aim of this study was to investigate the knowledge and attitude towards prenatal Down syndrome screening in order to asses to what extent the Romanian women make informed choices in this area. Methods A cross-sectional study was carried out that included 530 postpartum women, clients of Romania’ south-east region maternities, during April–September 2016. The level of knowledge and the attitude concerning the Down syndrome screening were evaluated using a questionnaire. Data were analyzed using SPSS version 20.0. Results 48.1% of the women have never heard about any tests for Down Syndrome and from those 51.9% who have heard, only 14.2% made an informed choice, 78.9% had a positive attitude for screening, 88% were classified as having insufficient knowledge and 68.3% made a value-consistent decision to accept or decline prenatal screening. A higher knowledge level was associated with a higher education level and the urban residence. The information satisfaction and confidence in the overall value of screening were predictive factors of positive attitude. More informed choices were made by women monitored by an obstetrician in a private practice. Conclusions The prenatal screening tests for Down Syndrome were mostly unknown and the women who accepted or not to perform a test were insufficiently knowledgeable that means that the ethical concept of the informed choice wasn’t followed. In our opinion the Romanian Health System needs to improve the antenatal policy by developing an adequate information strategy at the reproductive population level based on a network of trained specialists. Electronic supplementary material The online version of this article (10.1186/s12884-018-2077-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melania Elena Pop-Tudose
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Pasteur Louis Street No.6, 400349, Cluj-Napoca, Romania.
| | - Dana Popescu-Spineni
- Department of Specific Disciplines, Faculty of Midwifery and Nursing, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"Francisc I. Rainer" Anthropology Research Centre, Bucharest, Romania
| | - Petru Armean
- Department of Specific Disciplines, Faculty of Midwifery and Nursing, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioan Victor Pop
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Pasteur Louis Street No.6, 400349, Cluj-Napoca, Romania
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Scheuner MT, Russell MM, Chanfreau-Coffinier C, Peredo J, Yano EM, Hamilton AB, Lerner B, Provenzale D, Knight SJ, Voils CI. Stakeholders' views on the value of outcomes from clinical genetic and genomic interventions. Genet Med 2018; 21:1371-1380. [PMID: 30377384 DOI: 10.1038/s41436-018-0344-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/09/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Robust evidence about the value of clinical genomic interventions (CGIs), such as genetic/genomic testing or clinical genetic evaluation, is limited. We obtained stakeholders' perspectives on outcomes from CGIs to help inform their value. METHODS We used an adapted Delphi expert panel process. Two anonymous survey rounds assessed the value of 44 CGI outcomes and whether a third party should pay for them, with discussion in between rounds. RESULTS Sixty-six panelists responded to the first-round survey and 60 to the second. Policy-makers/payers gave the lowest ratings for value and researchers gave the highest. Patients/consumers had the most uncertainty about value and payment by a third party. Uncertainty about value was observed when evidence of proven health benefit was lacking, potential harms outweighed benefits for reproductive outcomes, and outcomes had only personal utility for individuals or family members. Agreement about outcomes for which a third party should not pay included prevention through surgery with unproven health benefits, establishing ancestry, parental consanguinity, and paternity. CONCLUSION Research is needed to understand factors contributing to uncertainty and stakeholder differences about the value of CGI outcomes. Reaching consensus will accelerate the creation of metrics to generate the evidence needed to inform value and guide policies that promote availability, uptake, and coverage of CGIs.
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Affiliation(s)
- Maren T Scheuner
- Department of Pediatrics, Division of Medical Genetics, University of California-San Francisco, San Francisco, CA, USA. .,San Francisco VA Healthcare System, San Francisco, CA, USA. .,VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.
| | - Marcia M Russell
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Catherine Chanfreau-Coffinier
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Jane Peredo
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Sara J Knight
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA.,Department of Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Dane AC, Peterson M, Miller YD. Talking Points: Women’s Information Needs for Informed Decision-Making About Noninvasive Prenatal Testing for Down Syndrome. J Genet Couns 2018; 27:1258-1264. [DOI: 10.1007/s10897-018-0250-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/06/2018] [Indexed: 01/24/2023]
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Michie M, Kraft SA, Minear MA, Ryan RR, Allyse MA. Informed decision-making about prenatal cfDNA screening: An assessment of written materials. ACTA ACUST UNITED AC 2016; 2:362-371. [PMID: 27699200 DOI: 10.1016/j.jemep.2016.05.004] [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: 02/01/2023]
Abstract
OBJECTIVES The introduction of prenatal cfDNA screening for fetal aneuploidy and other genetic conditions has exacerbated concerns about informed decision-making in clinical prenatal testing. To assess the information provided to patients to facilitate decisions about cfDNA screening, we collected written patient education and consent documents created by laboratories and clinics. METHODS Informed consent documents (IC) were coded by two independent coders. Each IC was assessed for readability, attention to elements of informed consent, and completeness of information about the test and the screened conditions. RESULTS We found variance between IC produced by commercial laboratories versus those provided by local clinics or health care systems, and considerable variance among materials from all sources. "Commercial" IC were longer and written at a more difficult reading level than "non-commercial" IC, and were less likely to state explicitly that cfDNA only screens for certain conditions. About one-third of IC were combined with laboratory order forms. Though most IC recommended confirmatory testing for positive results, only about half clearly stated that results could be incorrect-including mentions of false positives or false negatives. About one-third of IC explicitly stated that cfDNA screening was optional. While nearly all IC from any source listed the conditions screened by the test, only about half of the IC included any phenotypic descriptions of these conditions. Few IC mentioned psychosocial considerations, and only one IC mentioned the availability of support groups for families of children with genetic conditions. CONCLUSIONS Based on our findings, we recommend that written and well-informed consent be sought before performing cfDNA screening, and we offer minimal and recommended standards for patient education and consent materials.
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Affiliation(s)
- Marsha Michie
- Institute for Health & Aging, University of California, San Francisco
| | | | | | - Roberta R Ryan
- Institute for Health & Aging, University of California, San Francisco
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10
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Crombag NMTH, Boeije H, Iedema-Kuiper R, Schielen PCJI, Visser GHA, Bensing JM. Reasons for accepting or declining Down syndrome screening in Dutch prospective mothers within the context of national policy and healthcare system characteristics: a qualitative study. BMC Pregnancy Childbirth 2016; 16:121. [PMID: 27229318 PMCID: PMC4880977 DOI: 10.1186/s12884-016-0910-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uptake rates for Down syndrome screening in the Netherlands are low compared to other European countries. To investigate the low uptake, we explored women's reasons for participation and possible influences of national healthcare system characteristics. Dutch prenatal care is characterised by an approach aimed at a low degree of medicalisation, with pregnant women initially considered to be at low risk. Prenatal screening for Down syndrome is offered to all women, with a 'right not to know' for women who do not want to be informed on this screening. At the time this study was performed, the test was not reimbursed for women aged 35 and younger. METHODS We conducted a qualitative study to explore reasons for participation and possible influences of healthcare system characteristics. Data were collected via ten semi-structured focus groups with women declining or accepting the offer of Down syndrome screening (n = 46). All focus groups were audio- and videotaped, transcribed verbatim, coded and content analysed. RESULTS Women declining Down syndrome screening did not consider Down syndrome a condition severe enough to justify termination of pregnancy. Young women declining felt supported in their decision by perceived confirmation of their obstetric caregiver and reassured by system characteristics (costs and age restriction). Women accepting Down syndrome screening mainly wanted to be reassured or be prepared to care for a child with Down syndrome. By weighing up the pros and cons of testing, obstetric caregivers supported young women who accepted in the decision-making process. This was helpful, although some felt the need to defend their decision to accept the test offer due to their young age. For some young women accepting testing, costs were considered a disincentive to participate. CONCLUSIONS Presentation of prenatal screening affects how the offer is attended to, perceived and utilised. By offering screening with age restriction and additional costs, declining is considered the preferred choice, which might account for low Dutch uptake rates. Autonomous and informed decision-making in Down syndrome screening should be based on the personal interest in knowing the individual risk of having a child with Down syndrome and system characteristics should not influence participation.
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Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, P.O. Box 85090, Room KE04.123.1, 3508AB, Utrecht, The Netherlands.
| | - Hennie Boeije
- The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Rita Iedema-Kuiper
- Department of Obstetrics, University Medical Center Utrecht, P.O. Box 85090, Room KE04.123.1, 3508AB, Utrecht, The Netherlands
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center Utrecht, P.O. Box 85090, Room KE04.123.1, 3508AB, Utrecht, The Netherlands
| | - Jozien M Bensing
- The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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Wätterbjörk I, Sahlberg-Blom E, Nilsson K, Blomberg K. Reasons for declining extended information visit on prenatal screening among pregnant women and their partners. Prenat Diagn 2015; 35:1232-7. [PMID: 26289796 DOI: 10.1002/pd.4683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A two-step model on information on prenatal screening consists of brief information at the first visit at the Maternal Health Care Centre and an offer of extended information at a separate visit. There is a lack of knowledge why some pregnant women and their partners refrain from the extended information visit. The aim of this study was to explore their reasons. METHOD Eight qualitative interviews were analyzed using Interpretive Description. RESULTS In the first theme 'From an individual view', the interviewees saw the invitation from their own points of view. They refrained because they did not want to receive any more information or had taken an individual position against chromosomal testing. In the theme, 'From a societal view', the interviewees perceived the offer as part of a societal view on prenatal screening that they could not support. CONCLUSION The findings show that these interviewees' reasons of declining an extended information visit are multidimensional and influenced by different views, from both an individual perspective and a more societal one. Health care professionals should be aware that some persons could have a different view on health care services and could be reluctant to accept offered services.
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Affiliation(s)
- Inger Wätterbjörk
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Sahlberg-Blom
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kerstin Nilsson
- School of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Blomberg
- School of Health and Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Grinshpun-Cohen J, Miron-Shatz T, Berkenstet M, Pras E. The limited effect of information on Israeli pregnant women at advanced maternal age who decide to undergo amniocentesis. Isr J Health Policy Res 2015; 4:23. [PMID: 26284151 PMCID: PMC4538760 DOI: 10.1186/s13584-015-0019-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 04/13/2015] [Indexed: 11/22/2022] Open
Abstract
Background A primary goal of amniocentesis is the detection of trisomy 21 (Down syndrome- DS) in the fetus. This procedure involves a small risk of miscarriage. As the risk of DS increases with maternal age, screening tests (maternal serum triple test and others) and age are used to generate a risk assessment, and amniocentesis is offered to women with high risk. In Israel, amniocentesis is government funded for women of advanced maternal age (AMA, i.e., ≥35 years), even if their risk assessment is low. The purpose of this study was to explore the reasons AMA women undergo amniocentesis, their knowledge about risk estimates, and to evaluate whether their decision is informed. Methods Shortly after undergoing amniocentesis, 42 consecutive women without a medical indication for amniocentesis other than age, completed a questionnaire that assessed their knowledge and opinions regarding screening tests, pregnancy termination, amniocentesis risks and the factors that affected their decision. Results Women rarely deliberated before undergoing amniocentesis. One third of those who had the screening test did not wait for the results before undergoing amniocentesis. Only one third of those who received the screening results remembered their risk estimation before going ahead with amniocentesis. Almost half (41 %) cited “age” as their main reason for undergoing amniocentesis, though only 44 % of these women could recall their age related DS risk. Sixty percent estimated their DS risk as low or very low but still had amniocentesis. Most participants (74 %) stated that they would consider termination of the pregnancy if the fetus was diagnosed with an intellectual deficit. Conclusions These results cast doubt on whether AMA women’s decision to undergo amniocentesis is based on risk estimates, as women seem to disregard risk estimates, and sometimes not even wait for them when making the decision. The policy of funding amniocentesis solely on the basis of age may have led to the conception that being over 35 alone is sufficient reason to undergo amniocentesis. This finding should inform policy makers, as it raises questions about the link between public funding and the choices of individual women, and has implications for healthcare expenditures.
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Affiliation(s)
- Julia Grinshpun-Cohen
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel ; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Talya Miron-Shatz
- Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel ; Center for Medicine in the Public Interest, New York, NY USA
| | - Michal Berkenstet
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel
| | - Elon Pras
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Hashomer, Israel ; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Grinshpun-Cohen J, Miron-Shatz T, Rhee-Morris L, Briscoe B, Pras E, Towner D. A Priori Attitudes Predict Amniocentesis Uptake in Women of Advanced Maternal Age: A Pilot Study. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1107-1113. [PMID: 26065331 DOI: 10.1080/10810730.2015.1018632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Amniocentesis is an invasive procedure performed during pregnancy to determine, among other things, whether the fetus has Down syndrome. It is often preceded by screening, which gives a probabilistic risk assessment. Thus, ample information is conveyed to women with the goal to inform their decisions. This study examined the factors that predict amniocentesis uptake among pregnant women of advanced maternal age (older than 35 years old at the time of childbirth). Participants filled out a questionnaire regarding risk estimates, demographics, and attitudes on screening and pregnancy termination before their first genetic counseling appointment and were followed up to 24 weeks of gestation. Findings show that women's decisions are not always informed by screening results or having a medical indication. Psychological factors measured at the beginning of pregnancy: amniocentesis risk tolerance, pregnancy termination tolerance, and age risk perception affected amniocentesis uptake. Although most women thought that screening for Down syndrome risk would inform their decision, they later stated other reasons for screening, such as preparing for the possibility of a child with special needs. Findings suggest that women's decisions regarding amniocentesis are driven not only by medical factors, but also by a priori attitudes. The authors believe that these should be addressed in the dialogue on women's informed use of prenatal tests.
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Affiliation(s)
- Julia Grinshpun-Cohen
- a Department of OB/GYN , University of California Davis Medical Center , Sacramento , California , USA
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Dixon V, Burton N. Are midwifery clients in Ontario making informed choices about prenatal screening? Women Birth 2014; 27:86-90. [PMID: 24656607 DOI: 10.1016/j.wombi.2014.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/30/2014] [Accepted: 02/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Informed choice is often lacking in women's decisions about prenatal screening. AIM The aim of this study is to evaluate how well midwives in Ontario, Canada are facilitating informed choice in this area. METHODS An Internet-based survey was used to investigate 171 midwifery clients' knowledge, attitude towards and experience of prenatal genetic screening tests, and to determine the proportion of study participants who made an informed choice about prenatal screening. FINDINGS All participants demonstrated adequate knowledge of prenatal screening. The vast majority (93.0%) of participants made an informed choice. Participants who chose to screen had lower knowledge scores than those who opted out of screening. Client satisfaction rates in regard to care received in this area ranged from 97% to 100%. CONCLUSIONS Results of this study suggest that Ontario midwives are effective in conveying information on prenatal genetic screening, contributing to high levels of client knowledge and satisfaction in comparison to similar studies in other jurisdictions.
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Affiliation(s)
- Vanessa Dixon
- Midwifery Education Program at Ryerson University in Toronto, Toronto, ON, Canada.
| | - Nadya Burton
- Midwifery Education Program at Ryerson University in Toronto, Toronto, ON, Canada.
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Crombag NM, Bensing JM, Iedema-Kuiper R, Schielen PC, Visser GH. Determinants affecting pregnant women’s utilization of prenatal screening for Down syndrome: a review of the literature. J Matern Fetal Neonatal Med 2013; 26:1676-81. [DOI: 10.3109/14767058.2013.798289] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ames AG, Jaques A, Ukoumunne OC, Archibald AD, Duncan RE, Emery J, Metcalfe SA. Development of a fragile X syndrome (FXS) knowledge scale: towards a modified multidimensional measure of informed choice for FXS population carrier screening. Health Expect 2012; 18:69-80. [PMID: 23067225 DOI: 10.1111/hex.12009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Genetic carrier screening is increasingly possible for many conditions, but it is important to ensure decisions are informed. The multidimensional measure of informed choice (MMIC) is a quantitative instrument developed to evaluate informed choice in prenatal screening for Down syndrome, measuring knowledge, attitudes and uptake. To apply the MMIC in other screening settings, the knowledge scale must be modified. OBJECTIVE To develop and validate a modified MMIC knowledge scale for use with women undergoing carrier screening for fragile X syndrome (FXS). SETTING AND PARTICIPANTS Responses to MMIC items were collected through questionnaires as part of a FXS carrier screening pilot study in a preconception setting in Melbourne, Australia. DESIGN Ten knowledge scale items were developed using a modified Delphi technique. Cronbach's alpha and factor analysis were used to validate the new FXS knowledge scale. We summarized the knowledge, attitudes and informed choice status based on the modified MMIC. RESULTS Two hundred and eighty-five women were recruited, 241 eligible questionnaires were complete for analysis. The FXS knowledge scale items measured one salient construct and were internally consistent (alpha = 0.70). 71% (172/241) of participants were classified as having good knowledge, 70% (169/241) had positive attitudes and 27% (65/241) made an informed choice to accept or decline screening. DISCUSSION AND CONCLUSIONS We present the development of a knowledge scale as part of a MMIC to evaluate informed choice in population carrier screening for FXS. This can be used as a template by other researchers to develop knowledge scales for other conditions for use in the MMIC.
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Affiliation(s)
- Alice G Ames
- Department of Paediatrics, The University of Melbourne, Parkville, Vic., Australia; Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia
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Dondorp W, Sikkema-Raddatz B, de Die-Smulders C, de Wert G. Arrays in postnatal and prenatal diagnosis: An exploration of the ethics of consent. Hum Mutat 2012; 33:916-22. [PMID: 22396320 DOI: 10.1002/humu.22068] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 02/21/2012] [Indexed: 11/06/2022]
Abstract
The introduction of genome-wide arrays in postnatal and prenatal diagnosis raises challenging ethical issues. Here, we explore questions with regard to the ethics of consent. One important issue is whether informed consent for genome-wide array-based testing is in fact feasible, given the wide range of possible outcomes and related options. The proposed alternative of "generic consent" will have to be studied in practice. From an ethical point of view, the question is whether consent would still be sufficiently "informed" in a generic approach. Another issue that has not yet been given much attention is how far parents, or pregnant women and their partners, should be allowed to determine the range of possible outcomes that will or will not be reported back to them. The scope and limits of parents' and prospective parents' right to know or not to know are far from clear. The complex normative issues on the content and weight of these rights can only be answered by taking full account of the rights and interests of all the parties involved: prospective and actual parents, children, and relatives. This paper is the result of a working group meeting preceding the European Society of Human Genetics 2011 Conference, where these issues were addressed.
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Affiliation(s)
- Wybo Dondorp
- Department of Health, Ethics and Society, CAPHRI and GROW Research Schools, Maastricht University, Maastricht, The Netherlands.
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Choi H, Van Riper M, Thoyre S. Decision making following a prenatal diagnosis of Down syndrome: an integrative review. J Midwifery Womens Health 2012; 57:156-64. [PMID: 22432488 DOI: 10.1111/j.1542-2011.2011.00109.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Prenatal screening for Down syndrome (DS) is a routine part of prenatal care in many countries, and there is growing interest in the choices women make following a prenatal diagnosis of DS. This review describes what is known about actual and hypothetical decision making following a prenatal diagnosis of DS and adds understanding about the factors that influence women's decision making. METHODS A search of empirical studies was conducted through electronic databases, major journals, and reference lists that were published in English between January 1999 and September 2010. Inclusion criteria were that the research explored attitudes toward continuation of pregnancy or induced abortion for DS and included at least 1 variable that explored factors influencing women's decision making following a prenatal diagnosis of DS. Studies that did not specify DS, unpublished manuscripts, review articles, and book chapters were excluded. RESULTS A total of 11 studies were identified that met the inclusion criteria. The decision to undergo an induced abortion varied depending on whether participants were prospective parents recruited from the general population (23%-33% would terminate), pregnant women at increased risk for having a child with DS (46%-86% would terminate), or women who received a positive diagnosis of DS during the prenatal period (89%-97% terminated). Multiple factors influence women's decision making following a diagnosis of DS, including demographic factors such as religion, maternal age, gestational age, number of existing children, and history of induced abortion. Psychosocial factors including perceived parenting burden/reward, quality of life for a child with DS, attitudes toward and comfort with individuals with disabilities, and support from others also are important influences. DISCUSSION Multiple factors influence the decisions pregnant women make following the diagnosis of fetal DS. Therefore, it is critical that health care providers who work with pregnant women are aware of these factors.
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Affiliation(s)
- Hyunkyung Choi
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC 27599-7460, USA.
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Bryant LD, Green JM, Hewison J. Attitudinal ambivalence towards Down’s syndrome and uncertainty in prenatal testing and termination intentions. J Reprod Infant Psychol 2011. [DOI: 10.1080/02646838.2011.599063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lehmann A, Speight BS, Kerzin-Storrar L. Extended Family Impact of Genetic Testing: The Experiences of X-linked Carrier Grandmothers. J Genet Couns 2011; 20:365-73. [DOI: 10.1007/s10897-011-9360-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
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